Nurse-physician Relationships Research Articles

Variation in organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth for Black women in four states: a cross-sectional descriptive study

ObjectiveTo describe variation in hospital organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth (SVB) for Black women.DesignCross-sectional descriptive.SettingWe conducted a cross-sectional study using three datasets...

The role of machine learning in the improvement of physician-nurse relationships when the management of burn patients: A narrative review

In recent years, machine learning (ML) has emerged as a transformative technology in healthcare, providing significant advancements in patient care and management. Burn care, which necessitates comprehensive and coordinated efforts due to the severe and multifaceted nature of burn injuries, particularly benefits from ML's capabilities. This literature review investigates how ML enhances the collaboration between physicians and nurses in managing burn patients. In the present study, significant findings show that ML's predictive analytics can predict patient outcomes and complications, helping with proactive care strategies. ML-driven decision support systems offer real-time, evidence-based recommendations, ensuring consistent care approaches. In addition, ML-powered virtual simulations improve training and comprehension of roles, while advanced electronic health records (EHR) systems streamline documentation and information sharing. Continuous quality improvement is supported by ML's data-driven insights, leading to improved patient monitoring and management. Ultimately, integrating ML in burn care significantly improves physician-nurse collaboration, resulting in better patient outcomes. This includes reduced infection rates and shorter hospital stays. This highlights the vital role of ML in transforming healthcare delivery and professional collaboration in managing complex conditions like burn injuries.

New Nurse Turnover Intention and Related Factors in Japan and China: Focusing on Nursing Practice Environment and Burnout.

With rapidly declining birth rates and aging populations worldwide, the demand for nursing care has increased in recent years. High turnover, an important cause of nurse staffing shortages, directly affects the quality of nursing care. However, no comparison studies on turnover intention in East Asia have been published. The purpose of this study was to clarify the relationships among turnover intention, the work environment, and related factors among new nurses in Japan and China. A self-administered questionnaire survey was used to collect data from nurses employed for < 2 years. This questionnaire included participant characteristics, assessment of desire to become a nurse at the start of employment, current turnover intention, the Practice Environment Scale of the Nursing Work Index, and the Maslach Burnout Inventory-Human Services Survey. The relationship between current turnover intention and, respectively, number of hospital beds, strength of desire to become a nurse at the start of employment, level of participation in hospital affairs, emotional exhaustion (EE), personal achievement, and demographic variables was assessed. The number of nurses who intended to leave the hospital was higher in Japan (74.1%) than in China (42.4%). However, of those expressing intention to leave, 46.6% of the nurses in China and only 5.0% of those in Japan indicated intention to quit the nursing profession altogether. In Japan, collegial nurse-physician relations and EE were related to turnover intention, whereas in China, number of hospital beds, strength of desire to become a nurse at the start of employment, participation in hospital affairs, EE, and personal achievement were all related to turnover intention. To enhance retention and reduce turnover intention among nurses, the strength of desire to become a nurse in China and the nurse-physician relationship and EE in Japan should be taken into particular consideration when designing retention strategies and nurse education programs.

Nursing categories’ perceptions of the practice environment and quality of care in North West Province: a cross-sectional survey design

BackgroundThere is a substantial amount of literature on the perception of the practice environment and quality of care as perceived by registered nurses and community services nurses in South Africa and worldwide, but there is little to no research that could be found regarding other categories of nurses, and how these perceptions differ between the different categories. Therefore, the aim of this study is to describe the different nursing categories’ perceptions of the practice environment and quality of care and the association between the variables.MethodsThis study applied a cross-sectional survey design. Data were collected in April 2021 in the public sector of the North West Province. Multiphase sampling was applied to all categories of nurses who worked in an in-patient unit in the selected hospital for at least 3 months (n = 236).ResultsAll nursing categories perceived the practice environment as negative, regarding nurse participation in hospital affairs; nurse manager ability, leadership, and support of nurses and staffing and resource adequacy. Perceived quality of care and patient safety items were perceived as neutral and good. However, in all instances, the perceptions of community service nurses and registered nurses were most negative, and enrolled nurse assistants most positive. Adverse events towards patients and nurses were perceived to only occur a few times a year. Overall, nurse perceptions of quality of care and patient safety were most correlated with the subscale of nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses. Adverse events towards patients were most correlated with the collegial nurse-physician relationship subscale, while adverse events towards nurses were correlated with the foundations of quality of care subscale.ConclusionImproving the practice environment, especially regarding the subscale nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses, is associated with improved quality of care. Nurses with higher qualifications, registered nurses and community service nurses rated quality of care lower than other categories of nurses, contributing to literature that higher qualified staff are more competent to assess the practice environment and quality of care.

Task shifting in Dutch nursing practice: A repeated cross-sectional analysis of nurses' experiences.

This study aims firstly to identify shifts in the execution of medical tasks by nurses in the past decade. Secondly, it aims to explore nurses' perspectives on task shifting: how they think task shifting affects the quality of care, the attractiveness of nursing practice and their collaboration with physicians. A quantitative repeated cross-sectional study. A nationwide survey was conducted among Dutch registered nurses (RNs) working in hospitals and home care, first in 2012 and again in 2022, with sample sizes of 359 and 362, respectively. Analyses were based on descriptive statistics and logistic and linear regressions. Between 2012 and 2022, there was a significant increase in the execution of only one medical task by nurses, namely prescribing over-the-counter medication. The majority reported in both years that task shifting has positive impact on their professional autonomy and the attractiveness of nursing practice. However, most nurses also reported that task shifting increased their workload (72.7% in 2022) could lead to conflicts in care teams (20.9% in 2022 compared to 14.7% in 2012) and may cause physicians to feel threatened (32.8% in 2022 and 29.9% in 2012). There were no significant changes in nurses' perception of the impact of task shifting on quality of care, the attractiveness of nursing practice and the nurse-physician relationship. There was an increase in the execution of prescribing over-the-counter-medication by nurses between 2012 and 2022. However, both in 2012 and in 2022, as the majority of nurses reported that task shifting increased their workload, there is reason to worry about this negative consequence of task shifting, e.g. with regard to labour market issues. Further research, also among the medical profession, is needed to better understand and address the implications of task shifting for the nursing profession. Implications for the nursing profession include potential scope expansion with complex tasks, attracting more individuals to nursing careers, although an eye must also be kept on what that means for the workload of nurses and the relationship with physicians. Nurse prescribing medicines was more executed in 2022 compared to 2012. Nurses had a predominantly positive perspective on task shifting, but still felt it can cause conflicts in care teams, high workload and physicians feeling threatened. These results can help during implementation of task shifting and in monitoring the perceived effects of task shifting among nurses. This study followed the STROBE reporting guideline for cross-sectional studies. No Patient or Public Contribution. This study focussed on the task shifting (perspectives) of nurses.

Digital health competencies and affecting factors among healthcare professionals: additional findings from a systematic review.

In recent decades, nurses' and healthcare professionals' digital health competencies have emerged as key factors in enabling the digital healthcare transformation. Therefore, this review aims to describe the level of digital health competencies among nurses and healthcare professionals and the factors affecting them. We performed an additional analysis of a database populated in our original systematic review by identifying the data set, evaluating its appropriateness to the research questions, and performing the data analysis. Four areas of digital health competencies among nurses and healthcare professionals emerged: 'self-rated competencies', 'psychological and emotional aspects toward the use of digital technologies', 'knowledge about digital technologies' and 'use of digital technologies'. Item scores and affecting factors have been extracted and classified into poor, moderate and good levels of digital health competencies; factors have been categorised and then summarised. 'Use of digital technologies' was the area with the highest prevalence of poor-level scores, whereas the 'knowledge about digital technologies' had a good level of competence. Across categories, most of the items' scores reflected a moderate level of competence. The main factors affecting digital health competencies in nursing were being younger, more educated, having positive collegial nurse-physician relationships and participating in hospital business. Digital health competence might be further improved. Educators, policymakers and nurse managers should develop educational nursing programmes and opportunities by acting on the modifiable factors to develop digital health competencies.

What influences newly graduated registered nurses’ intention to leave the nursing profession? An integrative review

BackgroundNewly graduated registered nurses leaving the nursing profession in the early stages of their career have enormous financial and time implications for nursing organizations and affect the quality of nursing care.ObjectiveTo identify the factors influencing newly graduated registered nurses’ intention to leave the nursing profession over the past 10 years.MethodsThe framework developed by Whittemore and Knafl was used to conduct this integrative review. An electronic search was conducted for English articles to identify research studies published between 2011-2022 using the following databases of PubMed, MEDLINE, CINAHL, PsycINFO, and Scopus. Eligible publications were critically reviewed and scored using the Critical Appraisal Skills Program Checklist and the Center for Evidence-Based Management appraisal.ResultsTwenty-one studies were analyzed. The main factors affecting newly graduated registered nurses’ intention to leave the nursing profession included demographic factors (age, educational level, year of experience, professional title, employment status, health status, shift, hospital location and size), supervisor and peer support, challenges in the workplace, cognitive and affective response to work, work environment (collegial nurse-physician relations, insufficient staffing level, person-work environment fit), gender stereotypes, autonomous motivation, role models, and resilience.ConclusionsThe factors affecting newly graduated registered nurses’ intention to leave the nursing profession are multifaceted and should receive continuous attention from nurse managers. The findings provide more comprehensive for nurse administrators to develop intervention strategies to mitigate newly graduated registered nurses’ turnover intention.

AMBIENTE DA PRÁTICA PROFISSIONAL DA ENFERMAGEM EM HOSPITAL UNIVERSITÁRIO FRENTE À COVID-19

ABSTRACT Objective: to assess the environment of nursing professional practice during the COVID-19 pandemic. Method: cross-sectional study addressing a sample comprising nursing workers from a university hospital. The Brazilian version of the Practice Environment Scale was used, with 24 items distributed into five subscales. The analyses were performed in Statistical Package for the Social Sciences, version 25; the statistical significance was set at 5% (p≤0.05), and the internal consistency was assessed with Cronbach’s alpha. Results: 243 workers participated in the study: 62.1% of nursing technicians and aides and 37.9% of nurses. The mean score on the Practice Environment Scale was 2.58 (standard deviation=0.69). Three of the five subscales were poorly assessed: “Nursing foundations for quality of care” (mean 2.58 and SD ± 0.73), “Nursing manager, ability, leadership, and support of nurses” (mean 2.74 and SD ± 0.82), and “Collegial nurse-physician relations” (mean 2.78 and SD ± 0.76). The perception of the professionals who received training to care for Covid-19 patients was more favorable than those who did not receive any training. Conclusion: The nursing work environment during the pandemic was considered mixed; therefore, improvements are required to make nursing working conditions as adequate as possible.

The Impact of Nurse-Physician Relationships on Emergency Nurses’ Moral Distress

IntroductionMoral distress affects registered nurses’ job dissatisfaction, and may ultimately be associated with higher rates of turnover. Nurse-physician relationships have been shown to affect moral distress in the intensive care unit setting, but no research has evaluated this impact on emergency nurses. The purpose of this study was to investigate the impact of nurse-physician relationships on the moral distress of emergency nurses. MethodsA quantitative correlational design was used to evaluate the study’s aim. Point-of-care nurses currently working in an emergency department were asked to complete the Measure of Moral Distress Scale for Healthcare Professionals and the collegial nurse-physician relations domain of the Practice Environment Scale of the Nursing Work Index. Univariate and multivariate analyses were conducted to determine the impact of nurse-physician relationships on moral distress, controlling for demographic characteristics. ResultsThirty-two participants completed the survey. Multivariate regression showed that nurse-physician relationships are associated with moral distress in emergency nurses. Years of experience and gender did not affect moral distress in univariate or multivariate analyses. DiscussionGiven current staffing shortages and the need to retain expert nurses in high-acuity settings, strategies to improve nurse-physician collaboration opportunities should be explored in ED settings.

Relationship of the nursing practice environment with the quality of care and patients’ safety in primary health care

BackgroundNursing practice environment has impact on the quality of nursing care and on patients’ and nurses’ outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients’ outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.MethodsWe conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.ResultsNurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients’ safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients’ safety.ConclusionsThe perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses’ outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

Effect of Nurses’ Professionalism, Work Environment, and Communication with Health Professionals on Patient Safety Culture (AHRQ 2.0.): A Cross-Sectional Multicenter Study

Aims. To identify nurses’ professionalism, work environment, and communication with healthcare professionals as factors influencing clinical nurses’ perception of patient safety culture. Background. Patient safety is a representative indicator of the quality of nursing care. A multidisciplinary approach, including individual and organizational components, is needed to improve patient safety culture. Methods. A cross-sectional study was conducted in January 2021 involving a total of 271 nurses in six tertiary hospitals. Data were collected from participants on nurse professionalism, work environment, communication, and patient safety culture. A multiple regression model was used to analyze variables influencing patient safety culture. Results. Factors affecting patient safety culture were nursing foundations for quality of care (β = 0.230, p &lt; 0.001 ), nurse manager ability, leadership, support of nurses (β = 0.294, p &lt; 0.001 ), and collegial nurse-physician relations (β = −0.138, p = 0.026 ) in the nursing work environment. Accuracy (β = 0.117, p = 0.007 ), shift communication (β = 0.128, p = 0.026 ), satisfaction (β = 0.283, p = 0.001 ), and timeliness (β = 0.239, p &lt; 0.001 ) of communication between healthcare professionals and nurses have a significant impact on patient safety culture. All these predictors accounted for 59% (R2) of patient safety culture awareness ( p &lt; 0.001 ). Conclusions. Enhancing patient safety culture requires a systematic and organizational approach that considers individual characteristics. Nurse managers play a crucial role in promoting patient safety by employing various communication channels and leading team education and training initiatives to foster collaboration among healthcare professionals. Implications for Nursing Management. The provision of patient safety education directly influences patient safety culture, and continuous education enables nurses to grow within the institution. To ensure effective communication in healthcare settings, nurse managers should prioritize shift communication, evaluate the accuracy of information exchange, and establish diverse communication channels, including social media platforms or business messengers, for internal hospital communication.

Workplace violence against cardiovascular nurses during Covid-19 pandemic

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The National Federation of Orders for Nursing Professions (FNOPI - Italia) Background Workplace violence (WPV) impacts negatively both healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV, also during the COVID-19 pandemic. Purpose Describing the WPV against nurses and its predictive factors in cardiovascular settings during COVID-19 pandemic in Italy. Methods This is a secondary analysis conducted in cardiovascular hospital settings from a larger national study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI; Likert scale 1 to 4) and the adapted version of the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Descriptive and logistic regression analyses were conducted. Results The analysis was conducted on 360 cardiovascular nurses (76.7% female; mean age 42.6 years, SD 10.8). Thirty per cent (n=108) of them reported WPV in last year and/or last week and 14.2% (n=51) only in last week. The number of patients was higher for nurses with WPV (mean difference [MD] +1.9; p = .030). The work environment was significantly worse for nurses with WPV: mean PES-NWI composite score (MD -0.2; p&amp;lt;.001); PES-NWI subscales: staffing and resource adequacy (MD -0.3; p&amp;lt;.001); nursing foundations for quality of care (MD -0.2; p = .005); nurse participation in hospital affairs (MD -0.3; p&amp;lt;.001); physician-nurse relationship (MD -0.2; p = .004). Multiple linear regression demonstrated that the risk of WPV increases when a clear nursing philosophy was not completely implemented in cardiovascular setting (odds ratio [OR] 5.29; 95% confidence interval [CI], 1.07-26.05; p = .040) and the nurses restrain patients (OR 2.49; 95% CI, 1.04-5.97, p = .041). The risk of WPV decreases when protectives glasses were present (OR 0.36; 95% CI 0.19-0.70, p = .003). Conclusion Public healthcare services should reduce WPV by investing in improving the nurse work environment. Integrated and multimodal programs of prevention and management of WPV are useful to address it.

Interprofessional collaboration in telemedicine for long-term care: An exploratory qualitative study.

Widespread and sustained adoption of telemedicine in long-term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations. To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations. A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi-structured online interviews were conducted, and data were thematically analyzed. Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision-making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse-physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians. Interprofessional collaboration in teleconsultations is challenging because of lack of in-person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international-dominated healthcare workforce in long-term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse-physician collaborative practice. Telemedicine is increasingly adopted in long-term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.

Work success and the physician-nurse professional relationship in emergency departments

Background. Considering the importance of physician-nurse relationship in emergency departments and its role in improving the quality of services, patient satisfaction, job success and staff satisfaction, this study was conducted to investigate nurses' attitude about the professional doctor-nurse relationship and career success of the nurses in emergency departments. Methods. This study is a descriptive study in which 197 nurses working in the emergency departments of hospitals affiliated to Tabriz University of Medical Sciences participated. Data collection tools included demographic characteristic; physician-nurse professional communication questionnaire and nurses' career success questionnaire. The collected data were analyzed using descriptive and inferential statistical tests with SPSS ver.21 statistical software. Results. The findings showed that the mean (SD) of the professional physician-nurse relationship from the perspective of participating nurses was 3.07 (0.54). Cooperating dimension with the mean score of 3.34 (0.79) had the highest score and imposing opinions and tasks dimension with the mean score of 2.62 (0.85) had the lowest score. Also, the mean (SD) score of nurses’ career success was 4.21 (0.40) with the highest mean in the dimension of system assistant 4.33 (0.55) and the lowest mean in the effective dimension 4.08 (0.41). Conclusion. Considering the importance of the professional physician-nurse relationship, it is necessary to pay more attention to the effective factors in its promotion by implementing interventions such as professional communication skills training and effective interaction in strengthening the professional relationship of the treatment team. Practical Implications. The results of this study can be used to improve professional communication between health care team members and their work success. As a result, in addition to increasing job satisfaction and improving the psychological condition of personnel, the safety of patients will also be increased and the amount of injuries caused by communication defects will be decreased.

The Nursing Work Environment, Supervisory Support, Nurse Characteristics, and Burnout as Predictors of Intent to Stay among Hospital Nurses in the Republic of Korea: A Path Analysis.

This study aimed to examine the comprehensive impact of five aspects of the nursing work environment as well as supervisory support, nurse characteristics, and burnout on intent to stay (ITS) among Korean hospital nurses. A cross-sectional questionnaire was distributed in seven general hospitals from May to July of 2019. Data were collected from a sample of 631 Korean nurses. The hypothesized model was evaluated using the STATA program for path models. Findings demonstrated that burnout played a mediating role on the relationships between the nursing work environment, supervisory support, nurse characteristics, and ITS. Burnout was the most influential predictor of ITS (β = -0.36, p < 0.001). Nurse participation in hospital affairs (β = 0.10, p = 0.044) and collegial nurse-physician relationships (β = 0.08, p = 0.038) had a direct effect on ITS. Supervisory support had a significant direct effect on ITS (β = 0.19, p < 0.001). Therefore, to increase nurses' ITS, it is necessary to improve their participation in hospital affairs and collegial relationships, as well as strengthen support from supervisors and reduce burnout.

An integrative review of Indonesia’s quality of care

High-quality health care services would give good health outcomes to society. Nursing service is part of the quality-of-care process. The study aimed to investigate the quality of care in Indonesian hospitals over the last 20 years. The integrative review method was used, and 36 studies in Indonesia were analyzed, following the procedure: problem recognition, literature finding, data assessment, data review, and presentation of the results. Currently, the quality of care in Indonesia is low. The quality of care has increased over time in line with technology and science, and the factors which are related to quality have increased broader. Those factors are hospital management factors, nurse, and nursing organization the hospital management factors, including nurses staffing, environment, and job design. Nursing staffing factors are nursing shortage, workload, job satisfaction, burnout, and turnover. Meanwhile, work environment factors include supervision, empowerment, nurse-physician relationship, managerial, surveillance, and case management. Job design factors are nursing rounds, care delivery, competencies, training needs, roles, and documentation. Besides, personal factors are education, gender, ability/skills, and critical thinking. Therefore, the complicated factors related to nursing quality need further studies to explore whether they give significant results to improve quality of care.

Interprofessional Collaboration Between Nurses and Physicians in the Perioperative Period

PurposeTo explore nurses' and physicians’ experiences of the six dimensions of interprofessional (IP) collaboration when using Goal-Directed Therapy (GDT), and to examine how existing protocols on GDT facilitate the six dimensions of IP collaboration. DesignA qualitative design using individual semi-structured interviews and participant observations. MethodsA secondary analysis of data from participant observation and semi-structured interviews with nurses (n= 23) and physicians (n=12) in three departments of anesthesiology. Observations and interviews were carried out from December 2016 to June 2017. A deductive, qualitative content analysis using the Inter-Professional Activity Classification as a categorization matrix was used to explore interprofessional collaboration as a barrier to implementation. This analysis was supplemented by a text analysis of two protocols. FindingsFour dimensions were identified to influence IP collaboration: commitment, roles and responsibilities, interdependence, and integration of work practices. Negative factors included hierarchical boundaries, traditional nurse-physician relationship, unclear responsibility, and lack of shared knowledge. Positive factors included physician involvement of nurses in decisions and bedside education. The text-analysis showed a lack of clear directions of specific action and responsibility. ConclusionsCommitment and roles and responsibilities were dominant aspects of interprofessional collaboration in this context, causing problems for enhanced collaboration. Lack of clear guidance in the protocols might detract nurses’ feelings of responsibility.

Pain Management Competency and its Associated Factors among Nurses.

Nurses play a vital role to handle the situation in the care of the patients especially for prioritizing and managing care of pain. Nursing competency attributes personal characteristics, professional attitude, values, knowledge and skills to demonstrate professional responsibility through practices. Nursing competency helps to provide high quality essential care to the patients at a right time. This study aimed to explore pain management competency and its associated factors among nurses in a tertiary hospital, Nepal. A cross- sectional survey with correlational predictive design was conducted with 203 staff nurses who had work experience related to pain for more than two months at Tribhuvan University Teaching Hospital in Nepal. They were working in medical, surgical, gynecology and obstetrics, pediatric and neonatal, emergency and intensive care departments. The participants were selected from inpatient departments by convenience sampling technique from December 2020 to February 2021. SPSS 18.0 version was used for data entry and analysis using descriptive statistics, chi-square and logistic regression. Significant factors reported at P<0.05. In total participants, 67.5% of nurses were competent on pain management. Work experience [OR= 0.426 (95% CI: 0.205-0.887)] could significantly predict on nurses' competency for pain management. However, there was no significant association educational level, working unit, nurse-physician relationship, and training on nurses' competency. Based on the findings, two third (67.5%) nurses are competent on pain management and work experience is a factor contributed to the nurses' competency for pain management, the researcher recommends nurses with lower work experience should provide pre-service training on pain management.

Moral distress in psychiatric nurses in Covid-19 crisis

BackgroundThe COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic.MethodThis qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.ResultsBy continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses’ Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies).ConclusionNew dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

The Nurse-Physician Relationship During the COVID-19 Pandemic in Shanghai, China: Cross-sectional Study.

The nurse-physician relationship is important for the stability of collaboration. The COVID-19 pandemic has put unprecedented pressure on the health care system and has placed greater demands on nurse-physician collaboration. Nurses and physicians often struggle to share mutual responsibility and communicate effectively. This study aimed to evaluate the relationship between nurses and physicians during the COVID-19 pandemic and construct a new model combining the attitude and behaviors of the 2 groups to assess various factors' impacts on job satisfaction and confrontational behavior. We conducted this quantitative cross-sectional study to assess the relationship between nurses and physicians based on the attitudes and behaviors toward nurse-physician collaboration. We first investigated the satisfaction of nurses and physicians with their relationship and how they thought the COVID-19 pandemic had affected that relationship. We used an adapted and modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questionnaire that consisted of 17 items under 5 dimensions. Structural equation modeling was used to assess the relationships between domains. Ordinal logistic regression was used to evaluate the relationship between different domains of the questionnaire and the satisfaction of the current nurse-physician relationship. We included a total of 176 nurses and 124 physicians in this study. Compared to 7.2% (9/124) of physicians, 22.7% (40/176) of nurses were dissatisfied with the current nurse-physician relationship. Most physicians (101/124, 81.5%) and nurses (131/176, 74.5%) agreed that the nurse-physician relationship had become better because of the COVID-19 pandemic and that the public had greater respect for them. However, significantly fewer nurses (59/176, 33.5% vs 79/124, 63.7%; P<.001) thought that physicians and nurses were treated with the same respect. Nurses scored significantly higher scores in caring versus curing (mean 16.27, SD 2.88 vs mean 17.43, SD 2.50; P<.001) and physician's authority (mean 8.72, SD 3.21 vs mean 7.24, SD 3.32; P<.001) subscales compared with physicians. The shared education and collaboration subscale had a significantly positive relationship with the nurse's autonomy subscale (standardized coefficient=0.98; P<.001). Logistic regression showed that 4 subscales (shared education and collaboration: P<.001; caring versus curing: P<.001; nurse's autonomy: P<.001; and confrontation: P=.01) were significantly associated with the level of satisfaction of the current nurse-physician relationship. This study showed that nurses were more dissatisfied with the current nurse-physician relationship than physicians in Shanghai. Policy makers and managers in the medical and educational system should emphasize an interprofessional collaboration between nurses and physicians. Positive attitudes toward shared collaboration and responsibility may help to improve the relationship between the 2 parties.