Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study.

BACKGROUND: Prescription drug misuse has been identified as a global issue of concern. Nurses' prescription drug misuse is linked to personal health problems and impaired nursing care. This study explored the level of South Korean hospital nurses' prescription drug misuse and examined associations with workplace access and burnout. METHODS: This cross-sectional study used data from 1142 nurses working in South Korean hospital settings. Nurses completed the online survey anonymously. Descriptive analysis, logistic regression, and Shapley value assessment were conducted. RESULTS: Pain relievers (44.2%), IV drips (26.8%), and antibiotics (13.5%) were the most commonly misused drugs among hospital nurses. Accessibility in the workplace was high, with nurses reporting frequent administration of IV drips, pain relievers, and antibiotics and perceiving these drugs as easily accessible. Logistic regression demonstrated that perceived availability was significantly related to misuse across all drug types. Burnout was associated with IV drips, sleeping pills, and steroids, increasing the likelihood of misuse. Shapley feature importance analysis highlighted perceived availability as the most influential factor for IV drips, pain relievers, and steroids, while burnout emerged as crucial for antibiotics and sleeping pills. Notably, age played a significant role in appetite suppressant misuse, distinguishing it from other drugs. CONCLUSION: Our results revealed that workplace access and burnout are associated with nurses' prescription drug misuse. Effective educational strategies are essential for enhancing nurses' willingness to seek help for personal health issues. Hospital organizations play a crucial role in facilitating access to healthcare and fostering a supportive environment for nurses to seek treatment when necessary. Additionally, governmental policies should prioritize the implementation of active surveillance systems to monitor medication usage in healthcare settings, thereby mitigating drug misuse among healthcare professionals. By addressing these issues, we can ensure the well-being of nurses and promote a safer healthcare environment.

Individual-level positive psychological capital that enhances managers' transformational leadership effectiveness on nurse career success.

AIMS: This study investigated the impact of nurse managers' transformational leadership on the subjective career success of staff nurses, particularly through exploring potential variations in this relationship based on nurses' positive psychological capital. BACKGROUND: Amid a challenging nursing environment, nurses' perceptions of career success affect their individual psychological satisfaction and improve work performance. Human resource strategies often include factors for workers' subjective career success, e.g., managers' transformational leadership and individual-level positive psychological capital. METHODS: This cross-sectional study collected survey data in 2021 from 348 staff nurses in 40 wards of a Korean tertiary hospital. The survey instruments included the Transformational Leadership tool, the Subjective Career Success Inventory, and the Psychological Capital Questionnaire. Multilevel hierarchical regression analysis and a simple slope test were used to examine moderating effects. The STROBE checklist was used for reporting. RESULTS: Nurses reported significantly higher subjective career success when they worked in units where unit managers' transformational leadership was greater. This relationship strengthened when nurses had high positive psychological capital. DISCUSSION: To enhance staff nurses' perceptions of career success, both managers' transformational leadership and individual nurses' positivity should be emphasized in nursing practice and education. IMPLICATIONS FOR NURSING AND NURSING POLICY: Comprehensive efforts to highlight managers' transformational leadership and staff nurses' positive psychological capital can enhance subjective career success, which in turn improve nurses' job performance and intention to stay. Nursing policymakers should value transformational leadership among managers so nurses can achieve their subjective goals. An organization-wide institutional system should be developed so nurses can receive support to strengthen their positivity. Future research should include interventions to foster managers' leadership and nurses' positive capital.

Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study.

BACKGROUND: There has been little research regarding nursing teamwork, despite its important role in multidisciplinary teamwork in healthcare settings and its significance in ensuring high-quality nursing care. This study aimed to determine the teamwork levels of Korean nurses and examine the relationship between nursing teamwork and patient-centered care while controlling for other individual and work-related factors. METHODS: We conducted a cross-sectional analysis of online survey data. The study population consisted of 992 Korean registered nurses employed in hospitals who had a minimum of six months of clinical experience. We performed latent profile analysis to identify latent teamwork subgroups based on response patterns. We performed analysis of variance and Chi-square tests to examine differences in individual and work-related characteristics according to teamwork group. We used multiple linear regression to investigate how nursing teamwork could affect patient-centered care after controlling for covariates. RESULTS: We identified three nursing teamwork subgroups: low, mid, and high. Nurses with a higher level of teamwork in their units tended to work fewer hours with more adequate staffing (F = 5.88, p = 0.003 for working hours; F = 7.68, p < 0.001 for staffing adequacy). There was a significant positive association between nursing teamwork and patient-centered care after controlling for personal and work-related characteristics. Compared with low teamwork, mid and high teamwork increased patient-centered care scores by 0.32 (95% confidence interval [CI] = 0.23-0.40) and 0.57 (95% CI = 0.48-0.66), respectively. CONCLUSION: Our findings indicate that enhancing nursing teamwork can serve as an effective strategy for promoting patient-centered care. Providing nurse education and training to equip nurses with the necessary knowledge and skills for effective teamwork is a crucial step. Additionally, fostering management commitment to create a supportive working environment, including adequate staffing, can facilitate improved nursing teamwork and, subsequently, patient-centered care.

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study.

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20-64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.

Psychometric validation of the Korean versions of the Vaccine Hesitancy Scale and Vaccination Attitudes Examination Scale.

PURPOSE: Strategies for reducing vaccine hesitancy and negative attitudes toward vaccination and measures to accurately assess them have been developed worldwide. The Vaccine Hesitancy Scale (VHS) and Vaccination Attitudes Examination Scale (VAX) are reliable and valid tools. This study evaluates the validity and reliability of the Korean versions of the Vaccine Hesitancy Scale (K-VHS) and Vaccination Attitudes Examination Scale (K-VAX). METHODS: We translated the VHS and VAX into Korean using forward and backward translations and tested their psychometric attributes. We collected data from a sample of 2,292 Koreans, recruited in June 2021 from a large online panel using quotas for age and gender. We used content validity, construct validity with confirmatory factor analysis, concurrent validity, and convergent validity to assess the validity of the scales, and tested their reliability with evaluations of internal consistency and stability. RESULTS: The K-VHS and K-VAX showed good model fits in the validity tests, with seven items for one factor and 12 items for four factors, respectively. The internal consistency (Cronbach's alpha = 0.94 for the K-VHS, and 0.86 for the K-VAX) and stability (ICC = 0.86 for the K-VHS, and 0.88 for the K-VAX) of the measures indicated that they are reliable. CONCLUSIONS: Both tools are effective psychometric instruments for assessing vaccine hesitancy and vaccination attitudes in Korean adults. K-VHS and K-VAX would be useful for predicting vaccination behaviors in novel infectious disease contexts and communicating the evidence needed to develop related policies or programs.

Translations and psychometric validation of the Korean version of the Nursing Teamwork Survey.

Enhancing nursing teamwork benefits both patients and nurses. The Nursing Teamwork Survey is a reliable, valid tool to evaluate nursing teamwork. This study was conducted to translate and psychometrically validate the Nursing Teamwork Survey for nurses in Korea. In Phase 1, the Nursing Teamwork Survey was translated into Korean using forward and backward translations. Content and face validity were determined using expert review and pilot testing, respectively. In Phase 2, we evaluated construct and convergent validity and internal consistency, and test-retest reliability. We used survey data from 1119 hospital nursing staff; 98 of whom completed the Korean version of the Nursing Teamwork Survey after 2 weeks. Confirmatory factor analysis showed an acceptable fit (χ2 /df ratio = 3.96, root mean square error of approximation = 0.05, standardized root mean square residual = 0.05, comparative fit index = 0.91, and Tucker-Lewis index = 0.90) with good internal consistency (Cronbach's α = 0.76-93) and test-retest reliability (rs = 0.63-0.83). Convergent validity was supported by the correlation between the subscales of the Korean version of the Nursing Teamwork Survey and the Teamwork Within Units subscale of the Hospital Survey on Patient Safety Culture (rs = 0.45-0.69, ps < 0.01). These findings indicate that the Korean version of the Nursing Teamwork Survey is a reliable and valid measurement for assessing nursing teamwork. The Korean version of the Nursing Teamwork Survey can inform management strategies to promote nursing teamwork and improve patient safety and nurses' well-being.

Workplace Exposures and Prescription Drug Misuse Among Nurses.

OBJECTIVE: This study examined the association between workplace exposure and prescription drug misuse in nurses. BACKGROUND: Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse. METHODS: Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression. RESULTS: Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse ( P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index. CONCLUSIONS: Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.

Smartphone-based home workout program for shift-work nurses working during the COVID-19 pandemic.

This study aimed to develop a smartphone-based home workout program for shift-work nurses to increase their levels of exercise and examine its effects on health (sleep disturbance, fatigue, musculoskeletal problems, and resilience) and nursing performance. For this quasiexperimental study with a nonequivalent control group, 54 shift-work nurses were recruited from two general wards at a hospital in Korea and assigned to the intervention and control groups. Nurses in the intervention group were encouraged to exercise regularly using the home workout application for 18 weeks. For the first 12 weeks, text-message counseling and environmental improvement were carried out; only environmental improvement was implemented in the remaining 12-18 weeks. The control group did not receive any intervention. After excluding dropouts, the data of the final 25 participants in the intervention group and 24 participants in the control group were analyzed. Compared with the control group, the intervention group showed statistically significant improvements in physical and psychological health. Hospital organizations could adopt a smartphone-based home workout program to overcome obstacles to exercise, which could lead to positive health outcomes for shift-work nurses.

Attitudes Toward Older Adults and Need for Education Among Nurses and Nursing Assistants.

BACKGROUND: Attitudes toward older adults and education needs could influence the quality of care provided by nurses and nursing assistants. The goal of this study is to assess attitudes toward older adults and geriatric nursing education needs among nurses and nursing assistants working at long-term care hospitals in Korea. METHOD: Data were collected with a structured self-reported questionnaire. The study included 124 nurses and 145 nursing assistants working at six long-term care hospitals in Korea. RESULTS: No statistically significant difference was found between the nurses and nursing assistants in their attitudes toward older adults, with both groups showing neutral attitudes. Both nurses and nursing assistants had a high need for education in health issues affecting older adults. CONCLUSION: To improve nursing quality, a practical and systematic curriculum on older adults and their health issues is needed for nursing staff working in long-term care hospitals. [J Contin Educ Nurs. 2021;52(11):517-524.].

Differences in Health Behavior Profiles of Adolescents in Urban and Rural Areas in a Korean City.

Through a latent class analysis approach, we can classify individuals and identify subgroups according to health behavior patterns, and find evidence for the development of customized intervention programs to target high-risk groups. Our study aimed to explore differences in latent classes of health behaviors in adolescents by region (urban vs. rural areas) in a Korean city. This cross-sectional secondary analysis utilized data collected from all first graders' student health checkups in middle school and high school in a city of the largest island in Korea in 2016 (n = 1807). Health behavior indicators included both healthy (consuming breakfast regularly, consuming vegetables daily, consuming milk daily, consuming fast food on a limited basis, engaging in vigorous physical activities, brushing teeth, and practicing hand hygiene) and unhealthy (drinking, smoking, and overusing the internet) behaviors. Nutritional and diet behaviors were important factors for classifying healthy and unhealthy adolescents in both regions. Approximately 11% of rural students belonged to the risky group, which was characterized by a high level of drinking alcohol and smoking. These results suggest that when developing health policies for adolescents, customized policy-making and education based on the targeted groups' behavioral patterns could be more effective than a uniform approach.

Unit work environment, psychological empowerment and support for patient activation among nurses.

AIMS: To investigate the relationship between the unit work environment and psychological empowerment of nurses and their perceptions of patient activation. BACKGROUND: Nurses' support for active patient roles in the care process is critical for better patient outcomes. The factors influencing nurses' support for patient activation should be thoroughly investigated. METHODS: This study was a cross-sectional secondary data analysis using the survey data of 1,042 nurses in 98 units at six hospitals in Korea. RESULTS: Nurses with perceptions that their work was valuable and autonomy in their work were more likely to work in units where managers had greater managerial and leadership skills and staffing and resources were sufficient. Those with confidence in their work were more likely to work in units with adequate staffing and resources. Nurses who worked with adequate staffing and resources and considered their work meaningful were more likely to perceive patient activation as more important. CONCLUSION: Favourable work environments at unit level and psychological empowerment at nurse level can strengthen nurses' support for patient activation. IMPLICATIONS FOR NURSING MANAGEMENT: To strengthen nurses' support for active patient roles, organisations should ensure optimal staffing and resources to each unit and help nurses find value in their work.

Moderating Effects of Structural Empowerment and Resilience in the Relationship between Nurses' Workplace Bullying and Work Outcomes: A Cross-Sectional Correlational Study.

This cross-sectional correlational study aimed to evaluate the moderating effects of structural empowerment and resilience in the relationship between workplace bullying and nursing work outcomes. Data were collected from 435 nurses and nurse managers working at a tertiary hospital in Seoul, South Korea. The moderating effects were examined using stepwise hierarchical multiple regression models. The bootstrapping method was utilized to verify the magnitude and significance of the moderating effects. Structural empowerment showed a moderating effect in the relationship between workplace bullying and nursing work outcomes: for the conditional values above the average level of structural empowerment, workplace bullying was significantly associated with nursing work outcomes, while work outcomes were low regardless of workplace bullying for the conditional values less than average. However, resilience had no moderating effect. To improve work outcomes, bullying must be reduced and structural empowerment and resilience increased.

Scheduled Naps Improve Drowsiness and Quality of Nursing Care among 12-Hour Shift Nurses.

Scheduled naps in the workplace are an effective countermeasure to drowsiness in safety-sensitive industries. This quasi-experimental study with a one-group, pre- and post-test design aimed to examine the effects of scheduled naps on nurses working 12-h shifts. Nurses in two pediatric intensive care units at a tertiary hospital were provided 30-min scheduled nap opportunities during their shifts. A total of 38 nurses completed pre- and post-test work diaries for sleepiness, fatigue, work demands and pace, and quality of nursing care at the end of each shift. The drowsiness of 13 nurses was continuously assessed during their shifts using infrared reflectance oculography. Nurses who reached naps reported improved levels of fatigue on the first night shift and better quality of nursing care the second night and day shifts post-test, while nurses who did not reach naps showed no significant improvements. The oculography successfully assessed drowsiness during 73% and 61% of the pre- and post-test total work hours, respectively. The total cautionary and cautionary or higher levels of drowsiness decreased. Nurse managers should consider scheduled naps in clinical settings to improve nurses' alertness during their shifts.

Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea.

PURPOSE: This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment. DESIGN: This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018. METHODS: A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods. FINDINGS: The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment. CONCLUSIONS: This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes. CLINICAL RELEVANCE: Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.

Knowing in Nurses' Belief and Attitude about Patient Activation: A Validation of the Korean Clinician Support for Patient Activation Measure Using Rasch Analysis.

BACKGROUND: Patient engagement is considered a critical factor in improving healthcare delivery. This study aimed to test the Korean version of the Clinician Support for Patient Activation Measure (CS-PAM) using Rasch analysis, and to explore nurses' beliefs about patient self-management. METHODS: A cross-sectional, exploratory study design was employed. The staff nurses who were recruited from six hospitals were requested to complete the Korean CS-PAM. Their responses were subsequently subjected to Rasch analysis to validate the Korean CS-PAM. The CS-PAM was paraphrased into Korean using the standardized forward-backward translation method. RESULTS: The internal consistency of the scale had good Cronbach's alpha value. For all items, the infit and outfit statistics fell well within the acceptable range of 0.5-1.5. This measure formed a unidimensional Guttman-like scale that explained 54.7% of the variance. CONCLUSIONS: The Korean version of the CS-PAM showed good psychometric properties and appeared to be consistent with the meaning of the original CS-PAM. However, the items have a somewhat different ranking order when compared to the English and Dutch versions. The instrument might be useful for identifying the supportive beliefs and attitudes of nurses or healthcare providers in order to improve patient activation in healthcare.

Sleep diary- and actigraphy-derived sleep parameters of 8-hour fast-rotating shift work nurses: A prospective descriptive study.

BACKGROUND: Given the harmful effects of night shifts and rotating schedules on nurses' sleep and work performance, shift nurses' sleep patterns have been a research concern. Actigraphy involves acquisition of data using a movement sensor worn continuously on the nondominant wrist, typically for a week or more. Although actigraphy provides objective and accurate sleep data, sleep diaries have been a practical alternative. However, there is a lack of research on the agreement and consistency between the two methods of measuring sleep for shift work nurses. In addition, differences in sleep patterns by shift types among 8-hour fast-rotating shift work nurses has not yet been examined. OBJECTIVES: To evaluate the agreement between the sleep diary and actigraphy methods for sleep assessment, and to compare sleep parameters of 8-hour fast-rotating shift work nurses according to shift type. DESIGN: Descriptive and prospective study design. SETTINGS: Two tertiary hospitals in Seoul, South Korea. PARTICIPANTS: A total of 94 shift work nurses who wore actigraphy along with completing a sleep diary. METHODS: Subjective and objective sleep parameters were recorded during a two-week period in a sleep diary and actigraphy, respectively. Bland-Altman plots and intraclass correlation coefficients were used to analyze the agreement between the two methods. Sleep parameters according to shift type were compared using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Good agreement was observed between the sleep diary and the actigraphy data for total sleep time (intraclass correlation coefficients = 0.765 or 0.858) and variability in sleep time (intraclass correlation coefficients = 0.838). When compared to the actigraphy data, diary-derived data were overestimated by 41-45 min for total sleep time and 0.4% for variability in sleep time. There was a difference of 2-3 h of sleep quantity by shift type: 5.3-5.8 h for day shifts and 7.1-8.4 h for night shifts. CONCLUSIONS: A sleep diary can function as an acceptable alternative to actigraphy for measuring shift work nurses' sleep patterns, specifically total sleep time and variability in sleep time. Given the high variability in sleep among shift work nurses, both personal and organizational efforts are required. Nurses should monitor their sleep quantity and develop their own regular sleep schedules to fit their work schedules. Hospitals should establish healthy schedules for nurses to guarantee sufficient sleep hours before work. Future research on shift work nurses' sleep should examine fluctuations in sleep duration.

Association of Happiness and Nursing Work Environments with Job Crafting among Hospital Nurses in South Korea.

Nurses are key professionals in healthcare sectors, whose job attitude is closely associated with patient health outcomes and safety. Job crafting describes how workers shape their tasks to find a sense of meaning and value in their work. This study aimed to examine the associations of happiness at the individual level and nursing work environments at the organizational level with job crafting among hospital nurses in Korea. This cross-sectional study analyzed survey data from 220 nurses working in four Korean hospitals. Multiple linear regression modeling was used to examine associations among the study variables. Nurses who were satisfied with their lives were significantly more likely to exhibit higher levels of job crafting (B = 0.07, p < 0.001). Nursing work environments had no significant association with nurses' job crafting. In comparison with nurses working in general units, operating room nurses were significantly less likely to craft their job (B = -0.35, p = 0.001). Organizational support should be established to improve nurses' happiness and job crafting. Hospitals should provide various opportunities for education and training to strengthen job crafting.

Novice nurses' sleep disturbance trajectories within the first 2 years of work and actual turnover: A prospective longitudinal study.

BACKGROUND: Novice nurses experience radical changes in their sleep-wake cycle and sleep difficulties after exposure to a rotating shift work schedule. The link between workplace hardship and employee turnover may be dependent on factors at the individual level, e.g., individual health. Nurses with sleep disturbance are more vulnerable to stressful stimuli and lack resilience at work compared with those without sleep disturbance. OBJECTIVES: To classify novice nurses according to sleep disturbance trajectories during the first 2 years of work, to compare turnover rates according to trajectory classification, and to compare levels of sleep disturbance between stayers and leavers within each trajectory class. DESIGN: Prospective longitudinal design. SETTINGS: A tertiary hospital in Seoul, South Korea. PARTICIPANTS: A total of 465 newly graduated nurses who started work between September 2014 and December 2015. METHODS: Data were collected 6 times within the first 2 years of work (on the first day of orientation before ward placement, at 6 weeks after starting work, and at 6, 12, 18, and 24 months of work). Sleep disturbance was assessed using the General Sleep Disturbance Scale. Turnover information was retrieved from the hospital's administrative data system to determine whether anyone had left the hospital at each data collection point. Unconditional latent growth curve analysis was performed to identify latent classes of trajectories of sleep disturbance among novice nurses during the first 2 years of work. RESULTS: The 2-year trajectories of sleep disturbance were classified into two distinct groups: the high symptomatic group (Class 1: 57.4%) and the low symptomatic group (Class 2: 42.6%). In comparison with Class 2, Class 1 consistently showed a higher turnover in each period. In Class 1, leavers who left the hospital at the next measurement point tended to report more severe sleep disturbance at prior measurements. This pattern was also observed for the overall sample. However, in Class 2, an inconsistent pattern between stayers and leavers was observed. CONCLUSIONS: This study identified two distinct classes of sleep disturbance among novice nurses during the first 2 years of work. Given that many nurses experience sleep problems at pre-employment and during the early career period, a comprehensive approach to address this issue should be implemented in nursing schools and hospitals. The basic nursing curriculum should include self-care management strategies for sleep difficulties to ensure retention at work. At-risk nurses should receive organizational support and early monitoring to prevent the adverse effects of poor sleep.

Three-factor structure of the eHealth Literacy Scale and its relationship with nurses' health-promoting behaviours and performance quality.

AIMS: To examine the factorial validity of the eHealth Literacy Scale among hospital nurses and to investigate the associations of its components with health-promoting behaviours and nursing performance quality. DESIGN: This cross-sectional study used survey data of 484 Korean hospital nurses, which were collected between March-May 2016. METHODS: The three-factor structure was tested using confirmatory factor analyses. Multiple linear regression was conducted to test associations of the three components' scores with health-promoting behaviours and self-rated nursing performance quality. RESULTS: The eHealth Literacy Scale supported a three-factor structure: awareness of internet health resources (awareness), having skills needed to access resources (skills), and the ability to evaluate the quality of internet health resources (evaluation). All the three components were significantly associated with higher quality of nursing performance and better interpersonal relations. Stress management, spiritual growth, and health responsibility were linked with evaluation or skills but physical activity and nutrition were not. CONCLUSION: Strategies to enhance eHealth literacy among nurses could improve nurses' health and further patient care. Training to build nurses' self-efficacy to evaluate internet health information could improve eHealth literacy and should be developed and examined. IMPACT: To improve nurses' health and patient care, training programs to build nurses' self-efficacy to access and evaluate internet health information should be developed.

Comparing residential long-term care regulations between nursing homes and assisted living facilities.

BACKGROUND: Nursing homes (NHs) are federally regulated under uniform standards, whereas assisted living facilities (ALFs) use individual state regulations for staffing, training, and oversight of care quality and safety. PURPOSE: To describe ALF staffing, training, inspection, and enforcement regulations for 50 U.S. states and the District of Columbia, and compare them to NH regulations. Publication of ALF quality and safety outcomes data also was assessed and compared to NHs. METHODS: Regulatory data were compiled from administrative and regulatory data sources, state websites, and regulatory compendia. FINDINGS: NHs followed a standard set of regulations, whereas ALF regulations varied widely. Overall, state ALF regulations were less stringent than NH in all categories. DISCUSSION: As ALF populations and acuity levels increase, staffing, training, nursing presence, and outcomes data requirements are warranted, and could be tailored from NH regulations to protect ALF quality and safety.