DEVELOPMENT, RELIABILITY, AND VALIDITY OF NURSES' WORK-LIFE BALANCE SCALE IN REGIONAL THAI HOSPITALS.

Background and Purpose: Factors influencing work-life balance of regional hospital nurses are different from other professions. This study aimed to develop an instrument to measure work-life balance, and examine its psychometric properties. Methods: Psychometric properties were tested with content validity, construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and reliability with 598 professional nurses recruited using multi-stage sampling. Results: The Nurses' Work-life Balance Scale (NWLBS) had 38 items and seven components, explaining 64.46% of total variance. Content Validity Index was 0.94. CFA results indicated good fit with empirical data. Cronbach's alpha ranged from 0.53 to 0.94 for the seven subscales in 30 professional nurses. Conclusions: NWLBS demonstrated good content validity, construct validity, and reliability for assessing nurses' work-life balance.

Perspectives of nurses regarding total rewards and their preferences in Thailand: A qualitative descriptive study.

BACKGROUND: In this time of global nursing shortages, investment in nursing is vital, and hospitals need to apply a range of strategies to attract and retain nurses. Rewards are an effective strategy for the retention of nurses and help improve the performance and productivity of hospitals. In rural and remote communities, however, nurses may not have access to the rewards that urban-based nurses have. AIM: To explore the preferred rewards of registered nurses in rural and remote community hospitals in Thailand. METHODS: An explanatory mixed-methods design was employed for the overall study, and the results from the qualitative descriptive phase are reported here using the COREQ checklist. We collected data during in-depth interviews with 24 informants from 8 community hospitals. Thematic analysis was used for data analysis. FINDINGS: Four major themes regarding reward types were preferred by the nurses: reasonable pay, good benefits, accessible learning and development, and a favorable work environment. CONCLUSION: A package of total rewards that best suit nurses working in rural and remote areas needs to be implemented, for a combination of different types of rewards has a greater impact than a single reward at both individual and organizational levels. IMPLICATION FOR NURSING AND HEALTH POLICY: It is crucial to identify those rewards to attract and retain nurses. In Thailand, nursing and health workforce policies need to be based on nurse preferences regarding salary, benefits, and recognition commensurate with other healthcare professionals, including civil servant status, as well as improving the work environment.

Development and psychometric testing of the Perceived Organizational Climate Scale for nurses.

AIM: Retaining nurses on the job is vital, and their successful retention is related to the organizational climates (OC) of healthcare settings. The purpose was to develop and test the psychometric properties of the Perceived Organizational Climate Scale (POCS). DESIGN: The methodologic research design was used by following the scale development strategies by DeVellis (2017). The conceptual framework for this study was based on the broader theoretical framework of the Competing Value Framework (CVF) of Quinn et al. (2015), the concept analysis and extensive literature review (1939-2018), and combined with the inductive qualitative data. METHODS: A two-phase study of scale construction and psychometric testing was conducted for content validation, construct validation and internal consistency reliabilities of the instrument. An expert panel validated the 4-point scale, followed by exploratory factor analysis, the known-group approach and split groups. Data were collected from (1161) registered nurses in eight general hospitals across Myanmar from August 2019 to September 2020. RESULTS: The 35 items with four essential dimensions: transformational climate, bureaucratic climate, team climate and strategic climate, explained almost 50% of the variation with all factor loading greater than .40. The internal consistency reliabilities of the instrument showed the Cronbach's alpha coefficient of .93, and the dimensions were from .82 to .85. As hypothesized, the known-group approach demonstrated that experienced nurses had higher mean scores than novices. The internal consistency reliabilities of the scale and dimensions across the splitting groups illustrated the stability. CONCLUSION: This evidence supports this instrument as having satisfactory initial psychometric properties with a comprehensive picture of OC by its essential components contributing to an inclusive understanding of this climate globally. IMPACT: This instrument can be used as an objective tool for evaluating OC as perceived by nurses in healthcare settings to inform improvements in working environments.

Testing a model of Thai nurses' intent to stay in employment.

AIM: To test the causal model of intent to stay in employment of nurses in regional medical centers. BACKGROUND: Effectiveness and quality of nursing care are determined by an adequate number of nursing staff; however, there is an ongoing challenge of nursing shortage. Improving nurses' intention to remain in employment is an effective way to address the problem of nursing shortage. METHODS: This study employed a cross-sectional design. The sample was 1224 registered nurses from nine regional medical centers across Thailand, selected using multistage random sampling. Data were collected between January and July 2019 and analyzed with structural equation modeling. RESULTS AND DISCUSSION: The final model could explain 40.3% of the variance in intent to stay. Transformational leadership, coworker support, professional autonomy, opportunities for promotion, marital status, and job satisfaction positively affected intent to stay, while burnout negatively affected intent to stay. This indicates that seven factors that should be considered by nurse managers in developing a framework for constructing interventions to increase nurses' intention to continue working in their organization. IMPLICATION FOR NURSING AND NURSING POLICY: Nurse managers should strengthen the intent to stay of nurses by providing consultations, building a positive work atmosphere, and encouraging nurse leaders to apply transformational leadership behaviors to the organizational administration. Policymakers should consider enacting policies and regulations for nurses' benefits, such as allocating civil servant positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, and considering salary and overtime pay, to increase nurses' intent to stay in an organization.

Nursing students' and faculty members' experiences of online education during COVID-19 across Southeast Asia: A Photovoice study.

BACKGROUND: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach. OBJECTIVES: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic. DESIGN: A descriptive qualitative design using Photovoice was adopted. SETTING: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong). PARTICIPANTS: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic. METHODS: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards. RESULTS: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not. CONCLUSION: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum.

Salutogenesis and COVID-19 pandemic impacting nursing education across SEANERN affiliated universities: A multi-national study.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. DESIGN: The descriptive cross-sectional quantitative design was used. SETTINGS: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. PARTICIPANTS: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. METHODS: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. RESULTS: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. CONCLUSIONS: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.

Nurse staffing, missed care, quality of care and adverse events: A cross-sectional study.

AIM: This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals. BACKGROUND: Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand. METHODS: This cross-sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient-to-nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations. RESULTS: Higher patient-to-nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse-reported missed care was significantly associated with higher odds of adverse events and poor quality of care. CONCLUSIONS: Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care.

Doctoral education, advanced practice and research: An analysis by nurse leaders from countries within the six WHO regions.

Doctoral education, advanced practice and research are key elements that have shaped the advancement of nursing. Their impact is augmented when they are integrated and synergistic. To date, no publications have examined these elements holistically or through an international lens. Like a three-legged stool they are inter-reliant and interdependent. Research is integral to doctoral education and influential in informing best practice. This significance and originality of this discussion paper stem from an analysis of these three topics, their history, current status and associated challenges. It is undertaken by renowned leaders in 11 countries within the six World Health Organisation (WHO) regions: South Africa, Egypt, Finland, United Kingdom, Brazil, Canada, United States, India, Thailand, Australia, and the Republic of Korea. The first two authors used a purposive approach to identify nine recognized nurse leaders in each of the six WHO regions. These individuals have presented and published papers on one or more of the three topics. They have led, or currently lead, large strategic organisations in their countries or elsewhere. All these accomplished scholars agreed to collect relevant data and contribute to the analysis as co-authors. Doctoral education has played a pivotal role in advancing nurse scholarship. Many Doctor of Philosophy (PhD) prepared nurses become faculty who go on to educate and guide future nurse researchers. They generate the evidence base for nursing practice, which contributes to improved health outcomes. In this paper, the development of nursing doctoral programmes is examined. Furthermore, PhDs and professional doctorates, including the Doctor of Nursing Practice, are discussed, and trends, challenges and recommendations are presented. The increasing number of advanced practice nurses worldwide contributes to better health outcomes. Nonetheless, this paper shows that the role remains absent or underdeveloped in many countries. Moreover, role ambiguity and role confusion are commonplace and heterogeneity in definitions and titles, and regulatory and legislatorial inconsistencies limit the role's acceptance and adoption. Globally, nursing research studies continue to increase in number and quality, and nurse researchers are becoming partners and leaders in interdisciplinary investigations. Nonetheless, this paper highlights poor investment in nursing research and a lack of reliable data on the number and amount of funding obtained by nurse researchers. The recommendations offered in this paper aim to address the challenges identified. They have significant implications for policy makers, government legislators and nurse leaders.

Social transformation and social isolation of older adults: Digital technologies, nursing, healthcare.

BACKGROUND: The incidence of social isolation among older adults is on the rise in today's health care climate. Consequently, preventing or ameliorating social isolation through technology in this age group is now being discussed as a significant social and health issue. AIM: The purpose of the opinion paper is to clarify social transformation through technology and shed light on a new reality for older adults in situations of social isolation. Our goal is to persuade the reader that our position on this topic is a valid one. We support our claims with practice-based evidence and published research studies. METHODS: To do so, we checked the most recent literature, most of which came from the last decade. Our literature survey focused primarily on what is known about technology and how technology can affect social transformation and perceptions of social isolation. FINDINGS: Two dominant transformative realities became the focal points: the precarious implications of loneliness for older adults and the emerging reality of social change through digital technology central to eHealth and mHealth. DISCUSSION: To benefit from new technologies and reduce the detrimental effects of social isolation, we must engage older adults in a meaningful way and adapt the system of smart devices to reflect the specific physiological and psychological characteristics of the ageing population. CONCLUSION: Older adults need to comprehend the meanings of their social experiences to preserve their active lifestyle. Human interactions may be desirable, but technological dominance may also minimize the adverse effects of social isolation.

Development and psychometric testing of quality nursing care scale in Mongolia.

BACKGROUND: Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms. METHODS: Exploratory sequential mixed-method design was implemented to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. Second, we dedicated to ascertaining psychometric performance of QNCS-M. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated. RESULTS: The initial version of QNCS-M contained 66 items of which 7 (I-CVI < .78) were deleted after item-content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items (<.3). Additional 12 items were excluded after inter-item correlation (<.3, >.7). Results from Spearman rank-order correlation analysis of the remaining 44 items indicated relationship between social desirability and 6 items (r = -.09 to r = .11). These items were excluded to reduce the likelihood of potential information bias. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items (factor loading <.4) were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach's α = .92; the coefficient values for the 6 domains ranging between .72 and .85 and Pearson correlation for stability reliability yielded an acceptable (r = .82, P < .001). CONCLUSION: Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.

Nurses' Qualitative Descriptions of the Organizational Climate of Hospitals.

PURPOSE: To explore nurses' perceptions of the organizational climate in general hospitals in Myanmar. DESIGN AND METHODS: Using a qualitative descriptive design, data were purposively collected from all levels of registered nurses in eight general hospitals across Myanmar during August to October 2019. Seventeen individual in-depth interviews and eight focus group discussions with 65 nurses were undertaken and analyzed using Graneheim and Lundman's qualitative content analysis. FINDINGS: Four categories of organizational climate from a Myanmar nursing context emerged: organizational uniqueness, organizational alignment, sense of empowerment, and the reinforcing organization. Organizational uniqueness included the subcategories of perception of features and orientation of the organization, whilst organizational alignment comprised the three subcategories of the values inherent in the management process, the criteria of success, and strategic emphasis. The sense of empowerment category embraced the subcategories of the perceptions of the decision making and roles of leaders or managers; the last category, the reinforcing organization, incorporated the subcategories of bonding and recognition of the organization. CONCLUSIONS: This was the first qualitative nursing study on nurses' perceptions of organizational climate in Myanmar hospitals. Participants revealed a rich source of information that needs to be considered by hospital administrators and other policymakers to enhance quality clinical care by nurses, and their overall well-being and working conditions. The emphasis on the holistic nature of this concept points to further investigations of working conditions, the lives of nurses, and management of nurses within the hospital environments in Myanmar hospitals, and can inform other countries. CLINICAL RELEVANCE: Nurses revealed a rich understanding of what an organizational climate represents or should represent, and they need to work with hospital administrators and managers to contribute to the development of positive organizational climate, which in turn should increase nurse retention and the efficacy of health care provided in hospitals.

Commonalities in Nursing Perspectives Among 6 Countries/Regions.

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."

A contemporary understanding of organizational climate in healthcare setting: A concept analysis.

AIM: The overarching objective of this report is to provide an updated definition of the concept of organizational climate and to strengthen its operational application. BACKGROUND: Organizational climate is one of the major contributing factors to the exodus of the nursing workforce from the profession. Extensive research has addressed the impact of "organizational climate" on the nursing workforce; yet variations in the interpretation of the concept calls for an updated definition. DESIGN: Walker and Avant's strategy was implemented. DATA SOURCE: Data were compiled from Medline and CINAHL, Google search engine, and book chapters. REVIEW METHOD: A comprehensive and detailed review of the literature was performed. Nineteen historic publications (1939-2012) and 39 healthcare-related publications (2013-2018) were included in the final review. RESULTS: The climate of an organization reflects a set of core values and behaviors that can be used to implement evidence-based leadership and management within the context of the 21st century. We have revised the definition of organizational climate to capture this context. CONCLUSION: The perception of a supportive and constructive climate in an organization propels the workforce, independent of ethnic or personal background, to a higher level of productivity and encourages loyalty and workforce stability.

Effects of Litsea cubeba (Lour.) Persoon Essential Oil Aromatherapy on Mood States and Salivary Cortisol Levels in Healthy Volunteers.

Aromatherapy is one of the complementary therapies to improve health. The aromatic essential oils have been used in the treatment procedure through inhalation of essential oil vapor, massage, and herbal bathing. Litsea species are generally used in traditional medicine, and Litsea cubeba (Lour.) Persoon is a potent fumigant plant, used in cosmetics and foods as essence. The chemical composition of the essential oil of different parts of L. cubeba has been found to be varied. L. cubeba essential oil (LEO) is known for the treatment of cognition-associated discomforts. The current study assessed the impact of inhalation of LEO on mood states and salivary cortisol levels of healthy people. Fifteen healthy volunteers were involved in the study. The Profile of Mood States (POMS) Questionnaire and ELISA methods were employed to determine the mood states and salivary cortisol level, respectively. (-)-ß-pinene, ß-citral, cis- and trans-citral, citronellal, limonene, linalool, and 6-methyl-5-hepten-2-one were detected in LEO by GC-MS analysis. The heart rate and blood pressure were not affected significantly during LEO exposure. The inhalation of LEO significantly improved the total mood disturbance and reduced the confusion among the healthy human subjects. LEO inhalation reduced the salivary cortisol level at a notable level. The results of the current study warrant further studies on the beneficial effect of LEO aromatherapy in healthy and diseased subjects to uncover the therapeutic nature of the L. cubeba plant.

Challenging times: ethics, nursing and the COVID-19 pandemic.

Globally nurses and midwives are working hard to detect cases of COVID-19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS-CoV-2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.

The Refined Middle-Range Theory on Women's Leadership in Asian Culture.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women's leadership in nursing, a middle-range theory on women's leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women's leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women's Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women's leadership in nursing across the globe.

Doctoral nursing education in east and Southeast Asia: characteristics of the programs and students' experiences of and satisfaction with their studies.

BACKGROUND: The characteristics of nursing doctoral programs and the doctoral students' experience have not been thoroughly investigated. Hence, this study aimed to describe the characteristics of nursing doctoral programs in East and South East Asian (ESEA) countries and regions from the views of doctoral program coordinators, and to explore the students' experiences of and satisfaction with their doctoral nursing program. METHODS: A cross-sectional survey was conducted using two self-designed questionnaires, one focusing on PhD program coordinators and the other on doctoral students. Characteristics of the nursing doctoral programs focused on program characteristics, faculty characteristics, career pathways for graduates, and challenges for nursing doctoral education. Doctoral students' assessment of study experiences included quality of supervision, doctoral training programs, intellectual/cultural climate of institutions, general facilities/support, and the overall study experience and satisfaction. RESULTS: In the PhD coordinators survey, 46 institutions across nine ESEA countries and regions participated. More than half of nursing departments had academic members from other health science disciplines to supervise doctoral nursing students. The majority of graduates were holding academic or research positions in higher education institutions. Faculty shortages, delays in the completion of the program and inadequate financial support were commonly reported challenges for doctoral nursing education. In the students' survey, 193 doctoral students participated. 88.3% of the students were satisfied with the supervision they received from their supervisors; however, 79% reported that their supervisors 'pushed' them to publish research papers. For doctoral training programs, 75.5% were satisfied with their curriculum; but around half reported that the teaching training components (55.9%) and mobility opportunities (54.2%) were not included in their programs. For overall satisfaction with the intellectual and cultural climate, the percentages were 76.1 and 68.1%, respectively. Only 66.7% of the students felt satisfied with the facilities provided by their universities and nursing institutions. CONCLUSION: Doctoral nursing programs in most of the ESEA countries value the importance of both research and coursework. Doctoral nursing students generally hold positive experiences of their study. However, incorporating more teaching training components, providing more opportunities for international mobility, and making more effort to improve research-related facilities may further enhance the student experience. There is also a need to have international guidelines and standards for quality indicators of doctoral programs to maintain quality and find solutions to global challenges in nursing doctoral education.