Transforming outcome expectations into retention among hospital nurses: A cross-sectional study.

AIM: To examine the main effects and interaction effects of outcome expectations (e.g., anticipated satisfactory salary and benefits), nurse identity (a sense of membership in the nursing profession), and information-access efficiency of the electronic medical record system (how the system enables nurses to quickly retrieve the needed information) on nurses' retention. DESIGN: This study uses a cross-sectional survey and adopts proportionate random sampling to recruit a representative sample of nurses of a medical centre in Taiwan. METHODS: This study successfully obtained completed questionnaires from 430 nurses during December 2021 to January 2022. Data are analysed by using hierarchical regressions. RESULTS: Positive outcome expectations and identification as a member in the nursing profession are associated with retention. Information-access efficiency strengthens the link between outcome expectations and retention, while nurse identity weakens this link. CONCLUSION: Outcome expectations can help retain nurses, particularly those who perceive high levels of information-access efficiency and possess weak nurse identity. That is, outcome expectations have a complementary role with nurse identity in retaining nurses. IMPLICATIONS FOR THE PROFESSION: Nurse managers should devise means to build positive outcome expectations for nurses. In addition, either strengthening nurses' identification with the nursing profession or improving the information-access efficiency of the electronic medical system may also help retain nurses. IMPACT: This study examined how to transform outcome expectation to nurse retention, offering nurse managers to devise new means to retain nurses. REPORTING METHOD: STROBE statement was chosen as EQUATOR checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Enhancing nurses' perceptions of having a place to reduce turnover intentions.

AIM: To investigate whether education, tenure, being an advanced practice nurse, skill level, and time pressure impact perceptions of "having a place" and, further, turnover intentions. BACKGROUND: Nursing shortages persist worldwide. Nurses' turnover intentions are negatively related to their perceptions of "having a place" (i.e., the feeling that the nursing workplace is their territory). However, the sources of nurses' perceptions of the perception of "having a place" remain unknown. METHODS: Our research employed a cross-sectional and correlational design. This research was conducted at a large-scale hospital in northern Taiwan from December 2021 to January 2022. We used personnel data pertaining to 430 nurses as well as scales for time pressure, "having a place" and turnover intentions to assess nurses' intention to leave their place of employment. The inclusion criteria focused on full-time nurses who worked for the hospital under investigation. Most of our participants were women. The STROBE statement was used as the EQUATOR checklist (supplemental file). RESULTS: "Having a place" was positively related to educational level, tenure, and skill level, while being an advanced practice nurse was negatively associated with perceptions of "having a place," which in turn were negatively related to turnover intention among nurses. CONCLUSION: Our study is the first to examine the antecedents of nurses' perceptions of "having a place," which include education, tenure, and skill level. IMPLICATIONS FOR NURSING POLICY: Nursing policymakers could encourage nurses to pursue higher degrees and update their nursing skills while instilling perceptions of "having a place" in nurses with a brief tenure and advanced practice nurses.

Professional engagement: Connecting self-efficacy to actual turnover among hospital nurses.

AIMS: To examine how nurses' self-efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover. BACKGROUND: The problem of nursing shortage has become a common global issue. Nurses' self-efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self-efficacy and their actual turnover remains unknown. DESIGN: This study adopts a three-wave follow-up design. METHODS: This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist. RESULTS: Self-efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self-efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover. CONCLUSION: This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self-efficacy on their actual turnover. IMPACT: Our findings impact nursing management that professional engagement is as well important as nurses' self-efficacy, with an aim to maintain the professional nursing workforce. PATIENT OR PUBLIC CONTRIBUTION: Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data.

Enhancing Nurse-Robot Engagement: Two-Wave Survey Study.

BACKGROUND: Robots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse-robot engagement. OBJECTIVE: This study aimed to examine how the benefits and maintenance of robots and nurses' personal innovativeness impact nurses' attitudes to robots and nurse-robot engagement. METHODS: Our study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave. RESULTS: Robot benefits are positively related to nurse-robot engagement (ß=.13, P<.05), while robot maintenance requirements are negatively related to nurse-robot engagement (ß=-.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075). CONCLUSIONS: Our study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses' engagement with them. We found that the impact of robot benefits on nurse-robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context.

Effects of Playing Exergames on Quality of Life among Young Adults: A 12-Week Randomized Controlled Trial.

Objective: The purpose of this paper is to investigate whether playing exergames can enhance quality of life among young adults and it examines the potential moderators. Methods: A 12-week randomized controlled trial was conducted. Quality of life was measured using the short-form 36-item version (SF-36) scale. All the participants were between 20 and 24 years old in Taiwan. Participants in the intervention group (n = 55) were asked to play exergames for 12 weeks, three times a week and 30 minutes at a time, while participants in the control group (n = 62) did not play exergames. The changes in the scores on quality of life between the beginning and the end of the 12-week trial were calculated. Independent t-tests were used to analyze the differences. Results: The intervention group participants experienced an enhanced quality of life in terms of physical functioning, role-physical (role limitations due to physical health), general health, and social functioning. Moreover, the intervention group participants who were not enthusiastic about exercisers experienced an enhanced quality of life in physical functioning, role-physical, and general health. The intervention group participants who attempted to control their weight experienced enhanced general health, vitality, and mental health. Conclusion: Playing exergaming could contribute to users' quality of life in terms of both physical and mental health.

How do three components of professional commitment influence nurse-reported patient-centred care and care quality?

AIMS AND OBJECTIVES: To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse-reported patient-centred care and care quality. BACKGROUND: Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap. DESIGN: This study adopted a two-wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan. METHODS: Proportionate random sampling was used. Full-time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient-Centered Care Scale of Laird-Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist. RESULTS: Affective professional commitment was positively associated with nurse-reported patient-centred care (ß = .18, p = .002 and .01), which was positively associated with nurse-reported care quality (ß = .85, p < .001). Affective and normative professional commitment were also positively associated with nurse-reported care quality (ß = .17, p < .001). CONCLUSIONS: Our findings offer insights for nursing managers that nurses' affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce. RELEVANCE TO CLINICAL PRACTICE: Nursing managers could publicise reports documenting nurses' significant contributions to public health. This could strengthen affective professional commitment among nurses.

How robots impact nurses' time pressure and turnover intention: A two-wave study.

AIMS: To examine the relationships among effort ensuring robots' smooth operation (EERSO), time pressure, missed care, and nurses' turnover intention, and how robot performance moderates such relations. BACKGROUND: Robots may reduce nurses' workload but typically still require some effort of nurses for robots' smooth operation. However, the negative impact of EERSO on nurses' workplace outcomes is unknown. METHODS: This study used a two-wave follow-up design. Data were collected in a medical center in Taiwan, with first wave collected in 2019 and second wave collected between 2019 and 2020. A total of 331 participants were followed through the two waves. RESULTS: EERSO is positively linked to missed care and time pressure. Time pressure is also positively linked to missed care and turnover intention. Positive robot performance weakens the positive link between EERSO and time pressure. CONCLUSION: Using robots may help reduce nurses' workload, but it also requires nurses' efforts to maintain robots' continuous operation, that is, EERSO. It may adversely impact nursing professional workplaces. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should reduce nurses' time pressure whilst suggest hospital managers to seek robots that require minimal EERSO.

Relationship between psychological ownership of the nursing profession and turnover intention: A correlational survey among Taiwanese nurses.

AIMS: The aim of this study is to examine the relationship between psychological ownership of the nursing profession and turnover intention. BACKGROUND: There is a severe shortage of nurses worldwide. Research is needed to understand how nurses' intention to leave hospitals and the nursing profession can be alleviated. METHODS: This study adopted a cross-sectional design and a survey method. Proportionate random sampling was used to ensure sample representativeness. This study surveyed 430 registered nurses in a medical centre in Taiwan between December 2021 and January 2022. We used Turnover Scale and Self-Efficacy Scale and developed Having a Place Scale. RESULTS: Psychological ownership comprises three dimensions: self-efficacy, nurse identity and 'having a place' in the nursing profession. This research is the first to examine how these three dimensions of psychological ownership of the nursing profession are related to the intention to leave a hospital or the nursing profession. Self-efficacy and 'having a place' are negatively related to nurses' intention to leave a hospital (r = -.23 and -.31, p < .001). Nurse identity is negatively related to nurses' intention to leave the nursing profession (r = -.38, p < .001). Intention to leave a hospital is positively related to nurses' intention to leave the profession (r = .76, p < .001). CONCLUSION: The findings provide novel insights for retaining nurses. Nurse managers could use strategies such as including nurses in making workplace decisions and encouraging them to personalize their workspace. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can enhance nurses' self-efficacy and sense of 'having a place' to retain nurses in hospitals, while enhancing nurse identity to retain nurses in the profession.

Reducing turnover intention to improve care outcome: A two-wave study.

AIMS: To ascertain how professional turnover intention impacts nurse-assessed care outcomes, including patient-centered care and care quality. BACKGROUND: Patient-centered care and care quality are critical to care outcomes. However, we do not know whether care outcomes would be improved by reducing nurses' professional turnover intention. DESIGN: We implemented a two-wave correlational follow-up design. METHODS: This study was conducted in a large-scale general in Taiwan during January and February 2018, and January and February 2019. We successfully obtained responses from 448 nurses in 2018 and subsequently followed up (in 2019). Most were women (97.5%), reflecting the profile of the local nurse population. Structural equation modeling was used to test hypotheses. RESULTS: Our findings indicate that nurses' professional turnover intention is negatively related to nurse-assessed, patient-centered care. Nurses' professional turnover intention is also negatively related to all the five perceptions of nurse-assessed care quality: that is, assurance, reliability, responsiveness, empathy, and tangibles. Moreover, years of working as a nurse is also positively related to nurse-assessed, patient-centered care and all the five perceptions of nurse-assessed care quality. CONCLUSION: This study examined nurses' professional turnover intention as an antecedent of nurse-assessed, patient-centered care and care quality. Our study shows that professional turnover intention may predict care outcomes. Overall, our study suggests that professional turnover intention not only impacts workforce stability but also impacts health-care outcomes. IMPACT: Our findings suggest that reduction of nurses' turnover intentions could benefit care outcomes. Hospital managers should know that nurses' turnover negatively impacts care outcomes.

How Robots Help Nurses Focus on Professional Task Engagement and Reduce Nurses' Turnover Intention.

PURPOSE: To examine how robot-enabled focus on professional task engagement and robot-reduced nonprofessional task engagement are related to nurses' professional turnover intention. DESIGN: We adopted a two-wave study design. METHODS: We collected the first wave of data in a large hospital in Taiwan during October and November 2019 and the second wave between December 2019 and February 2020. We used the data collected from 331 nurses who participated in both waves. FINDINGS: We found that robot-enabled focus on professional task engagement is positively related to nurses' overall job satisfaction and perceived health improvement. Robot-reduced nonprofessional task engagement is positively related to nurses' perceived health improvement. Both overall job satisfaction and perceived health improvement are negatively related to nurses' professional turnover intention. CONCLUSIONS: Robots' ability to focus nurses' efforts in professional tasks may help improve nurses' health and overall job satisfaction, and by extension reduce their turnover intention. CLINICAL RELEVANCE: Nurse managers could suggest hospitals introduce robots, particularly those that can share nurses' nonprofessional workload. This, meanwhile, could focus nurses' efforts on professional task engagement.

Impact of professional commitment on professional capability improvement and care quality dimensions: A multi-wave study.

AIMS AND OBJECTIVES: To examine how the three dimensions of professional commitment impact professional capabilities improvement and five key dimensions of care quality. BACKGROUND: While professional commitment is known to retain nurses, we do not know how its three dimensions-affective, continuance and normative commitment-formulate five care quality dimensions: assurance, reliability, responsiveness, empathy and tangibles. DESIGN: We used a three-wave, follow-up design to follow a sample of nurse participants. METHODS: We collected responses from 430 nurses who worked for a medical centre in Northern Taiwan during 2017-2019. Most (78.9%) of the respondents had an age between 20-40 years. We used Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538) and Care Quality Scale of Teng et al. (Journal of Nursing Scholarship, 2010, 41, 301). STROBE statement was chosen as EQUATOR checklist. RESULTS: We found that affective professional commitment is positively related to intention to improve professional capabilities, action to improve professional capabilities and thus to four dimensions of care quality: assurance, reliability, responsiveness and empathy. CONCLUSIONS: Our model explains how three key dimensions of professional commitment contribute to care quality. Our findings support the link between action to improve professional capabilities and dimensions of care quality. RELEVANCE TO CLINICAL PRACTICE: Nursing managers can inform nurses of positive patient feedback, thus enhancing nurses' affective professional commitment, which would likely motivate their devotion to upgrading their professional capabilities, thus further contributing to the quality of the care they provide.

Influence of headaches on nurse intentions to leave the profession and the hospital: a cross-sectional survey.

Background: Few studies had examined whether headaches impact emotional exhaustion among nurses, and nurses' intentions to leave the hospital (current employer) or nursing profession. Objectives/Aims/Hypotheses: To examine the impact of headaches on nurses' self-efficacy and emotional exhaustion, and nurses' intentions to leave the hospital or the profession. Design: A cross-sectional survey design with proportional random sampling was used to collect data. Methods: This study was conducted in one medical center in Taiwan during February and March 2017. Inclusion criteria were full-time registered nurses. Totally, 570 full-time registered nurses were surveyed. Results: Nurse headaches were positively related to emotional exhaustion, which was positively related to the intention to leave the hospital, further positively related to the intention to leave the profession. Self-efficacy was negatively related to the intention to leave the profession. Impact statement and Conclusions: Our findings advise nurse managers to take actions to reduce nurses' headaches.

Relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest.

AIMS: This study examined the relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest. BACKGROUND: Interest in the nursing career could help retain nurses in the nursing profession. A global nurse shortage warrants further research to understand what drives interest in the nursing career. METHODS: A cross-sectional design was employed. Data were collected in a medical centre in Northern Taiwan between February and March 2017, using employee records and a survey instrument. Proportionate random sampling was used to identify full-time registered nurses, of whom 524 provided useable responses. Employee records were used to measure nurses' upgrades in academic qualifications and practice accreditation. RESULTS: Upgrades in academic qualifications and upgrades in practice accreditation are positively related to outcome expectations. Both self-efficacy and outcome expectations are positively related to career interest. CONCLUSION: The pursuit of upgrades in academic qualifications and practice accreditation could enhance nurses' outcome expectations, thus enhancing their interest in a nursing career. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital managers could develop policies, procedures and programmes to encourage nurses to enhance their academic qualifications or practice accreditation, helping enhance their interest in remaining in the nursing career.

How career facilitators and barriers influence nurses' professional turnover intention.

AIMS: Our study investigates the influence of career facilitators and barriers on nurses' improvement of their professional capabilities and their professional turnover intention. BACKGROUND: Reducing nurses' professional turnover intention could help alleviate the global nursing shortage. Nevertheless, little research has addressed how career facilitators and barriers, nurses' improvement of their professional capabilities and professional turnover intention are related, indicating a gap. DESIGN: This study used a cross-sectional design. METHODS: We surveyed 502 out of 2,660 full-time nurses who worked for a medical centre in Taiwan between January-March 2018. Our items were adapted from Cunningham et al. and Teng et al. and had adequate reliability and validity. Structural equation modelling was used to test the study hypotheses. RESULTS: Human capital, social capital, and discrimination were positively related to intention to improve professional capabilities. Moreover, intention to improve professional capabilities was positively related to action to improve professional capabilities, which was negatively related to professional turnover intention. CONCLUSION: Most of the career facilitators and even barriers, boost the improvement of professional capabilities and are useful for retaining nurses in the nursing profession. IMPACT: Findings of this study should have an impact on nursing managers by offering them means to retain nurses, for example, enhancing human capital and social capital among nurses to reduce their turnover intention.

The impact of mentor-mentee rapport on nurses' professional turnover intention: Perspectives of social capital theory and social cognitive career theory.

AIMS AND OBJECTIVES: This study examines the impacts of mentor-mentee rapport on willingness to mentor/be mentored, self-efficacy, outcome expectations, career interest and subsequently on nurses' professional turnover intention. BACKGROUND: Workplace relationships, whether positive or negative, influence nurse turnover within an organisation. Yet little is known about the effects of mentoring on nurses' intentions to leave the nursing profession. DESIGN: A cross-sectional, survey-based research design was used to collect data from a large medical centre in Northern Taiwan. METHODS: Study concepts were measured using scales from social capital theory (SCT), social cognitive career theory (SCCT) and the nursing literature. Partial least square structural equation modelling was used to test all study hypotheses. The STROBE statement was chosen as the EQUATOR checklist. RESULTS: For mentors, rapport was positively related to willingness to mentor, which was positively related to outcome expectations, and further, positively related to career interest and negatively related to professional turnover intention. For mentees, rapport was positively related to willingness to be mentored, which was positively related to self-efficacy, outcome expectations and ultimately to career interest. Career interest was negatively related to professional turnover intentions. CONCLUSIONS: Rapport between mentors and mentees may be an important means to retain nurses in the profession. RELEVANCE TO CLINICAL PRACTICE: Managers should consider taking steps to enhance rapport between mentors and mentees. In doing so, managers improve nurse retention, a critical component of providing high-quality patient care.

The role of professional commitment in improving nurses' professional capabilities and reducing their intention to leave: Two-wave surveys.

BACKGROUND: Social cognitive career theory (SCCT) can explain the mechanism underlying the formulation of nurse turnover intention. However, little is known about the role of professional commitment in such a mechanism. AIMS: The aim of this study was to explore how elements of SCCT have an impact on the three aspects of professional commitment and thus nurses' intention to leave the profession. DESIGN: This study used surveys to collect two-wave data. METHODS: The participants were sampled in all available units of a major medical centre in 2017. By using proportionate random sampling methods, we successfully followed up a representative sample of 524 full-time nurses. Most participants (98.1%) were female. Items came from Cunningham et al.'s Self-Efficacy Scale, Outcome Expectations Scale, Human Capital Scale and Vocational Interest Scale; Meyer et al.'s Professional Commitment Scale; and Teng et al.'s Turnover Intention Scale. Structural equation modelling was used to test the hypotheses. RESULTS: Self-efficacy was positively related to outcome expectation. Outcome expectation was positively related to career interest. Career interest was positively related to affective professional commitment. Human capital was positively related to normative professional commitment. Affective professional commitment was positively related to intention to improve professional capabilities, which was further negatively related to intention to leave the profession. CONCLUSION: Aspects of professional commitment are important process variables in the impact of self-efficacy and outcome expectation on nurses' turnover intention.

How do career barriers and supports impact nurse professional commitment and professional turnover intention?

AIMS: This study examines how career barriers and supports (i.e., perceived discrimination, lack of advancement, human capital, and social capital) impact affective, normative, and continuance aspects of professional commitment and thus nurses' professional turnover intention. BACKGROUND: Professional commitment is known to influence professional turnover intention. However, little is known about how career barriers and supports contribute to professional commitment and reduce professional turnover intention. METHODS: This study adopted a cross-sectional design and a survey to collect representative data in a major hospital in northern Taiwan. We used proportionate random sampling to ensure sample representativeness and obtained 524 responses. RESULTS: Perceived discrimination and lack of advancement were negatively related to affective professional commitment. Human capital was positively related to affective, normative, and continuance professional commitment. Social capital was positively related to normative professional commitment. All aspects of professional commitment were negatively related to professional turnover intention. CONCLUSION: Career barriers and supports have an important influence on professional commitment. Reduced barriers and enhanced support may therefore help reduce nurses' professional turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers could aim to lessen career barriers while increasing career support for nurses, helping strengthen nurses' professional commitment and retention.

A Randomized Controlled Trial on the Role of Enthusiasm About Exergames: Players' Perceptions of Exercise.

Objective: Exergames are popular technology applications that encourage individuals to engage in exercise and create positive moods for players. However, little is known as to whether playing exergames makes players perceive to be more energetic and relaxed and whether enthusiasm about doing exercise moderates such perceptions. To answer these questions, we use the Flow Theory and the Self-Determination Theory to develop the hypotheses. Methods: We conducted a randomized controlled trial, which randomly assigned 337 participants to an intervention group and a control group. We asked the participants in the intervention group to play exergames for 2 weeks. We measured enthusiasm about doing exercise by asking the participants to evaluate themselves as having enthusiasm on doing exercise or not. We measured participants' perceptions of happiness, perceived energy (the perception of sufficient physical and mental resources), and relaxation before and after the 2-week exergame playing, generating scores to represent their changes. Results: We found that playing exergames induces positive changes in happiness, perceived energy, and relaxation. Such changes were significant for participants who are enthusiastic about doing exercise, but not for those who are unenthusiastic about doing exercise. Conclusion: This study was the first using the Flow Theory and the Self-Determination Theory to examine the impact of playing exergames on players' perceptions and to identify the moderator role of enthusiasm about doing exercise. These positive impacts of exergames can be used in rehabilitation settings in encouraging positive attitudes and behaviors toward exercise.

The impact of burnout on self-efficacy, outcome expectations, career interest and nurse turnover.

AIMS: To examine the impact of burnout on self-efficacy, outcome expectations, career interest and on nurses' intentions to leave the profession and to leave the organization. BACKGROUND: Burnout is associated with nurse turnover. Research clarifying the underlying mechanism may provide a novel means to mitigate the impact of burnout on nurse turnover. DESIGN: This study uses a cross-sectional design and proportionate stratified sampling. METHODS: Data were collected from a sample of nurses in one medical centre in northern Taiwan during February - March 2017. This study included nurses employed full-time at the medical centre. Burnout was measured using Maslach Burnout Inventory-Human Service Survey. Self-efficacy, outcome expectations and career interest were measured using the scale of Cunningham et al. Intentions to leave were measured using the scales of Teng et al. Structural equation modelling was used to assess the proposed framework. RESULTS: Burnout was negatively related to self-efficacy and outcome expectations. Self-efficacy was positively related to outcome expectations. Outcome expectations were also positively related to career interest. However, self-efficacy was not related to career interest. Career interest was negatively related to the intention to leave the organization, which was further related to the intention to leave the profession. The model fitted the data acceptably. CONCLUSIONS: When nurses leave the profession, patient outcomes may be affected. Policy makers should evaluate whether the healthcare system can instil expectations for satisfaction, power and adequate compensation in the profession and thus retain nurses.

Moderator Roles of Optimism and Weight Control on the Impact of Playing Exergames on Happiness: The Perspective of Social Cognitive Theory Using a Randomized Controlled Trial.

OBJECTIVE: The literature on exergames has examined their impact on user-perceived psychological health (i.e., user-perceived happiness), but little is known about whether such an impact depends on user characteristics. Therefore, this study used the perspective of social cognitive theory (SCT) to identify potential moderators (i.e., whether the user is optimistic or attempting to control his or her weight) of the impact of playing exergames on user-perceived happiness. MATERIALS AND METHODS: This large-scale randomized controlled trial recruited 337 college students (of whom 57.3% were female and all were aged 20-40 years) as participants. The participants were randomly assigned to the intervention group or the control group. Participants in the intervention group were asked to use an Xbox 360 to play 1 of 10 exergame programs for 30 minutes once a week for 2 weeks. Participants in the control group were not required to do so. Repeated-measures ANOVA was used for the analyses. RESULTS: The analytical results indicate that playing exergames helped to maintain happiness levels and prevented them from decreasing. The maintained happiness was more prominent among participants who were trying to control their weight, but did not differ between participants who were highly optimistic and those who were less optimistic. This study is the first using SCT to explain the contingent effect of playing exergames on user happiness. CONCLUSIONS: Exergames can maintain happiness among users, and such maintenance can be the strongest among users who are trying to control their weight.