Number of palliative care nurse home visits and duration of palliative care associated with domains of the Good Death Inventory: A national survey of bereaved family caregivers in a middle income country.

Background: In the lower-middle-income country of Kazakhstan, palliative care services are in the early stages of integration into healthcare services. No prior studies have investigated associations between palliative care service factors and a good death in lower-middle-income countries, nor explored how palliative care nurses contribute to a good death. In this paper, a good death is referred to as the control of pain and symptoms, clear decision-making, a sense of closure, being recognized and perceived as an individual, preparation for death, and still being able to contribute to others, all taken together. Objectives: To identify new opportunities for palliative care service nurses by investigating associations between palliative care service factors and a good death, as measured by the Good Death Inventory. Methods: Family caretakers of deceased patients from palliative care units and hospices were surveyed across six different regions of Kazakhstan. Data collected included demographics for patients and caregivers, palliative care service data, and Good Death Inventory items. Poisson regression analysis with r variance and linear regressions were conducted to identify determinants for achieving a Good Death and for the 18 Good Death Inventory domains. Results: Two hundred and eleven family caregivers participated in the survey. Bivariate analysis revealed five statistically significant associations (p ≤ 0.05) with the outcome of a good death. In multivariate linear regression analyses, a palliative care duration of greater-than-6-months, compared to less-than-1-month, was associated with improvements in 10 out of 18 domains of the Good Death Inventory (p ≤ 0.05). More-than-once-weekly palliative care home visits by nurses, compared to no visits, were also associated with improvements in four domains (p ≤ 0.05). Conclusion: We provide new directions for improvements in palliative care services in low-middle-income countries, giving impetus for resource allocation to palliative care home visits by nurses for achieving a good death for greater numbers of patients.

Effects of applying blended learning based on the ADDIE model in nursing staff training on improving theoretical and practical operational aspects.

Objective: To assess the impact of blended learning, based on the ADDIE model, on theoretical and practical aspects of nursing staff training. Methods: Retrospective analysis of data from 87 nursing staff members in Xi'an Qinhuang Hospital divided into control (n = 43) and observation (n = 44) groups. The control group received conventional training, while the observation group underwent blended learning. Comparative analysis included theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction. Results: The observation group showed significantly higher theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction compared to the control group (p < 0.05). Conclusion: Blended learning based on the ADDIE model enhances nursing staff training outcomes, improving theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction. This approach presents a promising method for enhancing nursing education and warrants further implementation in clinical settings.

Correlation analysis of mental toughness, family social support, and anxiety of nursing staff.

OBJECTIVE: This study aims to explore the impact of family social support affects anxiety levels and mental toughness among nursing staff, and to identify the pathways of how mental toughness develops. METHODS: We selected 256 nursing staff from the Third People's Hospital of Chengdu using a convenience sampling method. Participants completed a questionnaire assessing family social support, anxiety level and mental toughness of the nursing staff. The questionnaires included the general information questionnaire, Perceived Social Support Scale (PSSS), Self-Rating Anxiety Scale (SAS), and the Connor-Davidson resilience scale (CD-RISC). Then, we analyzed the correlation between nursing staff' family social support, anxiety symptoms and mental toughness by using Pearson correlation. Finally, we analyzed the effect of family social support on mental toughness and anxiety levels by using linear regression, and analyzed the path of family social support and psychological toughness on anxiety symptoms by using structural equation modeling. RESULTS: We finally collected 246 valid questionnaires with a valid recovery rate of 96.09%. 116 (47.15%) nursing staff reported a moderate level of family social support, with a mean PSSS score of (58.98 ± 7.64). Anxiety risk was identified in 43.39% of participants, with a mean SAS score of 50.47 ± 10.96. In terms of mental toughness, 104 (42.28%) nursing staff exhibited a low level of mental toughness, and 116 (47.15%) demonstrated moderate level of mental toughness with CD-RISC score of (58.23 ± 10.12). Correlation analyses revealed a strong negative correlation between the family social support, mental toughness and their anxiety (r = -0.586, -0.516, respectively), and a strong positive correlation between family social support and mental toughness (r = 0.571). Regression analysis showed that family social support was a significant negative predictor for anxiety (ß = -0.841, t = -9.488), but a significant positive predictor for mental toughness (ß = 0.756, t = 11.669). Mediation analysis indicated that mental toughness mediated 26.28% of the relationship between family social support and anxiety levels. CONCLUSION: Family social support can significantly reduce anxiety levels in nursing staff directly, as well as indirectly by increasing mental toughness.

Measuring the relationship between reciprocity behaviour and technology readiness of nursing staff working in residential care and community nursing: A cross-sectional study.

AIM: The aim of this study is to measure how collaborative factors are associated with the technology readiness of nursing staff working in residential care and community nursing. The Reciprocity Instrument and Technology Readiness Index 2.0 were applied to measure this association. DESIGN: A cross-sectional survey was conducted between October 2020 and January 2021. METHODS: The Technology Readiness Index 2.0 was translated into Dutch, administered together with the Reciprocity Instrument and linguistically validated. And 1660 Registered Nurses and Nursing Assistants received an invitation to the online survey. Descriptive statistics and regression analyses were used to analyse the data. RESULTS: A total of 475 nursing staff responded, a response rate of 28.6%. The following factors have a statistically significant association with technology readiness: age, education level, years of working experience, type of organization, reciprocity behaviour and conditions of reciprocity behaviour: digital communication usage to reach one another, multilayeredness and future perspective. CONCLUSION: This study shows that reciprocity behaviour is positively associated with technology readiness. The influencing factor reciprocity remains intact after the correction of the other factors that were measured. This confirms the relevance of collaborative factors that influence the technology adoption process of nursing staff working in residential care and community nursing. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study offers insights into how collaboration based on reciprocity behaviour positively impacts the technology readiness of nursing staff engaged in residential care and community nursing and could be used in the education of nursing staff and healthcare teams. IMPACT: Being aware of the impact that collaborative factors have on the adoption process of ICT among nursing staff could be used to support the desired preparatory activities as part of ICT implementation for healthcare managers, innovators, and nursing work groups charged with implementing technology in the healthcare process. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Activity, triage levels and impact of the pandemic on hospital emergency departments: A multicentre cross-sectional study.

AIM: Describe the activity of hospital emergency departments (EDs) and the sociodemographic profile of patients in the eight public hospitals in Spain, according to the different triage levels, and to analyse the impact of the SARS-CoV-2 pandemic on patient flow. DESIGN: An observational, descriptive, cross-sectional and retrospective study was carried out. METHODS: Three high-tech public hospitals and five low-tech hospitals consecutively included 2,332,654 adult patients seen in hospital EDs from January 2018 to December 2021. Hospitals belonging to the Catalan Institute of Health. The main variable was triage level, classified according to a standard for the Spanish structured triage system known as Sistema Español de Triaje. For each of the five triage levels, a negative binomial regression model adjusted for year and hospital was performed. The analysis was performed with the R 4.2.2 software. RESULTS: The mean age was 55.4 years. 51.4% were women. The distribution of patients according to the five triage levels was: level 1, 0.41% (n = 9565); level 2, 6.10% (n = 142,187); level 3, 40.2% (n = 938,203); level 4, 42.6% (n = 994,281); level 5, 10.6% (n = 248,418). The sociodemographic profile was similar in terms of gender and age: as the level of severity decreased, the number of women, mostly young, increased. In the period 2020-2021, the emergency rate increased for levels 1, 2 and 3, but levels 4 and 5 remained stable. CONCLUSION: More than half of the patients attended in high-technology hospital EDs were of low severity. The profile of these patients was that of a young, middle-aged population, mostly female. The SARS-CoV2 pandemic did not change this pattern, but an increase in the level of severity was observed. IMPACT: What problem did the study address? There is overcrowding in hospital EDs. What were the main findings? This study found that more than half of the patients attended in high-technology hospital EDs in Spain have low or very low levels of severity. Young, middle-aged women were more likely to visit EDs with low levels of severity. The SARS-CoV2 pandemic did not change this pattern, but an increase in severity was observed. Where and on whom will the research have an impact? The research will have an impact on the functioning of hospital EDs and their staff. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.

End-of-life care in German and Dutch nursing homes: a cross-sectional study on nursing home staff's perspective in 2022.

BACKGROUND: As society ages, the need for nursing home care is steadily increasing and end-of-life care of nursing home residents has become increasingly more important. End-of-life care differs between Germany and the neighbouring Netherlands. For example, a much higher proportion of German compared to Dutch nursing home residents is hospitalized at the end of life. Therefore, the aim of this study was to evaluate end-of-life care in German and Dutch nursing homes. METHODS: In this cross-sectional study, a postal survey was sent to 600 randomly selected German and Dutch nursing homes each and addressed to the nursing staff management. Participants were asked to estimate the percentage of nursing home residents whose wishes for emergency situations (e.g. cardiopulmonary resuscitation) are known and to indicate whether facilities offer advanced care planning (ACP). They were also asked to estimate whether general practitioners (GPs)/elder care physicians (ECPs) and nursing home staff are usually well trained for end-of-life care. Finally, participants were asked to estimate the proportion of nursing home residents who die in hospital rather than in the nursing home and to rate overall end-of-life care provision. RESULTS: A total of 301 questionnaires were included in the analysis; 199 from German and 102 from Dutch nursing homes (response 33.2% and 17.0%). German participants estimated that 20.5% of residents die in the hospital in contrast to the Dutch estimation of 5.9%. In German nursing homes, ACP is offered less often (39.2% in Germany, 75.0% in the Netherlands) and significantly fewer wishes for emergency situations of residents were known than in Dutch nursing homes. GPs were considered less well-trained for end-of-life care in Germany. The most important measures to improve end-of-life care were comparable in both countries. CONCLUSION: Differences in (the delivery and knowledge of) end-of-life care between Germany and the Netherlands could be observed in this study. These could be due to structural differences (ECPs available 24/7 in the majority of Dutch nursing homes) and cultural differences (more discussion on quality of life versus life-sustaining treatments in the Netherlands). Due to these differences, a country-specific approach is necessary to improve end-of-life care.

Job satisfaction in nursing: A qualitative inquiry into novice and experienced nurses' perspectives.

AIM: To explore factors associated with job satisfaction between novice and experienced nurses. BACKGROUND: Job satisfaction is crucial for better quality of patient care and nurses' job engagement in clinical setting. However, job dissatisfaction is commonly reported from clinical nurses leading to poorer patient outcomes and high turnover rate. Job satisfaction at different professional stages may have different expectations. Knowledge about factors influencing job satisfaction of junior and senior nurses is inadequate. DESIGN: A phenomenological study was conducted using face-to-face individual interviews. METHOD: Semi-structured interviews were conducted and audio-recorded. The Herzberg's Two-Factor Theory was used to understand the phenomena. Purposeful sampling was used to select eligible nurse participants who were working in hospital settings. RESULTS: Eight participants, consisting of four junior and four senior nurses, with clinical experience ranging from 1 to more than 25 years, were selected in this study. Four main themes related to job satisfaction were identified: "supportive working environment," "autonomy in practice," "professional training for competence enhancement," and "heavy workload and insufficient manpower." These themes highlighted the common aspects that contribute to job satisfaction among nurses according to the Herzberg's Two-Factor Theory. CONCLUSION: The findings of this study contribute to our understanding of the factors that influence job satisfaction among both novice and experienced nurses. While four themes highlighting common aspects of their needs have been identified, it is important to acknowledge that novice and experienced nurses may have their own unique perspectives within these aspects. According to Herzberg's Two-Factor Theory, job satisfaction factors can be complex and diverse. To enhance job satisfaction among nurses, hospital policymakers and senior management should be attentive to identify factors that have an impact on job satisfaction of nurses at different stages of their clinical experience. Developing a strategic plan to meet the needs of nurses based on their experience levels should take into consideration the disparities in work environment and responsibilities, ultimately job satisfaction can be improved, leading to better overall patient care.

Patient Safety Culture from a Nursing Perspective in a Chilean Hospital.

Patient safety culture is relevant both in the delivery of care and in the training of nursing staff, its purpose being to prevent and reduce risks associated with health care. This research aims to evaluate patient safety culture from the perspective of the nursing teams in a highly complex public hospital in the city of Valparaíso, Chile. A cross-sectional study with a quantitative approach applying descriptive, bivariate, and inferential statistical analysis was conducted on 259 nurses and nursing assistants from 13 adult medical-surgical units of the Carlos Van Buren hospital. The participants were obtained through a non-probabilistic convenience sample, answering the hospital survey on Patient Safety Culture version 2.0 (HSOPS 2.0), adapted to the Chilean population. The best-evaluated dimension was communication and receptivity; the worst was the support administrators provide for patient safety. This study identified the weaknesses and strengths of the hospital, the most worrying weakness being the shortage of human capital, material, and financial resources necessary to improve patient safety. This study was not registered.

Correlations between empathy fatigue, occupational identity, and sleep quality in nursing staff: a cross-sectional study.

Objective: To investigate the status quo of empathic fatigue, professional identity, and sleep quality of nursing staff in nursing institutions. To analyze the correlation between empathic fatigue, professional identity and sleep quality of nursing staff. Methods: This is a cross-sectional study. The method of convenient sampling was used to select 224 nursing workers from the older adult's institutions in the Panjin area as the investigation objects. The nurses' general data questionnaire, the Chinese version of the compassion fatigue short scale, the nurses' professional identity Scale, and the Pittsburgh Sleep Quality Index were used as evaluation tools. SPSS26.0 statistical software was used to sort out and analyze the data. Results: There was a positive correlation between empathic fatigue and sleep quality; there was a negative correlation between empathy fatigue and professional identity. Occupational identity and sleep quality were negatively correlated. Conclusion: There is a correlation between empathic fatigue, professional identity, and sleep quality of nursing workers. Empathy fatigue is positively correlated with sleep quality. Empathy fatigue was negatively correlated with professional identity. Occupational identity was negatively correlated with sleep quality. To provide a theoretical basis for the management of older adult's nursing staff and the formulation of corresponding management systems and policies, promote the mental health of older adult's nursing staff, improve sleep quality, and provide a theoretical basis and reference for future intervention research.

Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study.

BACKGROUND: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. OBJECTIVE: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. METHODS: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. RESULTS: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. CONCLUSIONS: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems.

Construction and application of procedural pathways combined with information management in nursing staff skills training system.

OBJECTIVE: To explore the application effect of procedural pathways combined with information management in the construction of nursing staff skills training system. METHODS: This was a quasi-experimental study with a control group and an experimental group. A total of 300 newly admitted nurses or nurses who required training within three years of admission were selected as the experimental group, and 267 nurses who were trained in the same hospital during the same period in 2020 were selected as the control group. The experimental group received skills training using a system that combines procedural pathways with information management, while the control group received traditional teaching mode. The outcome measures included theoretical score, operation score, nurse competency, patient satisfaction, and nursing-related adverse events. The data were analyzed using t-test, chi-square test, and rank-sum test. RESULTS: The experimental group had higher scores in theoretical assessment, skills assessment, nurse competency, and patient satisfaction, and lower incidence of nursing-related adverse events than the control group (P < 0.05). CONCLUSION: The strategy of procedural pathways combined with information management provides a new perspective and method for nursing operation skills training, effectively improves clinical nursing quality and ensures patient safety.

[Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design].

PURPOSE: This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload. METHODS: The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively. RESULTS: The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload. CONCLUSION: These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

Comparison of Knowledge, Attitude, and Practices of Nursing Staff Regarding Cervical Cancer Screening at Various Levels of Health Care Facilities in Western India.

Background: Cervical cancer is a public health problem, and nursing personnel are crucial for successful implementation of low-cost cervical cancer screening approaches in low-resource settings. The following study assessed and compared the knowledge, attitude, and practices regarding cervical cancer and its screening among female nursing staff at different levels of health care facilities in western Rajasthan, India. Methodology: An anonymous pre-validated, structured questionnaire was used as the study tool among 233 female nursing personnel of primary, secondary, and tertiary care health facilities. Multiple logistic regression was performed to determine the association between level of knowledge with level of health care and other demographic variables. Results: The nursing staff of the tertiary care health facility demonstrated significantly higher knowledge compared to those working at primary and secondary levels [adjusted odds ratio (95% confidence interval) 11.01 (3.80-32.40)]. At tertiary care, the practices of the nursing professionals were not found significantly associated with any socio-demographic variable including age, marital status, or level of health care facility. Conclusion: The overall knowledge of cervical cancer was poor, especially among staff nurses at primary and secondary levels of health care. In order to implement a successful population-based screening program in India, it is important to update the nursing curriculum and start in-service trainings at primary and secondary levels of health care facilities.

Reduced protein levels in latex gloves may play an alternative approach to lowering latex sensitization risks among health workers; a cross-sectional analytical study.

BACKGROUND: Latex gloves are essential for protecting healthcare workers from biological hazards but pose a risk of latex allergy, particularly due to powdered, protein, and allergen content. Recent advancements in latex glove manufacturing have led to reduced levels of extractable proteins, a known factor triggering allergenic reaction. This study aimed to compare latex sensitization between nursing staff using low-protein and high-protein latex gloves at a tertiary university hospital in Thailand. METHODS: A cross-sectional analytical study categorized participants into two groups based on glove exposure: the low extractable protein group (only exposed to non-powdered latex gloves with extractable protein levels below 50 µg/g) and the high extractable protein group (exposed to powdered latex gloves with levels above 50 µg/g). The sample size comprised 163 individuals in the low protein group and 318 in the high protein group (1:2). Latex allergy symptoms and sensitization were assessed using a self-administered questionnaire and latex-specific IgE measurement (ImmunoCAP), respectively. Data analysis involved descriptive and inferential statistics, including odds ratios and 95%CI. RESULTS: Demographic data was mostly similar in both exposure groups except for age. No significant differences in latex sensitization between the low and high protein groups were found via latex-specific IgE measurement (crude OR 1.90, 95%CI: 0.5, 7.18), potentially attributed to lower extractable protein levels in powdered latex gloves compared to previous studies. In contrast, the low protein group exhibited significantly fewer current latex allergy symptoms in both bivariate (crude OR 0.24, 95%CI: 0.06, 0.74) and multiple variable analysis (adjusted OR 0.18, 95%CI: 0.04, 0.86). Moreover, there was a significant reduction in latex allergy symptoms among the low protein group, decreasing from 9.8% who reported experiencing symptoms (when powdered latex gloves were used) to 1.2% who still reported current symptoms (OR 0.11, 95%CI: 0.02, 0.44). CONCLUSIONS: This study underscores the importance of using non-powdered and low-protein latex gloves to reduce latex allergy symptoms while emphasizing the need for further investigation into the relationship between extractable protein levels in addition to the attempt of the major allergen removal and latex sensitization amid evolving glove manufacturing practices.

Telenursing as a tool in emergencies and disasters: A systematic review.

Telenursing as a tool in emergencies and disasters: a systematic review. BACKGROUND: Telenursing is an innovative strategy that allows nurses to care for patients in various situations with the help of technology. The aim of this systematic review is to analyse the current situation of telenursing in emergencies and disasters by means of a systematic review of the scientific literature. METHODS: A systematic review of the scientific literature was carried out following the PRISMA methodology. A systematic search was conducted using the CINAHL, Pubmed and Cochrane Library databases. Study selection and risk of bias were performed independently by pair of authors. RESULTS: A total of 14 publications were selected. The results of the study focus on two main themes; on the one hand, the benefits offered by telenursing in the field of emergency and disaster situations and, on the other hand, the perspective of professionals who use it or who are likely to do so. CONCLUSIONS: Telenursing brings benefits to the emergency department, such as improved clinical outcomes, fewer unnecessary visits to the department, enhanced nursing autonomy and reduced healthcare costs. Nurses have a positive attitude towards the use of this technology; however, more training and equipment are required to increase its effectiveness.

Understanding organisational and nursing behaviour changes associated with a therapeutic engagement improvement tool in acute mental health inpatient settings: A qualitative analysis.

Background: Enhancing the quality of therapeutic engagement between nurse and service user is related to positive impact on care, safety, and recovery outcomes. Achieving improved therapeutic engagement remains challenging in the acute mental health inpatient setting, characterised by complex social processes and contextual features that constrain behaviour change. The Therapeutic Engagement Questionnaire is an evidence-based tool co-produced with service users and nurses to improve therapeutic engagement. Objectives: The objectives of this quality improvement project were to identify the organisational and nursing behaviour changes associated with the Therapeutic Engagement Questionnaire and to understand the active behaviour change ingredients of the improvement tool and how they exert their influence. Design: A qualitative multi-site case study design in which data were collected from study site field notes and document review. Setting: Four acute mental health inpatient case study sites in England. Methods: Data referencing Therapeutic Engagement Questionnaire-linked behaviour change in project meeting field notes and documents from each study site were analysed using an inductive and deductive approach with thematic analysis. The Capability Opportunity Motivation-Behaviour model was employed as a theoretical framework. Findings: The therapeutic engagement tool had the capacity to prompt behaviour change across all three components of the behaviour change model: Capability - through nurses sharing good therapeutic engagement practice and use of statements in the questionnaire to build nurses' knowledge and skills; Opportunity - through organisational barriers being addressed and ward-level practice and culture changes; Motivation - through nurses' awareness of their influence on service user recovery, nurses' alertness to their therapeutic work, and connections between the therapeutic engagement tool and nursing core values. However, the tool did not accord with the values of some nurses, reported to be unmotivated by the recognition it gave their profession for contribution to service user recovery. In sites evidencing more prominent behaviour change, senior leader and ward-level agents of change played a valuable facilitative role. Conclusion: The therapeutic engagement tool had the potential to prompt behaviour changes at organisation and ward level and to the ways individual nurses therapeutically engage with service users, helping strengthen therapeutic engagement practice. Leadership at senior organisational and ward level was important to address contextual barriers to change. The project resulted in a conceptual framework to explain and understand the behaviour change techniques and functions linked to the therapeutic engagement tool. Longevity of the behaviour changes and their impact on service user quality of care requires future evaluation. Tweetable abstract: A therapeutic engagement tool can prompt organisational and nursing behaviour change in acute mental health inpatient settings.