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Anteayer Journal of Advanced Nursing

Workplace Incivility and Nurses' Job Satisfaction and Leaving Intentions in Taiwan: A Cross‐Sectional Study

ABSTRACT

Background

Workplace incivility is a pervasive challenge in healthcare. Few studies drew on theoretical concepts to simultaneously examine organisational correlates of incivility and its associations with nurses' work outcomes.

Aim

This study examined workplace incivility among nurses, focusing on job control, psychological job demands and workplace justice as workplace characteristics, and assessing its association with job satisfaction and intentions to leave.

Methods

A cross-sectional survey was conducted among 528 full-time nurses at a medical centre in Taiwan. Validated questionnaires assessed workplace incivility (the Workplace Incivility Scale), workplace characteristics, job satisfaction and intentions to leave. Multivariable linear regression examined associations of workplace characteristics with incivility, and associations of incivility with job satisfaction and intentions to leave, adjusting for demographic and workplace factors.

Results

High workplace incivility was reported by 41.1% of nurses. In adjusted analyses, lower job control and lower workplace justice were associated with higher incivility scores. After adjustment for demographic and workplace factors, workplace incivility was negatively associated with job satisfaction and positively associated with leaving intentions. Among workplace characteristics, psychological job demands showed strong associations with both job satisfaction and leaving intentions.

Conclusions

Workplace incivility reflects underlying organisational conditions and is associated with lower job satisfaction and greater leaving intentions. Addressing job demands, autonomy and fairness may reduce incivility and sustain the nursing workforce.

Implications for the Profession and/or Patient Care

Workplace incivility is associated with lower job satisfaction and greater leaving intentions, and may co-occur with lower job control and perceived organisational justice, highlighting the need for organisational strategies that foster fairness and supportive work environments to enhance nurse retention.

Reporting Method

The authors adhered to the STROBE guidelines.

Patient or Public Contribution

No patient or public involvement.

Health‐Promoting Lifestyle and Associated Factors Among Head and Neck Cancer Patients in Northeast China: A Cross‐Sectional Study

ABSTRACT

Objectives

Health-promoting lifestyle (HPL) is strongly associated with health outcomes. In clinical practice, health-promotion behaviours in patients with head and neck cancer (HNC) are not good, which seriously affects patients' prognosis. This study aims to investigate the current status and influencing factors of HPL in HNC patients.

Design

A cross-sectional study.

Methods

This study used a convenience sampling method to select 264 consecutive HNC patients who attended a tertiary hospital in northeast China from November 2023 to May 2024 for the survey. Data were collected using the Questionnaire for General Information, the Health-Promoting Lifestyle Profile Revised-II (HPLP-II R), the Health Literacy Management Scale (He LMS) and the Acceptance of Illness Scale (AIS).

Results

The HPLP-II R scores of HNC patients were generally average (93.10 ± 15.60), with the highest scores on the nutrition dimension and the lowest scores on the exercise dimension. HPL was significantly and positively correlated with health literacy and disease acceptance. Multiple linear regression analysis showed that educational level, cancer recurrence, health literacy and disease acceptance were the influencing factors of HPL among patients with HNC, which altogether explained 25.9% of the total variance.

Conclusion

The HPL of HNC patients is at an average level and still has much room for improvement. Patients with high literacy levels, cancer recurrence, high health literacy and disease acceptance levels had relatively high levels of HPL.

Implications for the Profession

HPL can enhance patients' internal motivation, enhance their self-management ability and improve their daily functional performance while reducing complications and improving their quality of life. This suggests that medical staff should give personalised health guidance according to patients' different health literacy in clinical work, improve patients' disease acceptance and pay attention to the development of HPL.

Reporting Method

STORBE guidelines.

Patient or Public Contribution

No patient or public contribution.

Perceptions of Ontological Coaching Among Nurses (OCN): A Descriptive Qualitative Study

ABSTRACT

Aim

To examine the perceptions of nurses receiving the Ontological Coaching among Nurses (OCN) intervention in Singapore.

Design

Descriptive qualitative.

Methods

Convenience sampling was used to recruit 34 nurses who received OCN intervention and three coaches who provided the intervention. Written informed consent was obtained, and semi-structured, one-on-one interviews were used to collect data, which were then transcribed verbatim. Thematic analysis was used to analyse the data.

Results

Three themes with nine sub-themes were identified. The main themes were: (1) From ‘Outlet to Confide’: Ontological Coaching as an Enhanced Sense of Fulfilment; (2) Mindset Readiness and Openness for Successful Coaching; and (3) Future Endeavours for Sustainable Coaching Practices.

Conclusion

The findings show that nurses benefitted on personal and professional fronts from receiving coaching. Further evaluations are required to see the potential of using coaching intervention for novice nurses.

Implications and Impact

As frontline key players in our healthcare system, nurses face a unique set of challenges that impact their psychological well-being. The impact is even more significant for early-to mid-career nurses, leading to poorer quality of life and high turnover rates. This paper highlighted the importance of resources made available to novice and mid-career nurses through coaching. The perceptions of nurses who received coaching intervention serve as a foundation for future studies examining the relevance of ontological coaching in the nursing profession. The nurses' recommendations reported in this paper include building awareness of coaching and incorporating flexibility into coaching programmes to help enhance their readiness to receive and engage with coaching for a more fulfilling coaching experience. Incorporating these recommendations can help inform future coaching-related interventional studies.

Reporting Method

This study adhered to COREQ guidelines.

Patient and Public Contribution

None.

Nursing Students' Perceptions and Attitudes on the Application of Artificial Intelligence in Nursing Education: A Mixed‐Methods Systematic Review

ABSTRACT

Background

The utilisation of artificial intelligence in the context of nursing education has become increasingly extensive. However, various studies show differing perspectives and attitudes among nursing students, and the findings have not been systematically synthesised.

Aim

To systematically review the perceptions and attitudes of nursing students on the application of artificial intelligence in nursing education.

Design

Mixed-methods systematic review.

Method

A comprehensive literature search was conducted across 10 databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, Scopus, China Science and Technology Journal Database, SinoMed, China National Knowledge Internet, and WanFang database, the inclusive years of articles searched were from 1969 to 2025. Two researchers independently screened the literature and extracted the data. The mixed methods assessment tool was used to evaluate the risk of bias in the included literature. The relevant data were extracted and synthesised according to the Joanna Briggs Institute's convergence synthesis method, ensuring the comprehensive integration of qualitative and quantitative results. These results were then integrated into the Technology Acceptance Model.

Results

A total of 28 articles were included, including 13 qualitative studies, 13 quantitative studies, and 2 mixed-method studies. According to the Technology Acceptance Model, the perceptions and attitudes of nursing students on the nursing education's adoption of artificial intelligence were integrated into 10 categories of three comprehensive themes: (i) Nursing students' perceptions and attitudes of the ease of use of artificial intelligence in nursing education, including 3 categories; (ii) nursing students' perceptions and attitudes on the usefulness of artificial intelligence in nursing education, including 4 categories; (iii) nursing students' behavioural intention, including 3 categories.

Conclusions

Overall, our study demonstrated that nursing students had an active willingness to utilise artificial intelligence. However, they acknowledged that certain issues persist regarding the ease and practicality of artificial intelligence in nursing education.

Patient or Public Contribution

No patients or members of the public were directly involved in this systematic review, as the study synthesised existing literature.

Challenges and Support Strategies for Intensive Care Unit Nurses in the Organ Donation Process: A Scoping Review

ABSTRACT

Aims

To provide an overview of the challenges that Intensive Care Unit nurses experience during the organ donation process and identify recommended support models or strategies that may assist them when caring for potential organ donors and their families during the organ donation process.

Design

A scoping review was conducted in accordance with JBI methods.

Data Sources

Cochrane Library, MEDLINE (via Ovid), Embase (via OVID), APA PsycINFO (via OVID), Scopus, OVID Emcare, Web of Science and CINAHL (via EBSCO) were searched from the first available start date of the individual database to December 2023.

Review Methods

Eligible studies included peer-reviewed empirical quantitative, qualitative and mixed method studies exploring the challenges experienced by Intensive Care Unit nurses during the organ donation process in adult intensive or critical care settings. Reviewers used Rayyan systematic review software to screen titles, abstracts and full-text articles. Data were gathered using an adapted JBI data extraction tool for scoping reviews.

Results

Twenty-eight papers were included that were published between 1983 and 2023. Most studies (71.4%) used a qualitative approach. Seven key challenges were identified: direct patient care, care for the next of kin, concept of brainstem death, ethical challenges, emotional challenges, challenges around communication and organisational challenges. Several support models were identified including debriefing, training and education, and availability of local or national protocols and guidelines for organ donation.

Conclusion

This scoping review provides an increased understanding of the challenges that Intensive Care Unit nurses experience during the organ donation process. Appropriate support models or strategies may potentially improve nurses' care experience during the organ donation process.

Impact

Improved understanding of the nature of challenges during the organ donation process can facilitate the implementation of supportive strategies that may ultimately improve quality of care, consent rates and nurses' and donors' family experiences.

Patient or Public Contribution

A public representative with family experience of organ donation was involved in developing the protocol and search strategy.

Barriers and Facilitators for Nurses to Manage Medication of Cancer Pain: A Qualitative Systematic Review of Healthcare Professionals’ Perspectives

ABSTRACT

Background

Improving global access to pain management medications for cancer patients remains a critical priority. Nurses are now understood to play an essential role in cancer pain medication management, yet the barriers and facilitators they encounter require urgent identification.

Objective

This systematic review aimed to identify the barriers and facilitators for nurses in managing cancer pain medication.

Design

This systematic review followed the Joanna Briggs Institute (JBI)'s guidelines for qualitative systematic reviews.

Methods

Eleven databases (PubMed, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, OPENGREY.EU, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP) and SinoMed) were searched from their inception to 9th July 2025. Articles were evaluated for quality using JBI critical appraisal tools. Data extraction was performed according to JBI standardised protocols, and evidence synthesis was conducted using JBI meta-aggregation, which involved extracting findings, categorising them into thematic groups and synthesising them into comprehensive statements.

Results

Twenty-four qualitative studies were reviewed in the present study. Two synthesised findings regarding the barriers and facilitators for nurses in managing cancer pain medication were integrated: (1) Barriers for nurses to manage cancer pain medication were summarised into five categories: systemic barriers, resource barriers, knowledge and skills barriers, financial and cultural barriers and communication and psychological barriers; (2) Facilitators for nurses to manage cancer pain medication were summarised into three categories: nursing capacity building, supportive care environments and collaborative support systems.

Conclusions

Multilevel barriers impede nurse-led cancer pain management, necessitating policy reforms (e.g., tiered prescribing), investments in telehealth/training and culturally responsive interprofessional collaboration. Prioritising facilitators, capacity building, supportive environments and collaboration is vital to empower nurses in delivering equitable, evidence-based pain relief.

Impact

This review equips clinical managers and policymakers with evidence to implement policy and practice reforms, such as tiered prescribing and interprofessional collaboration, which are critical to empower nurses in delivering effective cancer pain management.

Registration

This systematic review was prospectively registered in PROSPERO prior to the initiation of the search (Registration ID: CRD42024570807).

Patient or Public Contribution

There was no patient or public contribution.

Prevention and Early Delirium Identification Carer Toolkit (PREDICT): A Study Protocol for a Stepped‐Wedge, Cluster Randomised Controlled Trial

ABSTRACT

Background

Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.

Aims

To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.

Method

A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.

Discussion

PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.

Public and Patient Involvement

This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.

Trial Registration

Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025

Using FRAME Documentation to Achieve RE‐AIM Goals During Iterative, Stakeholder‐Engaged Refinement of a Family Management Intervention for Parents of Preterm Infants

ABSTRACT

Aims

To co-identify adaptations with key stakeholders needed to optimise elements of a video-based intervention (i.e., PREEMIE PROGRESS [PP]), which trains parents in evidence-based family management skills to care for their very preterm infant in the neonatal intensive care unit (NICU).

Design

Descriptive qualitative study oriented with a pragmatic philosophy, informed by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and the framework for reporting adaptations and modifications-expanded (FRAME).

Methods

Semistructured interviews to identify potential adaptations with key stakeholders: family management researchers (n = 5), clinicians (n = 9), technology experts (n = 5) and parents of preterm infants (n = 17). Weekly design team meetings to select and implement high-priority adaptations necessary for the next research phase. Monthly NICU parent partnership meetings to review adaptations and make recommendations for potential adaptations with conflicting data.

Results

Stakeholders (N = 36) suggested 98 potential adaptations: 32 (33.0%) were completed, 8 (8.2%) were abandoned, 5 (5.2%) have work that is ongoing and 52 (53.6%) were tabled for future research phases. Content adaptations (70, 71.4%) were the most frequently suggested adaptation type. Potential adaptations mostly addressed RE-AIM dimensions of effectiveness (43, 43.9%), and implementation (46, 46.9%) and were directed at the parent (i.e., intervention recipient) level (79, 81.4%).

Conclusion

Use of the RE-AIM framework ensured we systematically identified needed adaptations with key stakeholders across a range of dimensions that would improve PP for parents now and in future phases of this research.

Implications for the Profession

Co-identifying potential adaptations with key stakeholders, paired with FRAME documentation, can help nurses prioritise adaptations most appropriate for each phase of implementation.

Impact

Our paper highlights for nurse clinicians and researchers how FRAME documentation of potential adaptations can support stakeholder engagement and a systematic approach to incorporating adaptations throughout all phases of the research process, thereby shortening the evidence to practice gap.

Reporting Method

COREQ guidelines for qualitative reporting.

Patient/Public Contribution

The research team was supported by members of the NICU's Parent Partnership Council (PPC), whose mission is to promote family-centred care improvement projects and research within the NICU. This committee is comprised of nursing, physician, allied health leadership and parents of infants previously hospitalised in the NICU. The NICU PPC met monthly to review conflicting data on potential adaptations and provide recommendations on adaptation decisions.

Barriers and facilitators of implementing the practice programme for upright positions in the second stage of labour: A mixed‐method study

Abstract

Objective

To explore the possible barriers and facilitators to implementing the Upright Positions in the Second Stage of Labour (UPSSL) programme in Chinese healthcare settings.

Design

A mixed-method convergent design with the guidance of Consolidated Framework for Implementation Research (CFIR).

Methods

An online survey study and semi-structured interviews were conducted between March and May 2023. Healthcare professionals were recruited from four hospitals in Shijiazhuang, China. One hundred and thirty-one participants completed the survey study, and 23 of them were interviewed individually. Descriptive statistics evaluated the possible barriers and facilitators of implementing the UPSSL programme within the CFIR framework quantitatively. Guided by the CFIR framework, qualitative data were analysed using directed content analysis to summarize healthcare professionals' perspectives on barriers and facilitators of the UPSSL programme.

Results

Multiple intersectional barriers and facilitators were identified from the survey and semi-interviews. Healthcare professionals believed that the UPSSL programme has a scientific evidence base, systematic contents, and possible benefits for women. However, various barriers existed at individual, system, and organizational levels. Major barriers included healthcare professionals and women's safety concerns towards the use of upright positions during childbirth, the healthcare professionals' unfamiliarity with assisting an upright position birth, poor adaptability of the programme protocol, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting.

Conclusions

To facilitate the implementation of the UPSSL programme in China, tailored antenatal education on upright positions, especially addressing safety-related issues, should be provided to pregnant women, their families, or peers to enhance their understanding of and familiarity with such positions. Healthcare professionals should also be offered adequate training opportunities and necessary facilities. Furthermore, national-level policy changes might be required to address midwifery workforce shortages. Additionally, further research is warranted to select, adapt, and test effective implementation strategies for programme adoption.

Implications for the Profession and/or Patient Care

What problem did the study address? The adoption of upright positions during the second stage of labour could promote better maternal and neonatal outcomes and a positive childbirth experience. However, the adoption of upright positions during the second stage of labour is suboptimal in healthcare settings in China. Barriers and facilitators of implementing upright positions during childbirth are unclear. What were the main findings? A range of barriers and facilitators within the CFIR framework to promote upright positions during childbirth from healthcare professionals' perspectives were identified, and the major barriers included safety concerns towards and unfamiliarity with an upright position birth, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting. Where and on whom will the research have an impact? This study will enable a better understanding of the barriers and facilitators to promoting upright positions in the second stage of labour in China. The smooth and effective implementation of the UPSSL programme could help to promote better maternal and neonatal outcomes and improve women's childbirth experiences.

Reporting Method

The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) and Good Reporting of A Mixed Methods Study (GRAMMS) guidelines.

Patient or Public Contribution

In this study, healthcare professionals were involved in refining the topic guides and survey questions. Additionally, findings from the interviews were returned to them for comments and corrections.

Women's Experiences of Care and Support Following Postpartum Psychosis: A Meta‐Ethnography

ABSTRACT

Background

Postpartum psychosis is a psychiatric emergency that occurs following childbirth. Women are often cared for in general psychiatric units or in psychiatric Mother and Baby units. Postpartum psychosis is associated with a significant risk of relapse. There is a need to explore how women perceive care to understand what works well or needs further improvement.

Aims

This review aimed to explore women's experiences of care and support for postpartum psychosis.

Design

A systematic review using meta-ethnographic methods was conducted.

Data Sources

Comprehensive searches were conducted between 4 March 2024 and 4 March 2025 on five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science). Backward and forward chain searching was also undertaken.

Review Methods

Critical appraisal was conducted following screening. Reciprocal and refutational translation were used to form the synthesis, and a line of argument was developed. The eMERGe reporting guidelines were used.

Results

Fifteen studies were included within this synthesis. All the studies were conducted in high income countries and included 235 women. Three main themes were developed. ‘Navigating the unknown’ explored women's perceptions of postpartum psychosis as a less well-known condition, and their informational needs. ‘The double-edged sword of care’ found that there were helpful elements of formal mental health care, but that accessing care was sometimes traumatic, stigmatising and conflicting to women's identities. ‘Seeking consolation and recovery’ explored women's need for psychological support and experiences of peer support.

Conclusion

The findings of this review highlighted women's needs in respect to informational support, medication support, psychological support and in-patient care settings. Mother and baby units were strongly preferred by women.

Impact

The findings highlighted a need for specialised care for postpartum psychosis.

Patient or Public Contribution

There were no patient or public contributions.

Trial Registration

Prospero (CRD42024515712)

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