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This study aims to synthesize the factors associated with nurse emigration from lower and middle-income countries. Integrative review. An in-depth search of registries and five databases yielded 9466 records. Using the PRISMA guidelines, 11 were chosen after screening by two authors independently. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias. The destination countries were Europe and North America, with an inclination for nurse migration of 14.3%-85%. Emigration factors were poor salary, working conditions, poor quality  healthcare infrastructure; outdated healthcare technologies, lack of employment opportunities, younger age, relationship status (single), living environment, social pressure, urban residence, work experience, insecurity, high crime rates, political corruption and foreign language skills. Healthcare authorities and nursing leaders must implement practical measures to minimize nurse emigration.

Background Due to the rapid growth of the older adult population, multimorbidity has become a global concern for an aging society. Multimorbidity has been associated with poor health outcomes, including low quality of life and a high risk of mortality, resulting in an overload of healthcare systems. However, multimorbidity incidence and its related factors are poorly understood among older adults. This study aimed to determine whether sociodemographic characteristics, lifestyle, and psychosocial factors predict multimorbidity incidence among older adults in Korea. Methods This longitudinal study used the Korean Longitudinal Study of Aging (KLoSA) dataset from 2008 to 2018. The KLoSA is a panel survey of nationally representative samples aimed at providing data for developing socioeconomic policies for the increasing aging population in Korea. The study sample included 1967 older adults aged 65 years and over who had none or one of the chronic diseases at the baseline in 2008. Multimorbidity incidence was defined as the co-existence of two or more chronic diseases among 12 doctor-diagnosed diseases based on self-reports. Cox’s proportional hazards models were used to identify significant predictors of multimorbidity incidence over a 10-year follow-up period. Results Among 1967 respondents (female 54.5%, mean age 72.94), 625 (31.8%) incidents of multimorbidity were reported, contributing to 47.5 incidents per 1000 people after 10 years of follow-up. Low levels of social interaction, obesity, past smoking habits, and current or past drinking habits were identified as significant predictors of multimorbidity incidence among older adults in Korea. Conclusions This study identified older adults at high risk for multimorbidity incidence. These groups require more attention from health care providers in the course of chronic disease monitoring and management. Specific interventions and health policies to promote social interaction and a healthy lifestyle are essential to delay multimorbidity incidence. This longitudinal approach will contribute to developing preventive strategies to reduce the incidence of multimorbidity among older adults.

Background The Western Pacific region constitutes one-quarter of the world’s population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses’ professional development within the Western Pacific region. Methods This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 – December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. Results Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. Conclusions Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Background There is growing recognition of the importance of educating health professional students to enhance their competence in collaborating with individuals from other health professions in the area of global health. This study aimed to identify the performance levels in interprofessional global health competencies (IGHC) of health professional students, their educational needs, and the strategies for successfully developing IGHC. Methods This study used a mixed methods design involving an online survey followed by focus group interviews. A sample of 325 fourth-year undergraduate students from 14 health-related majors completed a self-report online survey (38.8% response rate). The performance of IGHC was measured on a five-point Likert scale using the IGHC items developed by the Consortium of Universities for Global Health. Additionally, 12 senior students and five professors in global health-related majors participated in focus group interviews. The students’ educational needs and priorities were analysed using the Borich needs assessment and the Locus for Focus model. Results The participants’ IGHC mean score was 3.11 (SD = 0.55) and differed by previous global health activity experiences (t = − 2.10, p  = .037). Nine competencies in six domains using the Locus for Focus model were identified as a priority for global health education. Suggested strategies to enhance IGHC included establishing IGHC education in formal curricula, developing value-based content and outcomes, and engaging students in learning activities. Conclusions It is necessary to design an interprofessional pre-departure course to achieve the priority IGHC and to organise learning activities where there is cooperation in problem solving while applying the expertise of each major within resource-limited settings. This study supports future health professional education that should foster enhanced roles and scopes of practice as changing agents to assure the achievement of sustainable development goals.

Purpose Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills. Methods This study employs the following criteria recommended byKhan Kunz, Keijnen, and Antes (2003)for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies. Results Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes. Conclusion With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes.

Introduction: The concept of clinical readiness for practice among nursing students is yet to be analyzed, and there is a lack of empirical evidence on its usage among academics and clinicians. Methods: This concept analysis is anchored on a systematic literature review that adhered to the PRISMA guidelines and incorporated the eight iterative steps of Walker and Avant’s concept analysis method. This concept analysis method involved: (1) choosing a concept; (2) determining the objectives of the analysis; (3) identifying usages of the concept; (4) determining the defining attributes; (5) identifying a model case; (6) identifying other cases, including borderline, contrary, and related cases; (7) identifying antecedents and consequences; and (8) defining empirical references. The integrative thematic data synthesis method was adopted. Results: The concept of nursing students’ clinical readiness for practice is said to have four interrelated attributes. These attributes included (1) professional skills, (2) communication skills, (3) self-management skills, and (4) self-confidence. The two antecedents for nursing students’ clinical readiness to practice are (1) personal factors, including demographic characteristics, prior healthcare experience, income, and emotional intelligence; and (2) educational factors, including the clinical learning environment, clinical internship program, learning resource, and learning strategy. The consequence of clinical readiness for the practice of nursing students includes obtaining practice skills that can lead to more personal and job-related satisfactory outcomes. Conclusions: clinical readiness for practice in nursing encompasses the acquisition and integration of professional knowledge, skills, effective communication abilities, and self-management capabilities and the application of these competencies with confidence toward the provision of high-quality care to patients. Clinical Relevance: Understanding the components of clinical readiness is crucial for nursing educators, preceptors, and healthcare institutions to ensure that nursing students are adequately prepared for the challenges they will face in clinical practice. By recognizing the importance of professional knowledge, skills, communication, and self-management in clinical readiness, educators and training institutions can tailor their curricula, programs, and support systems to better prepare nursing students for the demands of real-world healthcare settings. This focus on clinical readiness ultimately delivers safe, effective, and compassionate patient care.

Background: Few tools are available to measure nurses’ political competence, and the existing ones have limitations in reflecting the multidimensional factors of competence. This study developed a multidimensional political competence measurement tool—the Political Competence Scale for Nurses (PCS‐N)—and assessed its validity and reliability in measuring nurses’ political competence levels. Methods: This methodological study was based on the tool development and tool‐test stages suggested by DeVellis. Results: The validity and reliability of the PCS‐N were established. The PCS‐N was tested for construct validity through content validity, item‐total correlations of preliminary items, and exploratory factor analysis. The PCS‐N comprises 35 items across four factors: political knowledge, political efficacy, political interaction, and political activity. The suitability of this measurement tool was established through construct validity and confirmatory factor analysis. Concurrent validity was verified and was significantly correlated with existing political science measurement tools, political efficacy, and political interest ( r = 0.511, p < 0.001). Internal consistency reliability (Cronbach’s α = 0.951) and test–retest reliability were also established, confirming the stability of the PCS‐N. Conclusions: The PCS‐N can be used to evaluate nurses’ political competence and provide a basis for constructing education and training programs to strengthen political competence and evaluate their effectiveness.

Aim Migrant workers experience physical, mental, and social stress. Physical leisure activities are important for decreasing such stress and increasing quality of life. This study aimed to investigate the factors influencing migrant workers’ motivation to participate in physical leisure activities in Korea based on the Gelberg-Andersen behavioral model. Subjects and methods This is a descriptive correlational study, in which a structured self-report questionnaire was distributed to 124 migrant workers. Data were analyzed using a one-way ANOVA, Pearson’s correlation coefficient, and multiple linear regression analysis. Results In this study, the average age of the participants was 35.39 ± 9.37 years. Most were separated from their families. Religious discrimination and the level of anxiety influenced motivation to participate in physical leisure activities. Furthermore, the explanatory power of the regression model was 17.5%. Conclusion It is necessary to develop health-promoting, physical-leisure-based programs to increase migrant workers’ quality of life.

Background:This is a methodological study that aims to develop performance indicators based on a balanced scorecard for the clinical research coordinator (CRC) position.Methods:The CRC performance indicators were developed through a literature review, a data review, expert consultations, focus group interviews, and content validity verification. We also used these data to confirm whether the performance indicators were appropriately indexed.Results:We developed 10 strategies and 31 performance management indicators based on the 4 perspectives of the balanced scorecard (financial, customer, internal business process, and learning and growth).Conclusions:This research developed CRC performance indicators using a balanced scorecard in order to improve the quality of CRC work performance. These indicators establish the direction that tasks should take; they motivate CRCs by being associated with the compensation system, competence development programs, and a balanced performance evaluation system.