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This study examines the parallel multiple mediators of quality of sleep and occupational burnout between perceived stress and depressive symptoms in psychiatric nurses. Nurses are more likely to experience depression, anxiety, decreased job satisfaction, and reduced organizational loyalty as a result of the stressful work environment and heavy workload. A total of 248 psychiatric ward (PW) nurses participated in this cross-sectional survey study. Structural equation modelling was used for data analysis. In the model of parallel multiple mediators for depressive symptoms, quality of sleep and occupational burnout played mediating roles, and these two mediators strengthened the effect of stress on depressive symptoms, with the final model showing a good fit. Stress, occupational burnout, and quality of sleep explained 46.0% of the variance in psychiatric nurses’ depressive symptoms. Stress had no significantly direct effect on psychiatric nurses’ depressive symptoms, but it had a completed mediation effect on their depressive symptoms through occupational burnout and quality of sleep. This study showed that reduction of occupational burnout and improvement of quality of sleep play important roles against depressive symptoms among PW nurses. Healthcare managers should provide PW nurses with a better environment for improving quality of sleep and reducing occupational burnout.

Dignity is a basic human right that is related to psychological distress factors in patients with cancer such as depression and demoralization. Hence, the dignity issue is of great importance to healthcare professionals. The present study aimed to advise healthcare professionals regarding the related distress factors of dignity in patients with cancer by investigating its relationship with patients’ demographics, disease characteristics, and psychological distress. This was a cross-sectional study design. A convenience sample of 267 patients with cancer from a medical center was recruited into this study. Each patient completed demographics and disease characteristics questionnaires, the Patient Dignity Inventory Mandarin Version, the Demoralization Scale Mandarin Version (DS-MV), and the Patient Health Questionnaire-9 (PHQ-9). Data were analyzed with SPSS 22.0 software. Dignity was significantly correlated with age, demoralization, and depression. Cancer patients aged 65 or above were more likely to have a lower sense of dignity. In the present study, the sensitivity and specificity of the Patient Dignity Inventory Mandarin Version for demoralization (DS-MV≥30) were 84.8% and 79.1% and for depression (PHQ-9≥10) were 73.8% and 70.9% in patients with cancer with an aggregate score of 35 or above. Dignity is significantly correlated with personal demographic characteristics and psychological distress in patients with cancer. The results provide reference data for healthcare professionals to understand and enable dignity in patients with cancer and aid in the development of methods that promote their dignity.

Background Nurses play an indispensable role in healthcare teams. The quality of nursing care reflects nurses’ ability to integrate care and their overall performance in patient care, making it a core objective of clinical nursing. The Chinese version of the Quality of Nursing Care (QNC) scale is a multidimensional assessment tool used for self-evaluation of nursing care quality and holds significant importance in clinical practice. This study aimed to assess the reliability and validity of the Chinese version of the QNC scale among nurses. Methods This was an observational, cross-sectional, methodological study conducted at three hospitals in southern Taiwan. The 25-item Chinese version of the QNC scale was employed in the study. Data were collected from 944 nurses (response rate: 65.42%) through an online survey conducted between July and August 2022. The factor structure of the QNC scale was evaluated using confirmatory factor analysis (unidimensional, independent cluster model, higher-order, and bifactor) and first-order, higher-order, and bifactor ESEM. Model comparisons were conducted to determine the best-fitting factor structure. Results The bifactor ESEM provided the best fit for the QNC scale, consisting of a general QNC factor and seven specific factors: patient satisfaction, health promotion, complication prevention, well-being and self-care, functional readaptation, nursing care organization, and responsibility and rigor. Some items exhibited significant cross-loadings, highlighting the model’s ability to capture the multidimensional nature of nursing care quality. Conclusions The bifactor ESEM model demonstrated the best model fit for the Chinese version of the QNC scale, offering a reliable and interpretable representation of the multidimensional nature of nursing care. The validated scale provides a valuable tool for assessing nursing care quality in clinical practice.

The aim of the study was to examine the relationship between workplace bullying, mental health and an intention to leave among nurses, and the mediating role of self-efficacy. This cross-sectional study was conducted among 385 nurses in Taiwan. Data were collected by means of self-report questionnaires, including the , the , the , and the . Descriptive statistics, Pearson's correlation and hierarchical regression analyses were used. Bullying was found to negatively correlate with self-efficacy and mental health, and positively with an intention to leave. Self-efficacy positively correlated with mental health, and negatively with an intention to leave. Hierarchical regression showed that bullying and self-efficacy were significant predictors of both mental health and an intention to leave. Self-efficacy partially mediated the relationship between bullying and mental health, as well as an intention to leave. Self-efficacy acted as a mediator of workplace bullying, mental health and an intention to leave among nurses. It could protect victims from the devastating effects of bullying behaviors. Int J Occup Med Environ Health. 2019;32(2):245-54.

Purpose This study investigated the relationship among personality traits, social network integration (SNI), and resilience in emergency department (ED) nurses who had suffered from physical or verbal violence by patients or their families. Design and Methods A cross‐sectional study with convenience sampling was conducted for exploring the related factors of resilience on abused nurses. A total of 187 participants met our inclusion criteria and completed all questionnaires. Findings Higher degrees of extraversion and peer support were associated with greater resilience among all abused nurses, whereas neuroticism was inversely associated with their resilience. Conclusions Among all forms of SNI, only peer support was shown to enhance an individual's resilience. In addition, personality traits were associated with resilience, and religions did not play an important role in enhancing resilience among our participants. Clinical Relevance Through a clearer understanding of the role of peer support in resilience among ED nurses, healthcare managers should provide and enhance their peer support to intensify their resilience for prevention of consequences of workplace violence.

Background Workplace bullying is a prevalent problem in today’s work places that has adverse effects on both bullying victims and organizations. To investigate the predictors of workplace bullying is an important task to prevent bullying victims of nurses in hospitals. Objective This study aims to explore the relationships among nurses’ attitudes, negative perceptions, and negative acts regarding workplace bullying under the framework of the theory of planned behavior (TPB). Methods A total of 811 nurses from three hospitals in Taiwan were surveyed. Nurses’ responses to the 201 items of 10 scales were calibrated using Rasch analysis and then subjected to path analysis with partial least-squares structural equation modeling (PLS-SEM). Results The instrumental attitude was significant predictors of nurses’ negative perceptions to be bullied in the workplace. Instead, the other TPB components of subjective norm and perceived behavioral control were not effective predictors of nurses’ negative acts regarding workplace bullying. Conclusions The findings provided hospital nurse management with important implications for prevention of bullying, particularly to them who are tasked with providing safer and more productive workplaces to hospital nurses. Awareness of workplace bullying was recommended to other kinds of workplaces for further studies in future.

The aim of the study was to determine the effectiveness of dignity therapy for end-of-life patients with cancer. This study used a quasi-experimental study design with a nonrandomized controlled trial. Dignity therapy was used as an intervention in the experimental group, and general visit was used in the control group. Thirty end-of-life patients with cancer were recruited, with 16 in the experimental group and 14 in the control group. Outcome variables were the participants' dignity, demoralization, and depression. Measurements were taken at the following time points: pre-test (before intervention), post-test 1 (the 7th day), and post-test 2 (the 14th day). The effectiveness of the intervention in the two groups was analyzed using the generalized estimating equation, with the p value set to be less than .05. After dignity therapy, the end-of-life patients with cancer reflected increased dignity significantly [β = −37.08, standard error (SE) = 7.43, Wald χ2 = 24.94, p < .001], whereas demoralization (β = −39.55, SE = 6.42, Wald χ2 = 37.95, p < .001) and depression (β = −12.01, SE = 2.17, Wald χ2 = 30.71, p < .001) were both reduced significantly. Clinical nurses could be adopting dignity therapy to relieve psychological distress and improve spiritual need in end-of-life patients with cancer. Future studies might be expanded to looking at patients vis-à-vis end-of-life patients without cancer to improve their psychological distress. These results provide reference data for the care of end-of-life patients with cancer for nursing professionals.

Background Workplace bullying has been measured in many studies to investigate mental health issues. None uses online computerized adaptive testing (CAT) with cutting points to report bully prevalence at workplace. Objective To develop an online CAT to examine person being bullied and verify whether item response theory-based CAT can be applied online for nurses to measure exposure to workplace bullying. Methods A total of 963 nurses were recruited and responded to the 22-item Negative Acts Questionnaire-Revised (NAQ-R). All non-adaptive testing (NAT) items were calibrated with the Rasch rating scale model. Three scenarios (i.e., NAT, CAT, and the randomly selected method to NAT) were manipulated to compare their response efficiency and precision by comparing (i) item length for answering questions, person measure, (ii) correlation coefficients, (iii) paired t tests, and (iv) estimated standard errors (SE) between CAT and the random to its counterpart of NAT. Results The NAQ-R is a unidimensional construct that can be applied for nurses to measure exposure to workplace bullying on CAT. CAT required fewer items (=8.9) than NAT (=22, an efficient gain of 60% =1–8.9/22). Nursing measures derived from both tests (CAT and the random to NAT) were highly correlated ( r  = 0.93 and 0.96) and their measurement precisions were not statistically different (the percentage of significant count number less than 5%) as expected, but CAT earns smaller person measure SE than the random scenario. The prevalence rate for nurses was 1.5% (=15/963) when cutting points set at −0.7 and 0.7 logits. Conclusion The CAT-based NAQ-R reduces respondents’ burden without compromising measurement precision and increases endorsement efficiency. The online CAT is recommended for assessing nurses using the criteria at −0.7 and 0.7 (or <30 and <60 in summed score) to identify bully grade as one of the three levels (high, moderate, and low). The bullied nurse can get help from a psychiatrist or a mental health expert at an earlier stage.

Background: Emotional distress has long been a central concern for clinical health care professionals when caring for patients with cancer. Emotional distress evaluation is one of the accreditation criteria for cancer centers. The ability to quickly and effectively assess, identify, and treat emotional distress in patients with cancer has become an essential skill for health care professionals. Purpose: The purposes of this study were to explore the related factors of emotional distress and propose emotional distress score cutoff points to identify the presence of psychological problems or psychiatric disorders in patients with cancer. Methods: This cross-sectional study was conducted between August 2021 and April 2022 on 400 patients with cancer. The 5- item Brief Symptom Rating Scale (BSRS-5) was used to measure emotional distress in patients with cancer. Data collection employed a structured questionnaire including demographics, BSRS- 5, Patient Dignity Inventory-Mandarin version (PDI-MV), Demoralization Scale-Mandarin version (DS-MV), and Patient Health Questionnaire-9 (PHQ-9). Data analysis was performed using SPSS software version 26.0. Data were analyzed using an independent t test, one-way analysis of variance, Pearson's correlation, and receiver operating characteristic curve. Results: Emotional distress was found to be significantly related to cancer stage (F=3.37, p=.019), disease characteristics (t=2.29, p=.023), and treatment phase (F=3.12, p=.015), with being in stage IV, receiving a recurrence diagnosis, and receiving chemotherapy associated with a higher likelihood of emotional distress. Sensitivity and specificity of the BSRS-5 with an aggregate score of 3.5 or above were, respectively, 74.0% and 84.8% for low dignity (PDI-MV ≥35), 79.1% and 69.6% for demoralization (DS-MV ≥30), 76.7% and 83.8% for depression (PHQ-9 ≥ 10), and 92.0% and 84.0% for suicidal ideation. The BSRS-5 exhibits excellent discrimination for both psychological problems and psychiatric disorders, for example, low dignity, demoralization, depression, and suicidal ideation, in patients with cancer. Conclusions/Implications for Practice: In this study, emotional distress was shown to be significantly related to demographic factors, including cancer stage, disease characteristics, and treatment phase. Thus, health care professionals should be particularly concerned when patients with cancer are in stage IV, diagnosed with recurrence, or undergoing chemotherapy. Health care professionals should regularly employ brief and highly reliable questionnaires to help evaluate the emotional distress of patients with cancer. Regular evaluation can facilitate the early detection of emotional distress, psychological problems, and psychiatric disorders such as low dignity, demoralization, depression, and suicidal ideation in these patients.

To explore burden and its related factors among primary caregivers of patients with cancer. This study was conducted in an oncology ward at a medical center in southern Taiwan. A total of 137 dyads of patients with cancer and their primary caregivers were recruited. This cross-sectional correlational study used a structured questionnaire to assess the burden of primary caregivers. Data on patients' basic characteristics and disease profiles were extracted from medical records from January to June 2019. Linear regression analysis was used to identify factors associated with the burden of primary caregivers. The majority of primary caregivers were female (70%) and aged younger than 65 years (85%). Overall, the mean primary caregiver burden score was 38.83 (SD = 12.86), with spiritual burden ranking highest among the four domains assessed. Factors related to overall primary caregiver burden included psychiatric symptoms, daily care hours, patient age, and the lack of rotational support. Hospice and oncology nurses can actively identify psychiatric symptoms in primary caregivers, targeting high-risk groups to provide timely resources or psychiatric referrals, aiming to alleviate future caregiver burden.