Speaking up for patient safety among health care professionals is important because it can contribute to the prevention of adverse patient events, such as medication errors, infections, wrong-site surgical procedures, and other sentinel events. This systematic review identified factors that facilitate or inhibit nurses’ willingness to speak up regarding patient safety in East Asian hospitals. Following the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases, including PubMed, CINAHL, PsycInfo, and Web of Science, were searched. Nine studies were analyzed in this review, including five qualitative and four quantitative studies published between 2014 and 2019. Quality of included studies were evaluated using the Mixed-Method Appraisal Tool. Data synthesis was based upon qualitative-led synthesis adopting two existing multilevel frameworks on safety voice and employee voice signals. Four studies were conducted in Japan, three in South Korea, one in Hong Kong, and one in Taiwan. We organized factors influencing East Asian nurses’ willingness to speak up regarding patient safety according to the following four contexts: individual (motivation toward patient safety, organizational commitment, perceived effectiveness and importance of speaking up, and assertive personality), team (positive relationship and team trust, team culture, and mentoring), organizational (hospital administrative support and organizational culture) and sociocultural (hierarchy and power differential and collectivistic culture). However, due to the limited number of studies conducted in East Asian hospitals, further studies with larger cohort samples of nurses in various East Asian countries should be conducted to deepen our understanding of nurses’ willingness to voice their concerns for patient safety.

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Aim To explore the motivation and lived experience of nurses responding to the COVID‐19 pandemic in South Korea. Background Identifying motivation, barriers and facilitators to nurses' willingness to work during a pandemic is necessary to prepare for future pandemic responses. Methods Ten individual interviews were conducted. Interviews were analysed and synthesized following Colaizzi's method. Results Six major themes identified: Decision to participate in the COVID‐19 response; Facing hardship; Distress due to the nature of COVID‐19; Overcoming hardship; Growing through the COVID‐19 response; and The need for reciprocity. Conclusion The increased demands for nursing care during the pandemic highlight the need for strong organisational support and effective workforce strategies. Our study results can inform the development of programmes and policies that are proactive, rather than reactive, to prepare for future pandemic situations. Implications for Nursing Management To recruit and manage nurses during a pandemic effectively, a safe work environment with proper resources should be established. Additionally, adequate education, training and compensation are needed.

This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.

Aims:To identify factors that motivate or inhibit nurses' speaking up for patient safety.Design: A descriptive qualitative study. Methods:We conducted semi-structured interviews with 15 nurses from four Korean hospitals between December 2020 and January 2021. Data were analysed using inductive content analysis. Results:We identified safety culture, supportive unit managers and role models, positive reactions from or familiarity with others, high-risk situations and personal characteristics and beliefs as motivators of nurses' speaking up. Hierarchies and power differentials, seniority and unit tenure, concerns about relationships, and heavy workloads inhibited nurses' speaking up. Conclusion:Individual, organizational and cultural characteristics influence nurses' decisions on whether or not to voice their concerns, suggestions or ideas. Certain characteristics of Korean culture, such as strong hierarchies and the valuing of good relationships, play an important role in nurses' speaking up behaviours. Our findings can be used to inform educational interventions and management expectations about interpersonal behaviours, especially in a culture where age-and seniority-based hierarchies and collectivism are prevalent.Impact: Nurses perceived speaking up as a challenging behaviour, and they sometimes withhold their voices even when speaking up is needed for patient safety. We found that individual, organizational, and contextual factors affect the speaking up behaviours of nurses. Nurse managers can create environments that are more supportive of nurses' speaking up behaviours by using inclusive leadership to create psychological safety, by inviting and showing appreciation for staff input, and by helping physicians and senior nurses understand the importance of all nurses' voices.No patient or public contribution: Patient or public contribution does not apply to this study as its purpose was to explore the speaking up experiences of nurses themselves.

This review examined relationships between nurse unit managers’ leadership and patient safety and quality of care outcomes in hospital settings. Employing four databases (CINAHL, Embase, PubMed, and Web of Science) and ancestry searches, we identified 14 English-language, peer-reviewed, primary studies that examined such relationships using quantitative analyses. The studies were published between 2012 and 2021, and most used a cross-sectional design. Each study’s quality was assessed using the Mixed-Method Appraisal Tool. In synthesizing results by categorizing outcomes, we found a positive trend in associations between effective nurse unit manager leadership and better outcomes, including fewer patient adverse events, increased nurse error reporting, and higher patient satisfaction and care quality. However, the heterogeneity of leadership measurement approaches and outcomes limited integration of study findings. Future researchers should clearly define study concepts to support interpretation of their findings and should use a suitable theoretical framework to help determine appropriate units of analysis.

Purpose: Pediatric cancer is a difficult experience for children and their families. It is thus necessary to promote family resilience for the effective treatment and quality of life improvement among children with cancer. The aim of this systematic review was to identify the components of a resilience-promoting program for children with cancer and their families and to synthesize the literature findings on the outcomes of the resilience-promoting program. Method: A systematic search of the literature was conducted using five databases (PubMed, CHIAHL, PsycINFO, Web of Science, and Research Information Sharing Service) up to July 22, 2020. The search was limited to studies published in English and Korean, and to grey literature published in Korea. Studies were critically appraised using the Mixed Methods Appraisal Tool and Cochrane Risk of Bias tool. Extracted data were summarized as tables. Results: Eight studies were selected. The main components of the resilience-promoting program were providing information (on strategies, medical and psychoeducation, and community resources) and emotional coping (expressing feeling, reappraising cognition about adversity, and stress management). The main outcomes of these programs were reinforced outcomes (resilience, benefit finding, coping, positive affect, problem-solving skills, family adaptation, and self-concept) and improved outcomes (in depression, posttraumatic stress, anxiety, impact of illness of the family, and mood). Conclusion: As the components and outcomes of family resilience-promoting programs vary, it is necessary to consistently use valid tools to effectively identify interventions. Additionally, various methodological studies are required to further analyze the effect of these programs.

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