Background: Nurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. Objectives:To examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Methods:Using two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes.Results: Three statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. Conclusion:Patients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand.

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This article examined the critical elements that have been identified in the development of advanced practice roles of nurses in four countries: Brazil, Thailand, the United Kingdom and the United States of America. Several sociopolitical and professional forces were examined for possible insights and ways in which they may have shaped the development and evolution of the roles of advanced practice nurses (APNs). These forces were: the socio-political environment; the health needs of society; the health workforce supply and demand; governmental policy and support; intra- and interprofessional collaboration; the development of nursing education; and documentation of effectiveness of the advanced role. The development of APN roles in the four social systems was reviewed to illustrate how socio-political and professional forces may have shaped nursing roles in each health care delivery system. Commonalities and distinguishing features across the four health and social systems were analysed to assess the predictive forces that may be identified as advanced roles in nursing have evolved in the global community.

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Education is a driving force in improving the health and welfare of communities globally. Doctoral education of nurses has been identified as a critical factor for provision of leadership in practice, scholarship, research, policy and education. Since the genesis of doctoral education in nursing in the USA in the 1930s, this movement has burgeoned to over 273 doctoral programs in over 30 countries globally. The present article seeks to identify the issues and challenges in nursing doctoral education globally, and those encountered by doctoral program graduates in meeting the challenges of contemporary health care systems. Information was derived from a comprehensive literature review. Electronic databases and the Internet, using the Google search engine, were searched using the key words "doctoral education"; "nursing"; "International Network for Doctoral Education in Nursing"; "global health"; "international research collaboration". Doctoral education has been a critical force in developing nurse leaders in education, management, policy and research domains. An absence of consensus in terminology and of accurate minimum data sets precludes comparison and debate across programs. The complexity and dynamism of contemporary globalized communities render significant challenges in the conduct of doctoral programs. Addressing funding issues and faculty shortages are key issues for doctoral programs, especially those in developing countries, to achieve an identity uniquely their own. These challenges can also afford considerable opportunities for discussion, debate and the formulation of innovative and collaborative solutions to advance nursing knowledge and scholarship. In spite of discrete differences between countries and regions, the similarities in the issues facing the development of doctoral programs internationally are more striking than the differences. The harnessing of a global collective to address these issues will likely serve to not only forge the future viability of doctoral education of nurses but to improve the health and well-being of communities. This paper proposes international collaborative strategies to address a number of the challenges identified.

This exploratory study sought to test the relationship between nurses' job satisfaction and inpatient satisfaction with quality of nursing care in Taiwan. Patient and nurse data were collected from six inpatient care wards in a teaching hospital. Statistical results showed that nurses' general job satisfaction, general feelings of happiness when they are doing their jobs, and their job satisfaction are significantly correlated with at least one of the inpatient satisfaction factors studied, except for the factor of patient education. The results provide partial support for a linkage between nurses' job satisfaction and inpatient satisfaction with nursing care.

Along with increasing complexity of nursing services, hospital employers are demanding qualified and competent staff nurses for high quality clinical care. In Taiwan, disparities in the demand for competent nurses by employers and the supply produced by nursing educators still exist and require attention. A comprehensive understanding of the specific needs of Taiwan's medical care system for nursing services would help bridge the current gap between demand for and supply of competently trained nurses. This exploratory study investigated hospital employers' perceptions of the extent to which the nursing skills identified by Cleary et al. [Image: Journal of Nursing Scholarship (1998)20(4):39-42] were needed for staff nurses in Taiwan's medical care system. There were a total of 21 nursing competencies and classification on these items was also implemented. A cross-sectional, quantitative, survey design was conducted. Subjects' participation was voluntary, an information leaflet and an informed consent form was included in the questionnaire. A total of 89 nursing employers (nursing directors, associate directors, supervisor, or head nurse) participated, resulting in a 42.6% response rate. Factor analysis grouped these skills into three factors: basic-level patient care, intermediate-level patient care and basic management, and advanced-level patient care and supervision. This study confirmed that levels of nursing competencies needed differed by type of hospital accreditation. These levels also varied depending on types of services provided, employers' professional titles and tenure of currently employed nurses. The questionnaire developed for this study could be used as one of the tools to communicate demand and supply of nursing competencies between nurse educators and employers. These competencies could be used to develop a checklist for evaluating adequacy of nursing programmes in order to meet nurses' new roles and responsibilities and improve nursing care quality in the fast-changing health care environment in Taiwan.