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PubMed2026

The Impact of Nurse-to-Patient Ratios on Nurses' Burnout, Job Dissatisfaction, and Intention-to-Leave: A Systematic Review and Meta-Analysis.

BACKGROUND: Adequate nurse staffing is essential for ensuring workforce well-being and patient safety. Imbalanced nurse-to-patient ratios contribute to burnout, job dissatisfaction, and turnover, which compromise care quality. OBJECTIVE: This systematic review and meta-analysis evaluated the impact of nurse-to-patient ratios on nurse burnout, job dissatisfaction, intention-to-leave, and patient outcomes. METHODS: A systematic search of PubMed, Scopus, and Web of Science identified cross-sectional studies examining nurse-to-patient ratios and related outcomes. RESULTS: Eighteen studies involving 183 876 nurses from 4085 hospitals were included. Higher nurse-to-patient ratios increased the odds of burnout (OR: 1.08), job dissatisfaction (OR: 1.10), and intention-to-leave (OR: 1.09). Each additional patient per nurse increased mortality and readmission risks by 7% to 8%, with decreased perceived care quality. CONCLUSION: Higher nurse-to-patient ratios adversely affect nurses and patients. Ensuring adequate staffing is critical to prevent burnout and maintain safe, high-quality care.

Humans↗

PubMedDate not supplied

Hostile attribution of intent and aggressive behavior: a meta-analysis.

A meta-analytic review was conducted to explain divergent findings on the relation between children's aggressive behavior and hostile attribution of intent to peers. Forty-one studies with 6,017 participants were included in the analysis. Ten studies concerned representative samples from the general population, 24 studies compared nonaggressive to extremely aggressive nonreferred samples, and 7 studies compared nonreferred samples with children referred for aggressive behavior problems. A robust significant association between hostile attribution of intent and aggressive behavior was found. Effect sizes differed considerably between studies. Larger effects were associated with more severe aggressive behavior, rejection by peers as one of the selection criteria, inclusion of 8- to-12-year-old participants, and absence of control for intelligence. Video and picture presentation of stimuli were associated with smaller effect sizes than was audio presentation. Staging of actual social interactions was associated with the largest effects. The importance of understanding moderators of effect size for theory development is stressed.

Aggression↗

PubMed2004

Two-year-olds' sensitivity to speakers' intent: an alternative account of Samuelson and Smith.

Seventy-two 2-year-olds participated in a study designed to test two competing accounts of the effect of contextual change on children's ability to learn a word for an object. The mechanistic account hypothesizes that any change in context that highlights a target object will lead to word learning; the social-pragmatic account maintains that a change in context must be perceived as relevant to the speaker's communicative intentions. Consistent with the latter account, we found that children learned the word when a change in context was intentional but not when it was accidental, and children failed to learn the word for the highlighted object when a speaker naive to the preceding context named the object.

Child, Preschool↗

PubMedDate not supplied

Don't believe everything you hear: preschoolers' sensitivity to speaker intent in category induction.

A label can convey nonobvious information about category membership. Three studies show that preschoolers (N=144) sometimes ignore or reject labels that conflict with appearance, particularly when they are uncertain that the speaker meant to use those labels. In Study 1, 4-year-olds were more reluctant than 3-year-olds to accept that, for example, a cat-like animal was a dog just on the basis of hearing it called a dog. In Studies 2 and 3, this reluctance was overcome when the speaker explicitly or implicitly indicated that use of the unexpected labels was intentional. These studies demonstrate that preschoolers do not treat labels as atheoretical features of objects; rather, they interpret them in light of their understanding of the labeler's communicative intent.

Attitude↗

PubMedDate not supplied

Intentionality as measured in the persistence and elaboration of communication by chimpanzees (Pan troglodytes).

In human infancy, 2 criteria for intentional communication are (a) persistence in and (b) elaboration of communication when initial attempts to communicate fail. Twenty-nine chimpanzees (Pan troglodytes) were presented with both desirable (a banana) and undesirable food (commercial primate chow). Three conditions were administered: (a) the banana was delivered (successful communication), (b) half of the banana was delivered (partially successful communication), and (c) the chow was delivered (failed communication). The chimpanzees exhibited persistence in and elaboration of their communication in every condition except when the banana was delivered. Thus, their communication was about a specific item, demonstrating that both intentionality and nonverbal reference are capacities shared by humans with our nearest living relatives, the great apes.

Animal Communication↗

PubMed2006

CSF 5-HIAA, suicide intent and hopelessness in the prediction of early suicide in male high-risk suicide attempters.

OBJECTIVE: To study the predictive value of the Beck Suicide Intent Scale (SIS), the Beck Hopelessness Scale (BHS) and of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid for future early suicide in a group of high-risk male suicide attempters. METHOD: Fifteen consecutive male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital, who were not receiving any treatment with antidepressants were diagnosed according to DSM-III, assessed with SIS and BHS and submitted to lumbar puncture. All patients were followed up for cause of death. RESULTS: Five early suicides (within 2 years) were identified. Mean cerebrospinal fluid (CSF) 5-HIAA differed between suicides and survivors. Low CSF 5-HIAA was identified in those who committed early suicide. Neither the Suicide Intent Score nor the Hopelessness Score distinguished suicides from survivors. CONCLUSION: In high suicide risk hospitalized male psychiatric patients CSF 5-HIAA may be a better predictor of early suicide after attempted suicide than SIS or BHS.

Adult↗

PubMed2004

Knowledge and intentions of ninth-grade girls after a breast self-examination program.

Breast cancer ranks as the second-leading cause of death for women. Until recently the American Cancer Society advocated teaching breast self-examination (BSE) procedures. The Susan G. Komen Breast Cancer Foundation, active in the fight against breast cancer, continues to support educational efforts to teach breast self-examination skills to adolescent girls. Funded by the Komen Foundation, a BSE education program was developed and delivered by health educators at the Hult Health Education Center. The 50-minute program consisted of a PowerPoint slide presentation of breast cancer and BSE facts, and a video demonstration of proper BSE technique. Using a quasi-experimental design, the program was evaluated for changes in knowledge and intention to perform BSE. Ninth-grade girls at four public high schools (n = 255) in Peoria, Ill., were given a pretest to determine their knowledge about breast cancer and breast self-examination. A delayed posttest was administered between five to six weeks later (n = 211). Using the Kruskal-Wallis nonparametric test, girls who participated in the BSE education program (treatment group) recorded a significantly higher overall mean knowledge score than girls who did not participate (comparison group). Those who participated in the program retained that knowledge over a five- to six-week period. Analyses of variance revealed that more girls in the treatment group reported performing BSE in the past month as well as a higher intention to perform BSE in the future.

Adolescent↗

PubMed2005

Predictors of HIV testing and intention to test among Hispanic farmworkers in South Florida.

CONTEXT AND PURPOSE: This study examined the predictors of HIV testing and factors associated with intention to accept a free HIV test among 244 Hispanic migrant/seasonal farmworkers in South Florida. METHODS: Time and space sampling procedures were used to recruit participants in public venues. Bilingual staff interviewed eligible respondents in these settings. FINDINGS: Despite high rates of sexual risk, only 21% of respondents had been tested for HIV. The majority of those tested were females tested during prenatal care. In multivariable logistic regression analyses, being female (odds ratio [OR] = 3.73), having at least 12 years of education (OR = 4.46), earning more than $201 per week (OR = 2.76), and ever having used marijuana (OR = 3.31) were positively associated with having been tested for HIV, while not being documented (OR = 0.24) and having rated one's health as "very good" or "good" (OR = 0.42) were negatively associated with testing. The multivariable predictors of intention to accept a free HIV test were having visited a health care provider and/or an emergency room in the past 12 months (OR = 1.97), having been tested for HIV (OR = 2.36), preferring an HIV test that used a finger stick for specimen collection with results given in 30 minutes (OR = 4.47), and worrying "some" or "a lot" about getting HIV (OR = 3.64). Women (OR = 0.52) were less likely than men to intend to accept a free HIV test. CONCLUSIONS: Our findings highlight the importance of routinely offering HIV testing to sexually active individuals in high HIV prevalence areas. They also suggest the need to make testing more accessible to migrant and seasonal farmworkers.

Adult↗

PubMed2005

Failure to detect mismatches between intention and outcome in a simple decision task.

A fundamental assumption of theories of decision-making is that we detect mismatches between intention and outcome, adjust our behavior in the face of error, and adapt to changing circumstances. Is this always the case? We investigated the relation between intention, choice, and introspection. Participants made choices between presented face pairs on the basis of attractiveness, while we covertly manipulated the relationship between choice and outcome that they experienced. Participants failed to notice conspicuous mismatches between their intended choice and the outcome they were presented with, while nevertheless offering introspectively derived reasons for why they chose the way they did. We call this effect choice blindness.

Choice Behavior↗

PubMed2006

Consequences, action, and intention as factors in moral judgments: an FMRI investigation.

The traditional philosophical doctrines of Consequentialism, Doing and Allowing, and Double Effect prescribe that moral judgments and decisions should be based on consequences, action (as opposed to inaction), and intention. This study uses functional magnetic resonance imaging to investigate how these three factors affect brain processes associated with moral judgments. We find the following: (1) Moral scenarios involving only a choice between consequences with different amounts of harm elicit activity in similar areas of the brain as analogous non-moral scenarios; (2) Compared to analogous non-moral scenarios, moral scenarios in which action and inaction result in the same amount of harm elicit more activity in areas associated with cognition (such as the dorsolateral prefrontal cortex) and less activity in areas associated with emotion (such as the orbitofrontal cortex and temporal pole); (3) Compared to analogous non-moral scenarios, conflicts between goals of minimizing harm and of refraining from harmful action elicit more activity in areas associated with emotion (orbitofrontal cortex and temporal pole) and less activity in areas associated with cognition (including the angular gyrus and superior frontal gyrus); (4) Compared to moral scenarios involving only unintentional harm, moral scenarios involving intentional harm elicit more activity in areas associated with emotion (orbitofrontal cortex and temporal pole) and less activity in areas associated with cognition (including the angular gyrus and superior frontal gyrus). These findings suggest that different kinds of moral judgment are preferentially supported by distinguishable brain systems.

Adolescent↗

PubMed2004

A time to tan: proximal and distal effects of mortality salience on sun exposure intentions.

According to the dual defense model of terror management, proximal defenses are engaged to reduce the conscious impact of mortality salience, whereas thoughts of death outside of conscious awareness motivate distal defenses aimed at maintaining self-esteem. Two experiments examined these ideas by assessing women's intentions to engage in tanning-related behavior. In Study 1, when concerns about death (relative to dental pain) were in focal attention, participants increased intentions to protect themselves from dangerous sun exposure. In contrast, when thoughts about death were outside of focal attention, participants decreased interest in sun protection. In Study 2, participants primed to associate tanned skin with an attractive appearance responded to mortality concerns outside of focal attention with increased interest in tanning products and services. These findings are discussed in relation to the dual-defense model of terror management, societal determinants of self-esteem, and implications for health risk and promotion.

Attitude to Death↗

PubMed2004

Explaining the discrepancy between intentions and actions: the case of hypothetical bias in contingent valuation.

An experiment was designed to account for intention-behavior discrepancies by applying the theory of planned behavior to contingent valuation. College students (N = 160) voted in hypothetical and real payment referenda to contribute $8 to a scholarship fund. Overestimates of willingness to pay in the hypothetical referendum could not be attributed to moderately favorable latent dispositions. Instead, this hypothetical bias was explained by activation of more favorable beliefs and attitudes in the context of a hypothetical rather than a real referendum. A corrective entreaty was found to eliminate this bias by bringing beliefs, attitudes, and intentions in line with those in the real payment situation. As a result, the theory of planned behavior produced more accurate prediction of real payment when participants were exposed to the corrective entreaty.

Adolescent↗

PubMed2006

From psychological need satisfaction to intentional behavior: testing a motivational sequence in two behavioral contexts.

The present study tested a motivational sequence in which global-level psychological need satisfaction from self-determination theory influenced intentions and behavior directly and indirectly through contextual-level motivation and situational-level decision-making constructs from the theory of planned behavior. Two samples of university students (N = 511) completed measures of global-level psychological need satisfaction, contextual-level autonomous motivation, and situational-level attitudes, subjective norms, perceived behavioral control, intentions, and behavior in two behavioral contexts: exercise and dieting. A structural equation model supported the proposed sequence in both samples. The indirect effect was present for exercise behavior, whereas both direct and indirect effects were found for dieting behavior. Findings independently supported the component theories and provided a comprehensive integrated explanation of volitional behavior.

Adult↗

PubMed2003

Patient characteristics associated with nonprescription drug use in intentional overdose.

OBJECTIVE: Over-the-counter (OTC) medications remain freely available to suicidal patients, despite their potential lethality and common use in suicide. The study's main objective was to identify patient characteristics, particularly psychiatric diagnosis associated with the use of OTC medications in intentional overdose. METHODS: We retrospectively reviewed 95 charts from patients who presented to St Paul's Hospital from August 1, 1997, to July 31, 1998, with a discharge diagnosis of intentional drug overdose. Univariate analysis was carried out to identify potential risk markers for OTC medication use, and logistic regression was performed using these variables. RESULTS: When the variables age, sex, and concurrent psychiatric diagnoses were controlled, use of OTC medications in overdose was significantly lower in patients with a DSM-IV diagnosis of substance abuse (OR 0.11, P = 0.005) and in those who possessed prescription medications at the time of overdose (OR 0.18, P = 0.007). Most patients in this cohort (82%) had at least 1 of these 2 traits. Although not statistically significant, younger patients appeared more likely to choose OTC medications for overdose. CONCLUSION: Suicide-prone patients with a diagnosis of substance abuse and who possess prescription medications are unlikely to use OTC medications in overdose. For this cohort, this represents a relatively small proportion of patients whom clinicians should consider to be at greater risk for attempting suicide when using OTC medication, especially acetaminophen.

Adult↗

PubMed2005

The concept of intentionality in human science nursing theories.

Nursing as a human science focuses on life and health as humanly experienced. Intentionality is a philosophical idea of particular significance to nursing as a human science, particularly within Parse's theory of human becoming and Watson's theory of human caring. These two theorists' interpretations of intentionality are explored in relation to their respective theories and the implications for research and practice.

Empathy↗

PubMed2006

Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention.

This article examines the applicability of the Theory of Planned Behavior (TPB) with the addition of the self efficacy construct in the understanding of the motivation to obtain an initial screening mammogram among Cypriot women. The study sample consisted of 293 women aged 40 to 65 years, asymptomatic of breast cancer, and with no previous mammography experience. The study took place at the General Hospital of Nicosia in Cyprus. The results of the study provided support of the TPB with the addition of self-efficacy in an international setting. Self-efficacy was the strongest predictor of intention. Other predictors of intention included educational level, time of last clinical breast examination, and age. The study also provided some empirical support of the distinction between self-efficacy and perceived behavioral control. Researchers may want to include self-efficacy in addition to the TPB and other demographic characteristics in future applications to more fully explain behavioral outcomes.

Adult↗

PubMed2005

Leading the flock: organ donation feelings, beliefs, and intentions among African American clergy and community residents.

CONTEXT: Despite a considerable potential role in organ donation for African American clergy, there has been little investigation to date of the beliefs, attitudes, and personal intentions of such clergy regarding donation. OBJECTIVE: To compare the beliefs, attitudes, and behavioral intentions regarding organ donation among African American clergy to those of African American residents of the same large US city. DESIGN: Focus groups and 3 cross-sectional surveys. SETTING: Greater Houston, Tex, metropolitan area. PARTICIPANTS: A total of 761 randomly selected African American community residents and 311 African American clergy. MAIN OUTCOMES MEASURES: Beliefs about the importance of organ donation; how comfortable one is in thinking about donation; whether one believes that organ donation is against one's religion; trust in healthcare professionals regarding death declaration; concerns that donation leads to body mutilation; and the likelihood that one will donate one's own organs upon death. RESULTS: Compared to general African American residents, African American clergy in the Houston area were found more often to believe in the importance of donation; to be more comfortable with thinking about donation; to feel more certain that donation was not against their religion; to believe that they could trust healthcare professionals regarding death declaration; to feel less often that donation leads to mutilation of the body; and to indicate a greater likelihood of donating their own organs upon death. The same was found to be true among clergy and congregants of the largest religious denomination in Houston, the Baptists.

Adult↗

PubMed2002

Predicting intentions versus predicting behaviors: domestic violence prevention from a theory of reasoned action perspective.

A central assumption of many models of human behavior is that intention to perform a behavior is highly predictive of actual behavior. This article presents evidence that belies this notion. Based on a survey of 1,250 Philadelphia adults, a clear and consistent pattern emerged suggesting that beliefs related to domestic violence correlate with intentions to act with respect to domestic violence but rarely correlate with reported actions (e.g., talking to the abused woman). Numerous methodological and substantive explanations for this finding are offered with emphasis placed on the complexity of the context in which an action to prevent a domestic violence incident occurs. We conclude by arguing that despite the small, insignificant relationships between beliefs and behaviors found, worthwhile aggregate effects on behavior might still exist, thus reaffirming the role of communication campaign efforts.

Adult↗