Workplace social capital positively influences the quality but reduces the cost of healthcare services. Academic research suffers from limited and inadequate culturally sensitive nurses' workplace social capital instruments. Here we report on the design and protocol of a culturally focused instrument development study in China. The overarching objective of our dual phase study is to develop and validate a questionnaire measuring nurses' workplace social capital tailored toward Chinese cultural values and norms. In the first phase of INSTRUMENT DEVELOPMENT, the qualitative phase, we will conduct interviews with purposefully sampled nurses from five geographically diverse regions capturing 16 provinces in China to formulate the initial version of the Nurses' Workplace Social Capital Questionnaire (NWSCQ). Data collection will be stopped at the saturation point and content analysis will be performed for interview data in parallel. The initial version of the NWSCQ will be evaluated and confirmed by two-rounds of expert consultation (target N = 20) and pre-tested among 70 nurses. During the second phase of INSTRUMENT VALIDATION or the quantitative phase, we will validate the psychometric properties of the NWSCQ. The validity and reliability of the questionnaire will be examined and validated through three cross-sectional surveys among nurses (target N = 1154) randomly selected from 12 tertiary hospitals. We have reported our study protocol with the intention of sharing our experience with researchers in other countries who are striving to advance the phenomenon of culturally sensitive and social normatively appropriate nurses' workplace social capital. Findings from our study should advance the development of culturally appropriate and valid instrument of nurses' workplace social capital, another important step toward recognition and incorporation of cultural diversity in the daily operation of healthcare industry.

Background: The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals' experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care. Objective: This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals. Methods: Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals' experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute's quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers. Results: A total of 6 analytical themes concerning health care professionals' experiences of web-based patient-professional communication were identified. The themes were related to health care professionals' work, change in communication over patient portals, patients' use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles. Conclusions: Health care professionals' experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals' negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.

Objectives To examine antidepressant use among male and female human service professionals. Methods A random sample of individuals between 25 years and 54 years of age (n=752 683; 49.2% women; mean age 39.5 years). Information about each individual’s filled antidepressant prescriptions from 1995 to 2014 was provided by the Social Insurance Institution. First, antidepressant use in five broad human service categories was compared with that in all other occupations grouped together, separately for men and women. Then, each of the 15 human service professions were compared with all other occupations from the same skill/education level (excluding other human services professions). Cox models were applied and the results are presented as HRs for antidepressant use with 95% CIs. Results The hazard of antidepressant use was higher among men working in human service versus all other occupations with the same skill/occupational level (1.22, 95% CI 1.18 to 1.27), but this was not the case for women (0.99, 95% CI 0.98 to 1.01). The risks differed between professions: male health and social care professionals (including medical doctors, nurses, practical nurses and home care assistants), social workers, childcare workers, teachers and psychologists had a higher risk of antidepressant use than men in non-human service occupations, whereas customer clerks had a lower risk. Conclusions Male human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated risk.

Namibia has gone through great changes since its independence in 1990. The new constitution illegalized the apartheid rule and racial discrimination, but the history has left its marks on the contemporary society. The class inequalities are one the biggest in the world, and they still intertwine with the racial and tribal memberships. Although any kind of discrimination is strictly forbidden in the society, the prejudices still remain. Furthermore, the gender roles are in transition and women encounter multiple, sometimes conflicting expectations. In this context, the thesis studies multidimensional identity from the perspective of decency. More specifically, it explores how decency is conceived among black female nurses of Katutura township in Windhoek. The study investigates how the racial, tribal, gender, class and professional identities intersect and contribute to the perceptions of a ‘decent person’. The study also discovers how young women try to answer simultaneously to the traditional and modern female ideals. Lastly, the thesis illustrates how the class dominance, traditional gender roles and the ethnic and racial prejudices are resisted and reproduced through the perceptions on decency. In terms of class-related decency was demonstrated by diving the ‘indecent them’ to the upper and lower classes. The whites and the majority tribe of Owambos were accused of being discriminatory and having better opportunities in life. The lower classes were instead stigmatized as lazy and immoral individuals, who did not deserve the higher socio-economic positions. Thus, both the better and worse-off were claimed being less respectable than the interviewed nurses, who represented the middle class. However, the interviewees also identified with the lower class and admitted that the societal structures hindered their class mobility. To summarize, they simultaneously maintained and resisted the class dominance. Class also had a strong link to the female respectability. On the other hand, the modern woman was expected to be independent, to take care of herself and not to rely on the assistance of men. As the interviewees had succeeded in this, they achieved the dignity of a modern working woman. Still, on the other hand, the traditions expected them to follow the old gender roles. The conflicting expectations became apparent, for example when discussing the ‘ideal nurse’. The decent nurse was supposed to be a feminine mother-type of a figure, who put herself last in order to help others. Still, also the high professional expertise made the ‘proper nurse’. In this way, the nursing profession both strengthened and faded the women’s femininity and simultaneously rejected and reproduced the traditional gender ideals. However, it was the co-existence of the traditional and modern decency that enabled the nurses to maintain their respectability in the changing society. Regarding the racial and tribal relations, any kind of discrimination was condemned. Nevertheless, the condemnation was also an issue of differentiating those who had a good sense of morals and those who did not. The interviewees argued that the whites were still racist, but that they themselves promoted equality like a decent person should do. Considering this, it is controversial that they seemed to forget the principles of the universal equality when talking about the ethnic difference. They reproduced the same prejudices they judged in regard to racial discrimination. Moreover, they underlined their old and new identities as they draw strong lines between the racial and tribal groups, but also claimed for absolute equity. In this light, it is possible to argue that the societal transformation has a great impact on the decency perceptions of the Namibians. The historical stances remain side by side the ideologies of the post-apartheid era, although the attitudinal change is taking place. The class inequalities and discrimination clash with the aspirations of equality, the traditional gender roles are challenged by the modern female respectabilities and the group relations are defined by both reconciliation and boundary making.

Globally, there are only a few studies on healthcare professionals' experiences of their patient information systems, although user experiences are a key component of system development and assessment. A nationwide survey of nurses' experiences was conducted for the first time in Finland in early 2017. The survey was targeted to working-age nurses, community nurses and midwives from the Membership Registers of the Nursing Association and the Tehy. A similar study has been conducted for physicians in 2010, 2014 and 2017. An electronic questionnaire, based on the physicians’ questionnaire, was sent by the Nursing Association and Tehy to their members. A total of 3607 nurses responded to the questionnaire. The results were grouped using the objectives of the Finnish eHealth and eSocial 2020 Strategy theme "Smart Systems for Capable Users". Responses differed by patient information system brands and by the respondents' operating environments. One of the most prominent problems was the need to record the same thing in many places, which can expose to errors and indicates poor information system integration. Poor stability of information systems was also identified as a common problem; identified as a risk to patient safety in previous literature. There were differences between brands in usability of information systems and availability of up-to-date and high quality information in patient care locally, regionally and nationally. Respondents felt that in-service training was inadequate with regard to changes in operating methods required by information systems. Active user participation in the development of information systems was associated with better school grades given by the respondent for the information system. This will be studied in more detail in a separate article. Participation in the development of information systems and training take initially time from direct customer and patient work, but good usability and usage skills can later be expected to save time due to fluent use of information systems. The system and context specific differences in the information system usability and support to work as well as quality of care identified in this study can be used to pinpoint good design practices in different contexts of use. This is needed to improve efficiency of the nurses’ work and to increase patient safety and co-operation. Nurses need to be better consulted when developing information systems. Organizations need to design information system training so that the skills of the professionals remain up to date as information systems and their usage patterns evolve. The Nursing Association's e-Health Strategy also emphasizes the user eHealth competence and participation in development work.