Aims and objectives: To investigate the prevalence and extent of burnout on nurses and its association with personal resilience.Background: With the worldwide shortage of nurses, nurse burnout is considered one of the main contributing factors and has been the focus of studies in recent years. Given the well‐documented high level of burnout among nurses, resilience is expected to be a significant predictor of nurse burnout. The association between burnout and resilience has not previously been investigated extensively.Design: A cross‐sectional survey design was selected.Methods: A total of 1,061 nurses from six separate three‐level hospitals in Hunan Province, China, returned self‐reported questionnaires from March–June 2015. Data were collected using a socio‐demographic sheet, Maslach Burnout Inventory‐General Survey and the Connor‐Davidson Resilience Scale.Results: Nurses experienced severe burnout symptoms and showed a moderate level of resilience. Three metrics of burnout had significantly negative correlations with the total score and following variables of resilience. Linear regression analysis showed resilience, especially strength, demographic characteristics (exercise, alcohol use and marital status) and job characteristics (income per month, ratio of patients to nurses, shift work and professional rank) were the main predictors of the three metrics of burnout.Conclusion: The findings of this study may help nurse managers and hospital administrators to have a better understanding of nurse burnout and resilience. The significantly negative relationship between burnout symptoms and resilience has been demonstrated, and this informs the role of resilience in influencing burnout.Relevance to clinical practice: Adaptable and effective interventions for improving resilience are needed to relieve nurses’ burnout and reduce workplace stress. Moreover, nurse managers and hospital administrators should establish an effective management system to cultivate a healthy workplace and adopt positive attitudes and harmonious relationships.

Introduction: Prehospital care is one of the many issues that require addressing by lower-middle income countries (LMICs) where approximately 90% of global injuries occur. This may arise from more traffic in LMICs, poor road conditions, lack of public awareness of the importance of road safety, and the lack of ability to provide first aid to the victims. However, prehospital care in LMICs remains underdeveloped.Problem: There is insufficient evidence regarding the development of prehospital care among LMICs. Thus, the objective of this study was to investigate the status of Emergency Medical Services (EMS) systems in these countries.Methods: A review of medical-related electronic databases was designed to identify the development of EMS systems in LMICs. A search of the literature was undertaken using three electronic databases, CINAHL, Ovid Medline, and EMBASE via Ovid, from their commencement date until the end of July 2015. The grey literature was searched using Google Scholar. Articles were included if they reported on the establishment and current status of an EMS system and were excluded if they were letters to the editor, articles focusing on disaster management, a combination of more than one country if the other country was not a LMIC, written in a language other than English or Bahasa Indonesia, and/or focusing only on in-hospital care.Results: There were 337 articles identified in CINAHL, 731 in Ovid Medline, 891 in EMBASE via Ovid, and 41 in Google Scholar. Based on the title and abstract, 31 articles from CINAHL, 40 from Ovid Medline, 43 from EMBASE, and 11 from Google Scholar were retrieved for further review. There were 92 articles that met the inclusion criteria with 35 articles removed, as they were duplicated, leaving 57 articles to be reviewed. From those 48 countries categorized as LMICs, there were 16 (33.3%) countries that had information about an EMS system, including injury types, patient demographic, prehospital transport, and the obstacles in implementing the prehospital care system.Conclusion: The implementation and development of an EMS system is varied among LMICs. Many LMICs lack an organized EMS system with most ambulances used purely for transport and not as an emergency care vehicle. Financial issues are the most common problems faced by LMICs with support from developed countries a necessity. Suryanto , Plummer V , Boyle M .EMS systems in lower-middle income countries: a literature review.Prehosp Disaster Med.2017;32(1):64–70.

To explore the state of resilience and its predictors among nurses in mainland China. Resilience is considered as an important ability to influence the prevention of job dissatisfaction and burnout. There are few studies on resilience in Chinese nurses, particularly investigating the predictors of resilience. A cross-sectional survey was employed and 1061 nurses from six three-level hospitals in Hunan responded to participate in the study. Data were collected using self-reported questionnaires. Nurses experienced moderate levels of resilience and self-efficacy and tended to use a positive coping style. Multiple linear regression showed that a high level of self-efficacy and education, having a positive coping style rather than a negative coping style, exercising regularly and not using cigarettes predicted a high level of resilience (P < 0.01). This study shows a moderate level of resilience among nurses and suggests that a high level of self-efficacy and education, as well as having a positive coping style and choosing a healthy lifestyle may increase nurses' resilience. Hospital administrators and nursing managers need to explore the resilience state among nurses and understand the predictors of resilience. Then, scientific and evidence-based interventions for improving resilience should be adopted.