A National Study Links Nurses’ Physical and Mental Health to Medical Errors and Perceived Worksite Wellness

Study of Nurses' Malpractice Tendencies and Burnout Levels

Malpractice, which occurs when a reasonable standard of service cannot be provided, is a critical situation in nursing care and interventions. Nurses' tendency toward medical errors and burnout levels are important due to their impact on patient safety and the quality of care. This study was conducted to investigate nurses' malpractice tendencies and burnout levels and the relationship between the two. The data of this descriptive, cross-sectional, and correlational study were collected from 292 nurses working in a training and research hospital in Istanbul province between January and February 2021. A Descriptive Information Form, the Malpractice Trend Scale in Nursing (MTSN), and the Maslach Burnout Inventory (MBI) were used to collect data. In data analysis, internal consistency coefficient, descriptive, non-parametric comparisons, and correlation analyses were performed. The mean age of the nurses participating in the research was 31.13 ± 7.87 years; 79.8% were women, 50.7% were single, and 68.5% had an undergraduate degree. When nurses' opinions about malpractice were examined, it was determined that 88.7% had not committed malpractice before and 53.4% had witnessed someone who committed malpractice. Nurses' overall MTSN score was 233.48 ± 15.32. Their Maslach Burnout Inventory score was 18.20 ± 8.83 on the emotional exhaustion subscale, 8.07 ± 3.86 on the depersonalization subscale, and 21.31 ± 4.00 on the personal accomplishment subscale. The reliability coefficients of the scales and subscales ranged between 0.61 and 0.95. There was a significant difference between the MTSN scale and MBI subscales according to nurses' positions and satisfaction with the environment (p < 0.05). A negative correlation was found between the mean scores on the total MTSN and the MBI emotional exhaustion (r = -0.314) and depersonalization (r = -0.293) subscales, and a positive and statistically significant relationship (p < 0.001) existed between the MTSN total scale and the personal accomplishment (r = 0.359) subscale. The level of burnout is associated with a tendency to malpractice. Taking measures to prevent nurses from experiencing burnout may be important for reducing medical errors. These measures will be reflected in better care service and quality.

Defining a "healthy nurse"

ABSTRACT

Society benefits from healthy nurses. Prioritizing nurse well-being supports nurses' health, resilience, job satisfaction, and more. A healthy nurse provides quality care, reduces errors, and increases patient satisfaction. This article details the American Nurses Association's development of a definition of a healthy nurse to guide and articulate nurse health and wellness.

Employer-provided wellbeing support for nurses working in intensive care units: A national cross-sectional study

BACKGROUND

Intensive care units are characterised as high-stress work environments that may negatively affect nurses' wellbeing. Employer-provided support has a crucial role in reducing burnout and improving wellbeing.

OBJECTIVE

The aim of this study was to examine wellbeing supports routinely offered by employers of nurses working in intensive care units and examine the relationships amongst perceived organisational support, wellbeing, and burnout.

METHODS

A cross-sectional study of nurses working in Australian intensive care units was conducted from 4 to 19 September 2023. A web-based survey was distributed via the Australian College of Critical Care Nurses and social media, with snowball sampling. Validated tools for perceived organisational support, subjective wellbeing, and burnout were used.

RESULTS

Of 668 responses, 632 met inclusion criteria for analysis (94.6%). Education and training were the most common supports recognised by nurses (63.4%, n = 401). The most helpful support was childcare assistance (M = 3.17, standard deviation [SD] = 1.38). Higher levels of perceived organisational support were associated with better subjective wellbeing (r = 0.20; p < 0.001). Perceived organisational support was higher for nurses without burnout (M = 4.15, SD = 0.89) than for those with burnout (M = 3.64, SD = 0.85; t [625] = 7.43, p < 0.001, two-tailed). For every one-point increase in the mean value of perceived organisational support, nurses were 56% less likely to report experiencing burnout than those who perceived lower organisational support (B = -0.81, p < 0.001, odds ratio = 0.44, 95% confidence interval: 0.35-0.56). The strongest predictor of reporting burnout was engaging in an education/clinical support job role (B = 0.88, p = 0.04, odds ratio = 2.41, 95% confidence interval: 1.04-5.60).

CONCLUSIONS

Nurses working in Australian intensive care units perceived employer-provided wellbeing support to be inadequate. Perceived organisational support is a modifiable independent predictor of burnout, suggesting that employers need to work with nurses to improve wellbeing supports.

REGISTRATION

Not registered.

A Quantitative Analysis of Work System Factors and Well-Being Among Nurses and Physicians in Rural and Urban Settings During Covid-19 Pandemic

BACKGROUND

The aim of this study was to assess work system factors and nurse and physician well-being across professionals (nurse vs. physician) and geographic locations (rural vs. urban) during COVID-19 pandemic.

METHODS

This study invited nurses and physicians within four hospitals from one large healthcare system to participate: one urban academic medical center and three rural hospitals. We measured work systems factors using the National Academy of Medicine (NAM) framework and the National Institute for Occupational Safety and Health (NIOSH) survey. Wellbeing was measured using the 2-question summative burnout score, Patient Health Questionnaire (PHQ-9) to measure depression, and post-traumatic stress disorder (PTSD) checklist (PCL) to measure PTSD symptoms. Statistical analyses were conducted using Chi-square (for Likert-scale items) and t-tests (for continuous scales) as appropriate. Statistical significance was set at the .05 level, two-tailed.

RESULTS

Overall, our results suggested that nurses and physicians working in the urban settings experience more impeding work system factors and are more burned out, depressed, exhibit more PTSD symptoms, and face greater overall well-being issues, when compared to nurses and physicians working in the rural settings.Conclusions/Applications to Practice:This study examined a comprehensive set of work system factors and well-being measures to better understand differences between rural and urban settings, and nurses compared to physicians. By examining this entire set of measures, we were able to provide a greater insight into the key differences, highlighting opportunities for policy-level contributions to prevent work related impairments from reaching the healthcare workforce.

Factors Contributing to Well-Being Among Hospital-Based Nurses

BACKGROUND

Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.

PURPOSE

Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.

METHODS

In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from -2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.

RESULTS

The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).

LINKING EVIDENCE TO ACTION

Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.

Circumstantial Factors Among Kentucky Nurse Suicide Decedents, 2005 to 2019

Background: Nurse suicide, a complex occupational health concern, is urgently in need of research due to the personal and occupational suicide risk factors experienced by nurses, namely mental health problems (e.g., depression), job problems, and substance misuse. Therefore, the study aims were to determine the contextual characteristics and circumstantial factors associated with nurse suicide in Kentucky. Methods: Secondary suicide data were obtained from the Kentucky Violent Death Reporting System (KYVDRS) from 2005 to 2019. Nurse suicide cases were identified using the Bureau of Labor Statistics Standard Occupational Classification. A mixed-methods analysis using descriptive statistics and qualitative evaluation was conducted to determine the distributions of demographic, injury, and weapon characteristics, followed by a qualitative analysis of the KYVDRS incident narrative text of nurse suicide decedents. Results: There were 88 decedents identified with a nursing occupation. The predominant means of death for male (59%) and female (45%) nurses involved firearms. Thematic analysis showed nurse decedents experienced a mental health problem (51%) and premeditated (50%) suicide preceding death. Incidentally, 51% of all cases experienced multiple circumstantial factors (e.g., relationship problems and premeditation) preceding their death by suicide. Discussion/Application to Practice: Nurse suicide decedents experienced multifactorial risk factors preceding their death by suicide, namely depression, premeditated suicide, and relationship problems. Occupational health practitioners and health care organizations can implement individual and organizational prevention efforts to help prevent nurse suicide.

Temporal Changes in Nurse Mental and Behavioral Health Modified by Job Demands and Resources

BACKGROUND

The COVID-19 pandemic exacerbated barriers in the nurse work environment, influencing nurse well-being. This paper examines if workplace factors moderate temporal changes in the mental and behavioral health of nurses.

METHODS

Cross-sectional data from the HealthyNurse survey collected between May 2017 and July 2023 were analyzed (n = 34,273). Job resources was estimated by average agreement (0 = strongly disagree to 4 = strongly agree) with being treated with respect, recognized for efforts, and the employer values their well-being. Average agreement with working overtime, being assigned a high workload, and working through breaks estimated job demands. Multivariable regression models estimated the effect modification of job demands and job resources on changes over time in hours of sleep and odds of feeling sad, down, or depressed, past 30-day binge drinking, and current tobacco use.

RESULTS

By each year, nurses increased sleep hours (b = 0.011; 95% CI [0.004, 0.018]), but had greater odds of poor mental health (OR = 1.102; 95% CI [1.086, 1.117]), binge drinking (OR = 1.022, 95% CI [1.007, 1.036]), and tobacco use (OR = 1.070; 95% CI [1.043, 1.098]). With higher job resources, sleep increased at a greater rate over time (b = 0.016; 95% CI [0.007, 0.024]) and the odds of binge drinking increased at a lower rate over time (OR = 0.981; 95% CI [0.965-0.998]). Conversely, the prevalence of poor mental health increased at a greater rate over time when job demands were high (OR = 1.018; 95% CI [1.004, 1.033]).

LINKING EVIDENCE TO ACTION

Job demands and job resources may lead to differential mental and behavioral health among nurses. Understanding how these workplace factors can influence nurse health is an important and upstream approach to support well-being in times of crisis.

An Integrative Nursing Fellowship Approach to Increase Nurse Retention

Nurses are leaving the profession because of stress, burnout, and retirement. An integrative nursing fellowship pilot program was designed to enhance well-being, professional engagement, and development among new and experienced nurses. A hospital-based return-on-investment model is provided, and implications are discussed for nurse leaders to enhance retention using an integrative framework.

Relationships between role stress profiles, psychological capital, and work engagement among Chinese clinical nursing teachers: a cross-sectional latent profile analysis

BACKGROUND

Clinical nursing practice has a significant meaning and role in nursing education. Efficient clinical nursing practices under the guidance of clinical nursing teachers can promote patient safety and healthcare quality. This study aimed to investigate the profiles of clinical nursing teachers' role stress, determine whether sociodemographic factors and psychological capital correlate with different role stress profiles. It also examined the relationship between different role stress profiles and work engagement.

DESIGN

Cross-sectional study.

METHODS

A total of 412 clinical nursing teachers were enrolled in China through convenience sampling. The Role Stress Scale, Psychological Capital Questionnaire, Work Engagement Scale, and sociodemographic questionnaire were used. Latent profile analysis (LPA) was conducted by using Mplus version 8.0 to identify the different role stress profiles of clinical nursing teachers. Univariate and multivariate unordered logistic regression analyses were used to identify the factors associated with the profiles.

RESULTS

Four hundred and six valid questionnaires were returned. The findings of latent profile analysis showed three profiles: low role stress-high lack of teaching resources profile (34.3%), moderate role stress profile (57.0%), and high role stress-low lack of teaching resources profile (11.7%). Multivariate unordered logistic regression showed that clinical nursing teachers with lower education levels, contract employment, regular qualification audits, and lower psychological capital scores were more likely to belong to Profiles 2 and 3 when Profile 1 was used as a reference. The analysis of variance revealed that the work engagement scores of Profile 3 were significantly lower than those of Profiles 1 and 2.

CONCLUSIONS

Clinical nursing teachers reported heterogeneous sociodemographic and psychological capital, with significant differences in the degree of role stress between the identified profiles. Targeted interventions should be provided according to the role stress profiles to improve work engagement.

Healthcare educators experience in supporting student well-being: A scoping review

AIM

To explore the experiences of healthcare educators in providing support for student well-being / mental health whilst undertaking formal health professional training programs, including clinical placement and identify educator concerns, strategies and preparedness.

BACKGROUND

With increasing evidence of well-being concerns within the healthcare student population and the need for resilience and well-being cultures within healthcare, much literature proposes what healthcare educators must and should do to support student well-being. A healthcare educator's role encompasses well-being support; however, little is known about the impact supporting student well-being has on the educator.

DESIGN

A scoping review using the Joanna Briggs Institute Manual for Evidence synthesis methodology was undertaken.

METHOD

A systematised search of CINAHL, Medline OVID, Medline EBSCO, PubMed, Embase, EmCare, PsycInfo, Cochrane review, Google scholar and TRIP databases was conducted. 719 papers were screened and 12 papers identified to meet eligibility criteria for inclusion in this review.

RESULTS

Four themes were identified: educators perceive students to be under stress, educators experience role conflict when supporting student well-being, educators experience personal stress when supporting student well-being and educators identified strategies to support student well-being and their own knowledge.

CONCLUSION

The review identified a significant absence of literature understanding the experiences of healthcare educators when providing student well-being support and reinforces the urgent need to explore and understand the healthcare educators experience in much greater depth. Understanding how we can best support healthcare educators will ensure they are equipped to better support students' well-being in healthcare programs and clinical placements.

Nurses' health and work experiences during the COVID-19 pandemic in Swedish prehospital and hospital care: a deductive content analysis through the lens of the swAge model

Working as a nurse offers job security but also poses risks for mental health issues. This study aims to explore factors and processes that affected health and work experiences among nurses in Sweden during the COVID-19 pandemic. Semi-structured interviews were conducted with 14 nurses from high COVID-19 patient load areas (ambulance, emergency departments, ICU, infection wards, and specialized COVID-19 wards). A deductive content analysis using the SwAge model's nine determinant areas, was performed. The COREQ-checklist was adhered to. Nurses were prepared to sacrifice their health for the well-being of their patients, with many still facing the repercussions. They voiced their disappointment with healthcare organizations for providing insufficient support. The pandemic disrupted the social contract between healthcare organizations and the public, particularly in elder care. To perform effectively, nurses need adequate staffing, a safe work environment, fair compensation, manageable workloads, and recognition. Instances of deception and broken promises have undermined trust and professional well-being. During the pandemic, nurses leaned on their colleagues for support to manage stress and compensate for shortcomings. Nonetheless, nurses also reported experiencing resilience, adaptability, and flourishing. Nurses in Sweden face challenges such as undersized organizations and the need for primary care expansion to reduce hospital burdens. A better balance of resources is essential for effective performance. Improved working conditions and organizational support are crucial for retaining nurses. Identifying factors for a sustainable working life involves understanding key areas and their interactions. Healthcare organizations and managers should consider these areas to promote sustainability.

Nurse Well-Being and Patient-Specific Outcomes: A Scoping Review

BACKGROUND

The health and well-being of the nursing workforce has received recent attention due to nurse attrition and the critical nurse shortages projected across the country. A nurse's well-being may impact patient outcomes.

PURPOSE

The purpose of this scoping review was to assess the association between nurse well-being factors and specific patient outcomes.

METHODS

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) PRISMA Scoping Review protocol and 2020 reporting guidelines were utilized in this review.

RESULTS

Staffing, environment, physical health, and mental health of nurses were correlated to specific adverse patient outcomes among the 97 articles included in the final review. The majority of the articles reported significant findings.

CONCLUSIONS

Patient outcomes were reviewed as discrete events in the articles examined. With mixed results found on key patient outcomes, future research requires more in-depth investigation into the role nurse well-being has on patient outcomes.

Zen Den: A Novel Approach to Promote Well-Being in the Workplace

Purpose: In response to the COVID-19 pandemic, holistic nurses at an academic level 1 trauma center in Hawaii utilized a novel holistic approach to combat stress and anxiety symptoms while promoting nurse's well-being. This assessment aimed to determine whether a brief session incorporating Reiki and meditation could decrease nurses' perceived stress and anxiety while increasing perceived happiness and coping ability. Methods: Two Reiki-certified holistic nurses developed a mobile 10-minute individual well-being session called "Zen Den." In each session, the holistic nurse provided hands-on Reiki concurrent with a meditation streamed by a free online application. Pre and post-self-assessments were measured using a Likert scale. Findings: Participants (N = 92) showed an average decrease in perceived stress by 46% and anxiety by 45%, and an increase in feelings of happiness by 17% and perceived coping ability by 18%. Conclusion: This novel approach to promote well-being in the workplace can be achieved using existing resources such as Reiki-trained staff, a quiet space, and a 10-minute well-being session with guided meditation using a free online application.

The association between psychological reactions, resilience, and work engagement among Palestinian critical care nurses in West Bank

AIM

This study aimed to assess the association between psychological reactions (e.g., stress, anxiety, and depression), resilience, and work engagement among Palestinian critical care nurses in the West Bank and examine the correlation of psychological reactions and resilience with work engagement.

BACKGROUND

Work engagement is associated with psychological reactions and resilience, particularly among critical care nurses. There is a lack of studies on work engagement and these factors in Palestine.

METHODS

A cross-sectional, descriptive correlational design was adopted. A convenience sample consisting of 273 critical care nurses from private and governmental hospitals was recruited to participate. Depression, Anxiety, Stress Scale-21 (DASS-21), Connor-Davidson Resilience Scale-25 (CDRS-25), Utrecht Work Engagement Scale-9 (UWES-9), and demographic data were used to collect data during the period from March 20 to May 20, 2023.

RESULTS

Findings demonstrated that 53.9% of the nurses reported mild-to-moderate levels of depression, 49.8% reported moderate-to-severe levels of anxiety, and 49.1% reported moderate-to-severe levels of stress. Additionally, 57.5% and 52.7% of them had low resilience and work engagement, respectively. Moreover, work engagement negatively correlated with depression (r = -0.796, P < 0.01), anxiety (r = -0.654, P < 0.01), and stress (r = -0.796, P < 0.01), while positively correlated with resilience (r = 0.42, P < 0.01) and gender (r = 0.121, P < 0.05). Depression, anxiety, stress, resilience, and gender were the main predictors of work engagement.

DISCUSSION

The majority of the nurses suffered from depression, anxiety, and stress. Additionally, more than half of the participants had low resilience and work engagement. Moreover, increased depression, anxiety, and stress were correlated with decreased work engagement, while high resilience and gender as being female positively correlated with high work engagement.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers and hospital administrators should develop interventions to improve critical care nurses' resilience and minimize psychological reactions, which have a significant influence on work engagement. Future studies should be conducted to examine the effectiveness of these interventions.

Transcendental Meditation Enriches Nurses' Authentic Presence Through Caring for Self and Others

Purpose of Study: Given the enormity of the most recent challenges to clinician well-being, intensified by the pandemic, we decided to explore the influence of Transcendental Meditation® (TM)® on the well-being of clinical nurses. The purpose of our study was to use qualitative analysis to enhance our understanding of the experiences of clinical nurses who practiced TM, as viewed through the lens of our conceptual model and Watson's holistic unitary caring science theory. Design and Method: This qualitative study involved a thematic analysis of clinical nurses' written descriptions following the completion of the TM program during the COVID-19 pandemic. Findings: The nurse participants shared their experiences with the practice of TM as creating present moment focus, leading to enhanced self-care, and development of authentic presence with others. The overall theme uncovered in the analysis is that authentic presence is veritas (truth) in knowing, being, doing, and becoming. Conclusions: The findings were congruent with Watson's unitary caring science theory and provided illumination of the holistic value of TM as a self-care strategy for supporting nurses' well-being with the goal of retaining nurses in practice. When nurses care for themselves, they are more likely and able to care for others, thus helping them to enjoy their nursing careers.

Mediating role of resilience on burnout to well-being for hospital nursing staff in Northeast China: a cross-sectional study

OBJECTIVES

The well-being of nursing staff is closely related to nursing performance and patient safety. It has attracted much attention from nursing managers and researchers. However, the most important influencing factors and their relationships are not fully understood. The purpose of this study is to identify the factors influencing the well-being of nurses and find out the mediating role of resilience of from burnout to well-being of hospital nursing staff.

DESIGN

A descriptive, multicentre cross-sectional study design.

SETTINGS

111 hospitals in Northeast China were randomly selected by the random cluster sampling method.

PARTICIPANTS

An online survey was administered to 11 827 nurses in December 2021, who engaged in clinical, nursing or management work and volunteered to participate.

OUTCOMES MEASURES

The sociodemographic characteristics, general well-being schedule, Maslach burnout inventory and Connor-Davidson resilience scale were used to assess all participants.

RESULTS

There are 15 variables entered into the regression equation, which can jointly predict 57.80% of the variance. There were a number of well-being-related factors identified. The individual factors include age, educational level, exercise, smoke, drinking, general health status, chronic disease, burnout and resilience. The organisational factors include psychological group, participating in psychological group activities, leadership training or communication training, working years, monthly income and night shifts. The results showed that the structural equation model of partial mediating effect of resilience was established. And the partial mediating effect accounted for 16.91% (-0.083/0.488) of the total effect.

CONCLUSIONS

There were a number of well-being-related factors identified, including individual and organisational factors, which provide directions for targeted support and interventions of nurses. It could improve the resilience of hospital nursing staff, reduce burnout and enhance well-being.

The aftermath of COVID-19: generalized anxiety disorder and burnout among radiology practitioners and interns in Saudi Arabia

Background

The coronavirus disease (COVID-19) pandemic has presented unprecedented stressors and difficulties for healthcare professionals. This study explored the prevalence of generalized anxiety disorders and burnout among radiology practitioners and interns in various hospitals in Saudi Arabia after the end of the COVID-19 global public health emergency.

Methods

A cross-sectional survey of 230 radiology practitioners and interns was conducted between October and November 2023. This study utilized the Generalized Anxiety Disorder 7-item (GAD-7) scale and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP) 22-item questionnaire, employing a non-probability convenience sampling method. The average scores of the individual components constituting the GAD-7 scale and each burnout scale were calculated, and statistical analyses were conducted using the Mann-Whitney U and Kruskal-Wallis H nonparametric tests.

Results

Of 382 radiology practitioners and interns, 230 (60.2%) responded to the survey. Notably, 42.6% of the participants reported experiencing GAD. Regarding burnout, 82.3% were at moderate-to-high risk for emotional exhaustion, 93.5% for depersonalization, and 52.1% for personal achievement. The 31-40 years age group showed significantly higher burnout rates (p = 0.001) compared with the other age groups. Those with more than three years of experience had notably higher emotional exhaustion scores (p = 0.002) and a nearly significant increase in depersonalization scores (p = 0.051) than those with less experience.

Discussion

Our study revealed that 42.6% of radiology practitioners and interns experienced GAD, with the majority facing significant burnout. Furthermore, our research indicates a decline in GAD levels among radiology practitioners and interns compared with the peak COVID-19 pandemic period. It also showed a significant increase in both the incidence and severity of burnout, surpassing pre-pandemic levels in a comparable cohort. These findings emphasize the pressing challenges of GAD and burnout among healthcare workers, especially radiology professionals.

Comparative Outcomes of a Cognitive-Behavioral Skills Building Program on the Mental Health and Healthy Behaviors of Prenursing Students

BACKGROUND

Nursing students experience significantly more stress related diseases when compared to non-nursing students, and the state of their mental health can result in short-term increased attrition rates and increased nursing shortages.

PURPOSE

A preexperimental pre-post study design was used to examine mental health and healthy behaviors among prenursing students.

METHODS

Cohorts received the MINDSTRONG© program either in-person or virtually. Data analysis included Personal Wellness Assessments completed at both pre- and poststudy for all participants (n = 110).

RESULTS

Both groups postintervention had statistically significant decreases in anxiety, depression, and stress and statistically significant increases in healthy lifestyle behaviors and beliefs. Students with elevated depression and anxiety scores at baseline had greater decreases postintervention than the overall groups.

CONCLUSION

The outcomes for both cohorts were positive and effective in reducing stress, anxiety, and depressive symptoms. Healthy behaviors were improved and align with findings with an in-person format. Findings from this study support implementation of MINDSTRONG in synchronous sessions, either in-person or virtual.

Factors Associated with Stress among Healthcare Personnel after COVID-19 in Northeast Thailand: A Cross-sectional Study

Background

The coronavirus disease (COVID-19) has affected people psychologically worldwide, particularly healthcare personnel. Even though the COVID-19 pandemic situation has eased, healthcare personnel must still perform their duties, which has resulted in psychological impacts, particularly stress.

Objectives

This study aimed to examine the risk factors associated with stress among healthcare personnel post-COVID-19 pandemic in northeast Thailand.

Methods

A cross-sectional analytic design was conducted from January to April 2023. One thousand and three hundred healthcare workers were selected from primary, secondary, and tertiary hospitals across 16 districts within Chaiyaphum province. The questionnaires were used to collect data, and the stress test 5 (ST-5) questionnaire was used to investigate stress among healthcare personnel.

Results

The overall stress rate for healthcare workers was 15.47%, including very severe (8.85%) and severe (6.62%). The factors associated with stress consisted of work position, environment of work, personal life such as education level and income, and responsibility for taking care of family members, in addition to experiencing quarantine from COVID-19 were more likely to have a high risk of stress problems among healthcare workers.

Conclusion

This result highlighted that the mental health of personnel should be in critical situations, and those found severely afflicted should undergo professional care. To prevent psychological issues, particularly stress, health organizations should be concerned with strong organizational management, which includes supporting bonuses and providing high-quality personal protective equipment (PPE) to healthcare staff.

Risk factors and consequences of mental health problems in nurses: A scoping review of cohort studies

Mental health problems in nurses are prevalent and impairing. To date, no literature has comprehensively synthesised cohort evidence on mental health among nurses. This scoping review aimed to synthesise the existing literature on the risk factors and consequences of mental health problems in nurses. A systematic search was conducted on PubMed, EMBASE, Epistemonikos database, Web of Science, CINAHL, and PsycINFO from inception to March 2023. We identified 171 cohort studies from 16 countries, mostly (95.3%) from high-income economies. This review indicated that nurses worldwide encountered significant mental health challenges, including depression, cognitive impairment, anxiety, trauma/post-traumatic stress disorder, burnout, sleep disorder, and other negative mental health problems. These problems were closely related to various modifiable risk factors such as nurses' behaviours and lifestyles, social support, workplace bullying and violence, shift work, job demands, and job resources. Moreover, nurses' mental health problems have negative effects on their physical health, behaviour and lifestyle, occupation and organisation, and intrapersonal factors. These findings provided an enhanced understanding of mental health complexities among nurses, and shed light on policy enactment to alleviate the negative impact of mental health problems on nurses. Addressing mental health among nurses should be a top priority.

"We're Not Valued, We're Not Heard": Voices of Seasoned Nurses in a Rural State Following the Onset of COVID-19

The COVID-19 crisis shone a spotlight on long-standing issues in the nursing profession. Currently, nurses feel overworked, unsupported, and undervalued. This interpretive phenomenological study shares the perspectives of 10 seasoned nurses. The overarching theme is "My job doesn't love me back," supported by "Enough pizza already," "Band-Aid on a hemorrhage," "We were heroes and now no one remembers us," "We used to be so trusted," and "Nursing is psychological warfare." It is imperative that systems and leaders listen to the concerns of nurses and provide avenues for nurses to take action to collaborate and convene organizational culture change.

The Interplay Between Problematic Internet Use, Anxiety, Depression and Functional Impairment in Front-Line Healthcare Workers During the COVID-19 Pandemic

OBJECTIVE

We aimed to assess the interplay between functional impairment and anxiety, depression, and problematic Internet use levels in front-line healthcare workers who work in inpatient clinics of coronavirus disease-2019 (COVID-19) during the COVID-19 pandemic.

METHODS

Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Internet Addiction Test (IAT), and Sheehan Disability Scale (SDS) were administered to assess the depression, anxiety, problematic Internet use, and functional impairment levels of the participants.

RESULTS

Two hundred thirteen participants were enrolled in the present study. Medical doctors showed significantly higher scores of IAT than the nurses and other medical staff (Kruskal-Wallis=6.519, p=0.038). Levels of SDS total are significantly correlated with scores of IAT (r=0.257, p<0.001), BDI (r=0.383, p<0.001), and BAI (r=0.308, p<0.001). All subdomain scores of SDS (social, family, work) and total scores of SDS were significantly and positively correlated with BAI, BDI, and IAT scores (p<0.05). In the separation mediation analysis, problematic Internet use partially mediated the relationship between anxiety-depression and global functional impairment.

CONCLUSION

Health politicians should produce policies to develop strategies for coping with consequences of anxiety and depression in healthcare professionals during any health crisis. In addition, we should raise healthcare professionals' awareness that problematic Internet use is not suitable for dealing with anxiety and depression and may even lead to increase of functional loss.

The role of spirituality, religiosity, and self-care on infection preventionist well-being: Results from a national survey in the United States

BACKGROUND

The degree to which religiosity, spirituality, and self-care practices can improve well-being among infection preventionists is not well understood.

METHODS

We surveyed infection preventionists from a random sample of United States hospitals in 2021. Multivariable logistic regression models were used to examine the associations between measures of spirituality, religiosity, and self-care and well-being.

RESULTS

Our response rate was 47% (415/881). A total of 49% of respondents reported burnout, 17% reported increased feelings of uncaring, and 69% would choose to become an infection preventionist again. Most respondents found importance in spiritual well-being (88%), religious beliefs (82%), and self-care practices (87%). Spiritual well-being was associated with increased odds of choosing to become an infection preventionist again (odds ratio = 2.32, 95% confidence interval = 1.19-4.53, P = .01).

DISCUSSION

Our national survey provides evidence that spiritual importance is associated with career satisfaction among infection preventionists. Our findings contribute to a general body of evidence suggesting spiritual importance may translate to higher flourishing and well-being via serving a higher purpose.

CONCLUSIONS

Promoting spiritual well-being may positively influence career satisfaction and overall well-being among infection preventionists.

Factors associated with clinical nurse's mental health: a qualitative study applying the social ecological model

BACKGROUND

The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions.

METHODS

This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed.

RESULTS

Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy.

CONCLUSIONS

Our study provides a nuanced understanding of the multifaceted factors influencing nurses' mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings.

TRIAL AND PROTOCOL REGISTRATION

The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676 .

REPORTING METHOD

This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

How relational leadership can enhance nurses' well-being and productivity

Leadership is an essential skill in nursing and has a fundamental role in ensuring high-quality patient care and the effective functioning of healthcare systems. Effective nursing leadership is vital to support nursing teams as they negotiate the challenges confronting the profession, such as ageing populations and the increased use of healthcare technology. This article discusses various relational leadership styles that can be used to promote nurses' health and well-being and enhance productivity. The author also explores the benefits and challenges of implementing relational leadership in nursing.

"Did I do the right thing?" Nurses' experiences of caring for victims of child maltreatment: A qualitative study

PURPOSE

The purpose of this study is to explore and gain insight into pediatric nurses' lived experiences in caring for children who experienced maltreatment.

DESIGN AND METHOD

A qualitative descriptive phenomenological approach using Giorgi's method was used to support the inquiry of this study. Participants were recruited through the Society of Pediatric Nurses (SPN) and the International Association of Forensic Nursing (IAFN). To collect data, the research team conducted semi-structured interviews individually with each participant online via online video conferencing.

RESULTS

A total of 21 nurses participated in the study. In the final analysis of data, six meaning units are found: (1) helplessly watching children relive the traumatizing events, (2) lack of knowledge and training on caring for children who experienced maltreatment, (3) adversarial relationship and resentment towards parents, (4) conflicting emotions and feelings, (5) long-lasting effects of trauma, and (6) feelings of isolation and loneliness.

CONCLUSIONS

Pediatric and forensic nurses' experiences of caring for children who experienced maltreatment were highlighted by the fact that they lacked the knowledge of caring for these children and felt isolated.

PRACTICE IMPLICATIONS

Implementing simulation training on nurses' knowledge and confidence in caring for children who experienced maltreatment is a paramount of importance. This in turn may improve nurses' sense of belonging and enhance the quality of care victims receive.

Nursing Staff Presenteeism Scale: Development and psychometric test

BACKGROUND AND OBJECTIVES

Nurses tend to exhibit higher rates of presenteeism compared to other professions. Presenteeism can cause the work performance of nurses to suffer, jeopardizing their own and their patients' safety and leading to decreased quality of care and increased risks of errors. However, there is a lack of a validated assessment tool for presenteeism in Taiwan. Thus, the purpose of this study was to develop a Nursing Staff Presenteeism Scale (NSPS).

METHODS

To develop questionnaire items, participants from three medical centers in Taiwan were recruited. Through convenience sampling, 500 nurses who met the selection criteria were recruited from November 1, 2022 to January 18, 2023. The scale was developed based on a systematic literature review, a previous study, and expert consultation, and 50 items were initially generated. After removing three items that lacked discriminative power, the reliability and validity of the remaining 47 items were evaluated. An exploratory factor analysis was used to establish the construct validity. A confirmatory factor analysis and structural equation modeling for cross-validation were used to assess relationships of factors with items and the overall NSPS.

RESULTS

The final scale consisted of 44 items assessed on a five-point Likert scale that loaded onto three different factors of physical or mental discomfort (18 items), work performance (15 items), and predisposing factors (11 items). These three factors were found to explain 63.14% of the cumulative variance. Cronbach's alpha for the overall final scale was 0.953. The item-to-total correlation coefficients ranged 0.443 to 0.795.

CONCLUSIONS

The NSPS exhibited satisfactory reliability and validity. It can be applied to assess the level of presenteeism among clinical nurses and provide medical institutions with information regarding the causes of presenteeism, predisposing factors, and the impacts of presenteeism on their work performance to enhance the safety and quality of clinical care.

Culture of Safety and Preparedness: Benefits of Applying a Daily Mitigation Mindset in the Hospital Setting

AIM

Utilizing the subjective experience of nurse executives who have supervised nurses during a major disaster in a hospital setting, this study aims to describe the subjective experience of nurse executives (NE) who have supervised nurses' responses to major disasters. This paper will focus on strategies to support nursing response to disasters, specifically to strengthen resiliency and the ability to maintain function despite the shock of a disaster, including those caused by climate change.

METHODS

Semi-structured interviews were conducted with 11 hospital-based nurse executives who supervised nurses during some of the worst natural and human-made disasters in different regions of the United States. A phenomenological approach was used to analyze and describe emerging themes from the qualitative data.

RESULTS

Three nurse executives demonstrated theme saturation for mitigation steps to augment traditional disaster readiness activities: (1) Assessment of human infrastructure: daily skills needed during disaster response; (2) Identification and study of failure points and metrics; (3) Strengthening human infrastructure: rectifying deficiencies; and (4) Monitoring metrics and making corrections during conventional periods.

CONCLUSION

Mitigation steps may improve outcomes in hospital function during conventional times; therefore, these steps may improve resiliency and the ability to maintain functions during major disasters, including climate change.

Non-linear association of years of experience and burnout among nursing staff: a restricted cubic spline analysis

Background

Occupational burnout is intricately linked to a spectrum of physical disorders encompassing respiratory, cardiovascular, and gastrointestinal conditions, as well as manifestations such as headaches, type 2 diabetes, elevated cholesterol levels, chronic fatigue, and muscle pain. Despite this association, there remains a paucity of research on the specific risk factors contributing to burnout among nurses in China.

Methods

This cross-sectional study utilized convenience sampling to recruit participants, with data analyzed from 1,774 nurse staffs. Psychosocial traits were assessed using the Three-Item Loneliness Scale for loneliness, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms, the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms, the Connor Davidson Resilience Scale-10 item (CDRISC-10) for resilience, and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS) for burn out. Restrictive cubic spline analysis to investigate the dose-response relationship between years of experience and burn out. Multivariate linear regression was employed to investigate the relationship between burnout and various risk factors.

Results

After controlling for basic demographic variables, good sleep quality was associated with a reduction in emotional exhaustion (β = -0.307, p < 0.001), while loneliness (β = 1.334, p < 0.001), depressive symptoms (β = 0.896, p < 0.001), and anxiety symptoms (β = 0.504, p < 0.001) were significantly associated with increased emotional exhaustion. Moreover, higher levels of resilience were positively associated with personal accomplishment (β = 0.635, p < 0.001). Regarding depersonalization, loneliness (β = 0.577, p < 0.001), depressive symptoms (β = 0.429, p < 0.001), and anxiety symptoms (β = 0.152, p < 0.01) were found to increase its level. Conversely, good resilience was associated with a decrease in depersonalization (β = -0.069, p < 0.001). The non-liner association between year of experience and emotional exhaustion was significantly (p < 0.05).

Conclusion

Our findings revealed that significant risk factors contributing to burnout among nursing staff including bad sleep quality, loneliness, lower level of resilience, anxiety symptoms, depressive symptoms. Moreover, a nonlinear correlation between years of experience and the likelihood of experiencing emotional exhaustion was exist.

Clinical Nurse Well-being Improved Through Transcendental Meditation: A Multimethod Randomized Controlled Trial

OBJECTIVE

To evaluate the impact of Transcendental Meditation® (TM®) practice on the multidimensional well-being of nurse clinicians affected by the COVID-19 pandemic.

BACKGROUND

The health of clinical nurses has substantial impact on both the availability of a nursing workforce and the quality and safety of patient care. TM improved health and coping strategies across many populations.

METHODS

Clinical nurses were recruited from 3 Magnet®-designated hospitals during the COVID-19 pandemic. Well-being outcomes included flourishing, burnout, anxiety, and posttraumatic stress disorder. Participants were randomized following completion of baseline surveys into immediate (intervention) or delayed (control) TM instruction. Surveys were repeated at 1 and 3 months following baseline survey or TM instruction. Repeated-measures analysis of variance compared differences in groups over time.

RESULTS

Across the 3 sites, there were 104 clinical nurse participants. Repeated-measures analysis of variance showed significant medium to large effects in improvement over time in well-being measures for the intervention group.

CONCLUSIONS

TM improved multidimensional well-being of clinical nurses by reducing posttraumatic stress disorder, anxiety, and burnout and improving flourishing. TM is easy to practice anywhere. The benefits are immediate and cumulative. Organizations and individual nurses can use TM to support clinical nurses in the difficult and meaningful work of patient care, especially in challenging times. Future studies may consider the feasibility of integrating TM into clinical shifts and evaluating its impact on patient and organizational outcomes.

Work-Related Health Conditions Among American Nurses: A Scoping Review

Background

Working in the nursing profession is hazardous, and nurses report poor health. Risk factors associated with poor health outcomes have been documented. However, the extent of literature exploring the prevalence of health conditions among American nurses that may be attributable to their work has not been examined.

Method

A scoping review following the Joanna Briggs Institute recommendations was conducted of peer-reviewed quantitative studies to answer the question: What are health conditions experienced by American nurses that may be attributable to their work as nurses?

Results

Thirty articles met the inclusion criteria. Due to the methods used in many articles, studies of the prevalence of health conditions among the nursing population were lacking. Health conditions studied broke into six categories: (a) work-related injuries and hazards; (b) unhealthy lifestyles; (c) mental health conditions; (d) burnout; (e) fatigue, sleep, and migraines; and (f) reproductive health. The role of work in the health conditions studied varied from an immediate impact on health (e.g., a needlestick or injury) to a cumulative impact (e.g., scheduling or workplace demands). Within the work demands, the physical environment; physical, emotional, and cognitive demands of work; and shiftwork were all frequently identified as antecedents that could be further explored and addressed to improve nurse health.

Conclusions

Healthcare systems should seek to address the hazards and exposures that may be linked to health conditions in the nursing workforce. Understanding and mitigating the impact of the pandemic and nursing work on the workforce's health is crucial to the solvency of the workforce. Occupational health practitioners should assess for workplace hazards and exposures.

The Relationship Between Nurses' Psychological Well-Being and Their Work Productivity Loss: A Descriptive Correlational Study

Introduction

Nurses play a vital role in ensuring effective patient care delivery and organizational productivity. Hence, it becomes imperative to prioritize their psychological well-being and explore how its impairment may be associated with their productivity loss.

Aims

The study aims to investigate the relationship between nurses' psychological well-being and their work productivity loss by examining how nurses self-reported their own psychological well-being and work productivity loss.

Methods

A descriptive correlational design was conducted at an Egyptian university hospital. A convenience sample of 400 nurses completed two tools: (a) Outcome Questionnaire-45 was used to assess the psychological well-being of nurses and (b) the Work Productivity and Activity Impairment - General Health Questionnaire was used to measure nurses' work productivity.

Results

Among the 400 surveyed nurses, 66.7% reported overall poor psychological well-being. Regarding work productivity loss, 22.8% of nurses missed an average of 974.81 work hours due to absenteeism, and 62.0% lost an average of 10,630 work hours due to presenteeism. Additionally, 75.5% experienced impaired daily living activities. Approximately 13.4% of total working hours were missed due to health problems or psychological distress. Regression analysis revealed that poor psychological well-being significantly predicts work productivity loss, accounting for 2.0% of absenteeism, 11.0% of presenteeism, 17.0% of daily activity impairment, and 9.0% of overall productivity loss, with the model being significant (p < 0.01).

Conclusion

Nurses often experience poor psychological well-being and distress that hinder their daily activities and cause work productivity loss. Therefore, hospital management should prioritize improving nurses' physical and mental health and bolstering their self-efficacy and resilience to minimize the effects of symptom distress on productivity. Investing in nurses' well-being through managerial caring, organizational support, and fostering a supportive work environment are vital strategies for promoting quality patient care and enhancing their work productivity.

A cognitive-behavioral skills building program improves mental health and enhances healthy lifestyle behaviors in nurses and other hospital employees

BACKGROUND

Mental health outcomes in nurses have historically indicated a greater prevalence of anxiety, depression, and suicide than the general population. It is vital to provide programming for healthcare workers to gain the necessary skills to reduce burnout and improve their mental and physical health.

AIMS

The aims of this study were to evaluate mental health outcomes and healthy lifestyle beliefs and behaviors among nurses and other hospital employees who completed MINDBODYSTRONG, a cognitive-behavioral skill building program.

METHODS

A pre-experimental, pre- and poststudy design was used to examine mental health and well-being outcomes among 100 hospital personnel who participated in MINDBODYSTRONG, a program designed to improve coping and resiliency and decrease stress, anxiety, and depressive symptoms. Outcomes measured included healthy lifestyle behaviors, healthy lifestyle beliefs, anxiety, depression, stress, and burnout.

RESULTS

One hundred hospital personnel, including 93 nurses, completed the pre- and post-survey. Among all participants, post- MINDBODYSTRONG scores for healthy lifestyle beliefs (p = .00; Cohen's d = 0.52) and healthy lifestyle behaviors (p = .00; Cohen's d = -0.74) increased significantly with medium effects, while depression (p = .00; Cohen's d = -0.51), anxiety (p = .00; Cohen's d = -0.54), stress (p = .00; Cohen's d = -0.33), and burnout (p = .00; Cohen's d = -0.37) decreased significantly with small and medium effects. The program produced even stronger positive effects on mental health outcomes for participants who started the study with higher levels of depression and anxiety.

LINKING EVIDENCE TO PRACTICE

Anxiety, depression, stress, and burnout decreased significantly postintervention. Participants also significantly improved their healthy lifestyle beliefs and behaviors with the MINDBODYSTRONG program. MINDBODYSTRONG is an effective program that reduces anxiety, depression, burnout, and stress and improves healthy lifestyle beliefs and behaviors in hospital-based clinicians. It is of utmost importance to provide evidence-based programs to improve mental resiliency and decrease stress, anxiety, burnout, and depressive symptoms, which will ultimately improve the safety and quality of health care.

Toxic leadership, mental well-being and work engagement among nurses: a scale adaptation study and structural equation model approach

PURPOSE

Although the background on positive and supportive leadership styles and their positive effects is constantly increasing, it is known that negative and destructive leadership styles are less researched. Thus, examining the toxic leadership behaviors of nurse managers and the effects of these on nurses has a critical significance. When the measurement tools evaluating toxic leadership are examined, it is seen that there is a need for measurement tools that evaluate the toxic leadership behaviors of nurse managers. This study's purpose is to psychometrically examine the Turkish version of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM-TR) Scale and test the hypothesized conceptual model that includes the relationships between toxic leadership, mental well-being and work engagement.

DESIGN/METHODOLOGY/APPROACH

This quantitative research was carried out in psychometric, correlational and cross-sectional design. A total of 559 nurses were included in the study by using the convenience sample method. The ToxBH-NM-TR Scale, Warwick-Edinburg Mental Well-Being Scale and Utrecht Work Engagement Scale (UWES) were used to measure the latent variables of the study. The data were collected between June and October 2020 with the online survey method. IBM SPSS Statistics 24 and Amos 21 statistical programs were used to analyze the data.

FINDINGS

The scale-content validity index of the ToxBH-NM-TR was 0.88. Confirmatory factor analysis results showed that the fit indices were acceptable. The ToxBH-NM-TR had high internal consistency and temporal stability. In addition, the relationships between the latent variables of the study were in the expected direction and statistically significant (p < 0.001). The hypothesized conceptual model showed an acceptable or good fit to the data. Mental well-being partially mediated the relationship between toxic leadership and work engagement. The study showed that the ToxBH-NM-TR is a valid and reliable instrument and provided evidence that confirmed the hypothesized conceptual model.

RESEARCH LIMITATIONS/IMPLICATIONS

The first of these is the fact that managers' toxic leadership behaviors were determined based on nurses' self-report. For this reason, participants' potential prejudices may have affected the results of the study. The second limitation concerns the data collection technique. Using face-to-face data collection techniques during the COVID-19 pandemic could create a danger/risk for the health of nurses, researchers and patients. Therefore, the nurses in this research were reached through an online survey on social media platforms. The participants of the study were limited to those who had access to social media. Finally, some socio-demographic and professional characteristics of the participants may be a confounding variable for the model. For this reason, this conceptual model needs to be validated on other samples in different countries to increase the generalizability of the research results.

PRACTICAL IMPLICATIONS

The characteristics of this leadership style should be understood, and its effects on employees and organizations should be evaluated by screening regularly to prevent the development of toxic leaders and to eliminate the harmful effects of their behavior. The nurses should respond decisively to the forces that cause them to submit in order not to encourage a toxic leadership style. Healthcare institutions should develop procedures and take a proactive approach to destructive and negative leadership behaviors and practices. In addition, nurse managers should get feedback by using informal networks and 360-degree assessment tools and evaluate whether their leadership has a toxic function by regularly screening the effects of their leadership.

ORIGINALITY/VALUE

The results of this study offer important implications for nurses, managers and healthcare institutions and can be useful in gaining awareness about the negative effects of a toxic leadership style. In addition, the study provides a valid and reliable scale that will enable the identification of managers with this leadership style to prevent the development of toxic leaders and eliminate the harmful effects of their behavior.

Ramifications of the COVID-19 Pandemic on Nursing Students' Transition to Practice

As the COVID-19 pandemic altered the course of nursing education worldwide, it disrupted efforts to transition nursing students to professional practice. The investigators examined clinical nursing faculty members' assessment of senior students' practice strengths and challenges compared to graduates of prior years. Findings demonstrated COVID-19's wide-ranging impacts on nursing students' transition to practice and offered suggestions about the implications for nursing professional development practitioners.

Examining the health and functioning status of medical laboratory professionals in Ontario, Canada: an exploratory study during the COVID-19 pandemic

OBJECTIVES

This study aims to explore the overall and specific aspects of the functioning of medical laboratory professionals (MLPs) in Ontario, Canada during the COVID-19 pandemic.

DESIGN

A cross-sectional analysis where a questionnaire was used to assess the mental status of MLPs.

SETTING

An online questionnaire administered in Ontario, Canada.

PARTICIPANTS

632 MLPs (medical laboratory technologists, technicians and assistants) were included.

MAIN OUTCOME MEASURES

We employed the WHO Disability Assessment Schedule V.2.0 (WHODAS V.2.0) Questionnaire to assess functioning/disability and Copenhagen Psychosocial Questionnaire, third edition for psychosocial workplace factors. Multiple regression analysis examined the relationship between overall and specific domain functioning scores and psychosocial workplace factors.

RESULTS

Of the total 632 participants, the majority were female gender and Caucasian. It was found that health (β=2.25, p<0.001, CI: 1.77 to 2.73), management of environmental conditions (β=0.65, p<0.001, CI: 0.33 to 0.98), fear of unemployment (β=-0.72, p<0.001, CI: -1.09 to -0.35) and frequency of stress (β=-1.86, p<0.001, CI: -2.33 to -1.40), in addition to bullying exposure (β=0.56, p<0.01, CI: 0.15 to 0.98) and threats of violence exposure (β=0.90, p<0.01, CI: 0.25 to 1.54), significantly decreased functioning overall and within the specific WHODAS V.2.0 functioning domains.

CONCLUSION

This study provides preliminary evidence of the overall and specific aspects of functioning among the MLPs during the COVID-19 pandemic. Besides, these findings can support and guide the improvement of workplace practices and policies among MLPs in the future.

Characterizing burnout and resilience among nurses: A latent profile analysis of emotional exhaustion, emotional thriving and emotional recovery

AIMS

To identify subgroups of nurses with distinct profiles of burnout (emotional exhaustion) and resilience (emotional thriving and emotional recovery) and describe nurse characteristics associated with each profile.

DESIGN

Cross-sectional, correlational design.

METHODS

Data were collected via electronic survey from 2018 to 2019. Latent profile analysis was used to identify subgroups of nurses with distinct profiles of emotional exhaustion, emotional thriving and emotional recovery, with each measured on a 0-100 scale. Bivariate statistics were used to determine profile differences in nurse sociodemographic, professional and psychological characteristics.

RESULTS

Four distinct profile subgroups were identified: (1) "exhausted" (14% with very high emotional exhaustion, low emotional thriving and moderate emotional recovery), (2) "exhausted with thriving" (6% with high emotional exhaustion, moderate-high emotional thriving and low emotional recovery), (3) "exhausted with thriving and recovery" (52% with moderate-high emotional exhaustion, emotional thriving and emotional recovery), and (4) "thriving and recovery" (27% with low emotional exhaustion and very high emotional thriving and emotional recovery). Nurses in the "exhausted" and "exhausted with thriving" profiles reported greater depression and poorer work-life integration. Nurses in "exhausted" profile were more likely to work in an inpatient setting. Nurses in the "exhausted with thriving and recovery" and "thriving and recovery" profiles reported more positive emotions, more well-being behaviours, and better work-life integration, with the "thriving and recovery" subgroup having the highest levels of these characteristics, lower depression scores and greater racial minority representation.

CONCLUSION

Approaches designed to improve nurse well-being should be tailored to the nurses' profile of emotional exhaustion, thriving and recovery to maximize effectiveness.

IMPACT

Given the growing shortage of nurses in healthcare systems, it is critical that multilevel strategies be investigated to retain nursing staff that consider the intersectionality and complexity of the different aspects of burnout and resilience experienced by the nurse.

NO PATIENT OR PUBLIC CONTRIBUTION

The aim was to assess burnout and resilience among nurses.

A mixed-methods exploration of nurse loneliness and burnout during COVID-19

AIM

This study investigated the phenomenon of nurse loneliness as a potential contributor to burnout.

BACKGROUND

Nurse wellbeing is critical for safe and efficient healthcare delivery. However, evidence indicates nurses' wellbeing is at risk. The levels of burnout, the most commonly measured symptom of suboptimal wellbeing, are rising and may relate to a largely unexplored phenomenon: loneliness.

METHODS

A mixed-methods approach was used to investigate burnout and loneliness in direct-care nurses in four diverse hospitals in the midwestern and southeastern United States. Burnout and loneliness were measured, prevalence was estimated, and correlation was examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. While this study did not explicitly explore the impact of the global pandemic, data was collected in late 2021 and early 2022, during the Delta variant wave.

RESULTS

In the study population (n = 117), rates of burnout are high and positively correlate with loneliness. Qualitative interviews (n = 11) revealed that nurses feel unseen, emotionally detached from their work, and dehumanized. However, social connection with peers is protective and nurses still report a strong sense of devotion to the profession and solidarity with peers.

CONCLUSIONS

This study offers insight into nurse loneliness, highlighting the importance of social connectedness to improve nurse wellbeing.

Registered nurses' psychological capital: A scoping review

AIMS

The aim was to examine the extent and scope of empirical research concerning registered nurses' psychological capital.

BACKGROUND

In a time of global nursing shortage, identifying variables that could positively contribute to the retention of the nursing workforce is essential. Prior research has shown that psychological capital correlates positively with employees' better performance and well-being.

DESIGN

A scoping review.

DATA SOURCES

A systematic literature search was conducted in the following databases: PubMed, CINAHL, PsycINFO, Web of Science and Scopus covering the period from 1 January 2005 to 7 May 2023.

REVIEW METHODS

The JBI methodological guidance for scoping reviews was followed. The results were summarized narratively.

RESULTS

A total of 111 studies reported in 114 peer-reviewed articles were included. Studies were carried out across 20 countries, with the majority from China (45), Australia (nine), Pakistan (nine), Canada (eight), South Korea (eight) and the United States (eight). A positive correlation was found between registered nurses' psychological capital and desirable work-related outcomes, such as work engagement, commitment and retention intention.

CONCLUSION

A comprehensive overview of research evidence suggests that psychological capital is associated with many positive work-related outcomes and might therefore be a valuable resource for reducing nurse turnover.

State of Mental Health, Healthy Behaviors, and Wellness Support in Big 10 University Nursing and Health Sciences Faculty, Staff, and Students During COVID-19

BACKGROUND

Federal and national entities urge organizations to assess healthcare professionals' mental health and well-being as the COVID-19 pandemic has compounded the issue.

AIMS

This study aimed to (1) describe rates of mental health issues, healthy lifestyle behaviors, and perceptions of COVID-19's impact among Big 10 University nursing and health sciences faculty, staff, and students; (2) identify predictors of depression, anxiety, stress, and burnout; and (3) assess the relationships among perceived school wellness support, healthy lifestyle behaviors, physical/mental health, and mattering.

METHODS

A cross-sectional descriptive correlational design was used. Nursing and health science deans emailed invitations to faculty, staff, and students concerning an anonymous wellness assessment survey. Correlation coefficients tested associations among mental health indicators and wellness cultures. Multiple linear regression examined factors associated with mental health indicators.

RESULTS

Faculty, staff, and students responded (N = 1345). Findings indicated that most respondents were not getting adequate sleep, meeting physical activity recommendations, or eating the daily recommended number of fruits/vegetables. Fourteen to 54.9 % of participants reported depression, anxiety, and burnout. Overall, students, faculty and staff at colleges that operated under a strong wellness culture had better outcomes.

CONCLUSION

Wellness cultures impact the mental and physical health of faculty, staff, and students.

Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed-methods systematic review and thematic synthesis

AIM

To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and professional and career intentions.

DESIGN

Joanna Briggs Institute mixed-methods systematic review and thematic synthesis. Registered in Prospero (Redacted).

METHODS

Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.

RESULTS

Searches yielded 2343 hits. Seventy-seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well-being.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution to this systematic review.

A Contemporary Model for Improving RN Job Outcomes

The pandemic has highlighted three critical nursing workforce issues: turnover, wellbeing, and equity. A comprehensive framework is needed to understand the interactions between these concepts. This paper proposes a model that allows for more inclusive understanding of professional outcomes for RNs, with attention not just to job outcomes, but also to equity for underrepresented groups in the workforce and individual wellbeing. The model highlights the importance of systems and societal elements, contextual elements, and individual responses to the dynamic conditions of work and life, and can be used to advance research and practice to create effective retention and support strategies.

Thriving psychological well-being in undergraduate nursing student: a grounded theory study with the life grid approach

BACKGROUND

Psychological well-being (PWB) plays a vital role in successful adaptation to the Bachelor of Nursing journey and affects career development. However, there is little known about the functional and social processes associated with enhancing well-being specific to the subjective perspective of nursing students.

AIM

To investigate how nursing students promote their psychological well-being to conceptualize thriving psychological well-being.

METHOD

This qualitative study analyzed and reviewed a life grid and semi-structured in-depth interviews of 20 Chinese Nursing graduates by investigators and participants, following Charmaz's constructivist grounded theory. The constant comparative method was used to analyze data. This study took place between 2020 and 2022.

RESULTS

All participants experienced fluctuations in psychological well-being. This study identified a new understanding of how nursing students enhance their psychological well-being. Thriving awareness was co-constructed as the core category and based on the relationship with a supportive environment, the thriving psychological well-being of nursing students is conceptualized.

CONCLUSIONS

It is imperative to enhance the psychological counseling and support for nursing students during their clinical placements, during the period just entering university as well as after repeated outbreaks of COVID-19. Nursing educators and administrators could develop appropriate educational programs and interventions based on the theoretical model-Thriving psychological well-being.

Proof of Concept Testing of Safe Patient Handling Intervention Using Wearable Sensor Technology

BACKGROUND

Healthcare workers make up one of the occupations in the United States that experience the most musculoskeletal injuries. These injuries are often related to the movement and repositioning of patients. Despite previous injury prevention attempts, injury rates remain at an unsustainable level. The purpose of this proof-of-concept study is to provide preliminary testing of the impact of a lifting intervention on common biomechanical risk factors for injury during high-risk patient movements.; Methods: A before-and-after (quasi-experimental) design was utilized to compare biomechanical risk factors before and after a lifting intervention. Kinematic data were collected using the Xsens motion capture system, while muscle activations were collected with the Delsys Trigno EMG system.

RESULTS

Improvements were noted in the lever arm distance, trunk velocity, and muscle activations during the movements following the intervention; Conclusions: The contextual lifting intervention shows a positive impact on the biomechanical risk factors for musculoskeletal injury among healthcare workers without increasing the biomechanical risk. A larger, prospective study is needed to determine the intervention's ability to reduce injuries among healthcare workers.

Psychological capital, grit and organizational justice as positive strengths and resources among registered nurses: A path analysis

AIM

To examine registered nurses' individual strengths (psychological capital and grit) and an organizational resource (organizational justice) as well as associated work-related outcomes. In a time of a global nursing shortage, there is an urgent need to identify strengths and resources that can have a positive impact on the health, well-being and retention of registered nurses.

DESIGN

A cross-sectional survey.

METHODS

A nationwide convenience sample of 514 registered nurses responded to a survey. Data were collected using a self-reported questionnaire between March and May 2018. Data were analysed using descriptive statistics and multivariate path analysis.

RESULTS

Participants rated their psychological capital and grit moderately high. Grit and organizational justice were found to have significant direct effects on psychological capital. Furthermore, psychological capital had positive direct effects on engagement and the perception of well-conducted everyday nursing as well as negative direct effects on burnout, the stress of conscience and the intent to leave the profession.

CONCLUSION

The results suggest that nurse leaders and managers could consider improving registered nurses' well-being with two complementary approaches. It might be useful to reinforce positive, individual strengths, such as psychological capital, and at the same time create more favourable nursing work environments, for example by strengthening organizational justice.

IMPLICATIONS FOR THE PROFESSION

Psychological capital and grit are emerging concepts in nursing workforce research. Identifying registered nurses' positive strengths and resources is important for inventing interventions that enhance nurses' engagement and well-being as well as reduce turnover intentions.

IMPACT

Nurse leaders and managers play crucial roles in managing and developing registered nurses' individual strengths and organizational resources. This has gained even more importance now as the COVID-19 pandemic could have a long-term negative impact on nurses' well-being.

REPORTING METHOD

The study is reported following STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide

Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses' risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses' health and well-being are provided.

Shift work disorder, mental health and burnout among nurses: A cross-sectional study

AIM

The aim of the study was to examine the relationships among nurses' shift work disorder, mental health and burnout to inform efforts to alleviate shift work disorder.

DESIGN

This cross-sectional study was conducted in China using a web-based platform for questionnaire.

METHODS

The study was comprised of a convenience sample of 1,268 Registered Nurses from 21 public hospitals in mainland China from June 2019-July 2019. Participants completed a web-based survey designed to collect demographic and other self-reported data. An independent sample t test and Pearson correlation were performed to analyse the relationship between shift work disorder, mental health and burnout.

RESULTS

The vast majority (98.2%) of the participants were women between the ages of 20-59 years. The participants exhibited a higher incidence of mental health problems (58.1%) and burnout (65.5%) and those with shift work disorder exhibited a higher risk of mental health problems and burnout than those who did not have shift work disorder. Our research demonstrated that shift work disorder, combined with other variables, accounted for 40.5% of the variance in mental health (R²  = .405, adjusted R²  = .401, F = 107.214, p < .001) and 36.5% in burnout (R²  = .365, adjusted R²  = .361, F = 90.323, p < .001). Moreover, burnout negatively regulated the relationship between shift work disorder and mental health.

CONCLUSION

High-risk nurses with shift work disorder were at a much higher risk of mental health problems and burnout.

The State of Health and Intentions for Action to Advance Mental Health and Well-being for the Nursing Workforce

OBJECTIVE

The aims of this study were to explore the health of nurse leaders and assess intentions to integrate workplace mental health/wellness practices.

BACKGROUND

National efforts address high rates of poor mental health and lifestyle behaviors among nurses. Few studies describe the extent to which nurse leaders in academic and clinical environments can influence a strategic mission for health/well-being among the nursing workforce.

METHODS

Two hundred seventeen email invitations were distributed to nurse leaders from 5 Kentucky nursing organizations to complete a 1-time 46-item online survey assessing individual health behaviors and intentions to build a culture of workplace health/well-being.

RESULTS

Most respondents reported positive physical health (86%), positive mental health/intentions for action to change behaviors (80%), improved self-care practices (86%), integration of self-care practices in the workplace (79%), and commitment to integrate suicide prevention training (55%).

CONCLUSIONS

Overall, nurse leaders reported positive healthy behaviors. The finding that the highest intentions were reported to integrate, sustain, and/or advance lifestyle behaviors for self-care practices as well as to integrate practices for mental health and well-being in the work environment is encouraging. Enhanced strategies and efforts are needed to prioritize workplace cultures of wellness to benefit nurses and further promote well-being among nurse leaders.