Resilience as a moderator of the indirect effects of conflict and workload on job outcomes among nurses

Resilience as a moderator of the effects of types of workplace bullying and job performance

BACKGROUND

Workplace bullying is a problem that can occur in any occupation or organization and is a stressful and negative experience for employees; resilience helps employees to better resist workplace bullying. The purpose of this study was to examine whether resilience moderates the effects of workplace bullying on job performance and to determine whether this moderating effect differs between three types of bullying: personal, work-related, and physical bullying.

METHODS

A self-administered, paper-based questionnaire was distributed to full-time nurses at three regional hospitals in Taiwan. Cross-sectional data on workplace bullying behaviors, resilience and job performance were collected from 422 nurses using a questionnaire survey. Data were collected using the Job Performance Scale, the Negative Acts Questionnaire, and the Resilience Scale (CD-RISC-10), and the resulting data were analyzed using SPSS 21 and the PROCESS macro.

RESULTS

Resilience moderated the positive relationship between personal, physical bullying and job performance (b = .11, p < .05; b = .17, p < .05), but did not moderate the effects of work-related bullying.

CONCLUSIONS

The findings of this study highlight the need for organizations to be proactive in preventing work-related bullying and to promote and enhance individual resilience. Managers need to be aware of the detrimental effects of work-related bullying, which can damage employees' physical and mental health and contribute to workplace toxicity.

When home stress translates to work: The impact of interpersonal conflict at home on employee silence

Compared to research about the effects of work-related interpersonal experiences on employee behaviours at home, research on whether and how home-related interpersonal experiences can affect employee behaviours at work has received less attention. This study aimed to contribute to this literature by examining whether interpersonal conflict at home can predict employee silence through exhaustion at work. The moderating effect of affective commitment on the relationship between interpersonal conflict at home and exhaustion was also explored. Using a two-wave design with data from 246 full-time employees, the current study found that interpersonal conflict at home positively predicted employee silence through exhaustion at work. Further, affective commitment exacerbated the relationship between interpersonal conflict at home and exhaustion at work. Our findings extend the understanding of mediating and moderating mechanisms for the effect of negative experiences at home on work behaviours.

Nursing Students' Resilience and Intent to Work at the Bedside

AIM

The primary purpose of this study was to explore relationships between self-efficacy, peer support, coping style, intent to work at the bedside, and resilience in nursing students.

BACKGROUND

Resilience correlates with one-year retention at the bedside. Retention of bedside nurses improves patient outcomes.

METHOD

A quantitative, correlational design determined relationships between variables. Surveys were completed by 205 participants. Surveys included a program type list, intent to work at the bedside items, the Brief Cope Scale, the General Self-Efficacy Scale, the Peer Group Caring Interaction Scale.

RESULTS

Significant relationships were found between resilience and self-efficacy, resilience and coping style, and peer support and approach coping style. Half of the respondents intended to work at the bedside for two years after graduation. Self-efficacy and avoidance coping were resilience predictors.

CONCLUSION

To support resilience, educators should facilitate students' development of self-efficacy and approach coping style.

Effects of interventions to promote resilience in nurses: A systematic review

BACKGROUND

Various trials are investigating the effect of digital and face-to-face interventions on nurse resilience; however, it remains unclear whether these interventions have immediate, short-term or long-term effects.

OBJECTIVE

The objective of the systematic review is to identify the types of interventions and assess the immediate (<3 months), short-term (3-6 months), and long-term (>6 months) effects of these interventions on nurse resilience.

DESIGN

This systematic review was registered in the International Prospective Register of Systematic Reviews (Registered Number: CRD 42023434924), and results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.

METHODS

Data were collated from the databases of CINAHL, Cochrane Library, Embase (OVID), Medline, and Scopus between March and May 2023. The research protocol was determined following the framework of population, exposure, outcomes, and type of study. The articles with full text published between 2000 and 2023 were included. Studies were included if they (1) involved the nurses who provided patient care directly, (2) utilised digital or face-to-face interventions, (3) reported resilience outcomes, and (4) were randomised controlled trials or clinical trials. The JBI critical appraisal tool was utilised to assess the risk of bias for the studies collected.

RESULTS

A total of 18 studies met the criteria and were analysed. Pooled results demonstrated that digital interventions had a statistically significant positive effect on nurse resilience at 4-5-month follow-ups (standardised mean difference [SMD] = 0.71; 95 % CI = 0.13, 1.29; P = 0.02) compared to no interventions. Additionally, pooled data showed no effect on nurse resilience at all the follow-ups, compared to no interventions. No significant results were observed in comparisons of digital or face-to-face interventions between the intervention and control groups.

CONCLUSIONS

The review assessed digital and face-to-face resilience interventions in nurses across 18 trials. Digital methods showed a short-term impact within 4-5 months, whilst face-to-face interventions had no effect during follow-ups. Realistic expectations, ongoing support, and tailored interventions are crucial for nurse resilience enhancement.

TWEETABLE ABSTRACT

It was identified digital interventions had a short-term impact on nurse resilience, whilst face-to-face interventions had no effect during follow-ups @fionayyu.

Decoding Nursing Job Demands: A Multicenter Cross-Sectional Descriptive Study Assessing Nursing Workload in Hospital Medical-Surgical Wards

Background

Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload and work contexts.

Purpose

The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context.

Methods

We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts.

Results

We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency.

Conclusions

In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions.

Can psychological capital promote safety behaviours? A systematic review

Objectives.Occupational health and safety (OHS) is a relevant issue for many systems and stakeholders. This systematic literature review aims to expand knowledge on this topic starting from the integrated safety model (ISM) and to evaluate the role of psychological capital (PsyCap) on safety behaviours (SBs) (i.e., safety performance and prevention of occupational accidents and injuries). Methods. A total of 2704 studies was initially identified in the Scopus, PsycINFO and Web of Science databases. After rigorous screening, 20 empirical studies were included. Results. The results showed the relevant contribution of PsyCap in promoting SBs as a direct antecedent, a mediator between organizational factors and SBs or a moderator between job demands and SBs. Conclusion. Findings indicate that when workers feel resourceful, they feel also more confident and engaged, and, in turn, more focused on safety issues. Moreover, the results sometimes turn out to be contradictory, showing the dark side of personal resources. Considering these results, a plan to monitor and develop PsyCap could be implemented to promote SBs and safety environment. Indeed, PsyCap can be an essential individual resource for behaving safely also by reducing job demands' perceptions and improving safety leadership.

Defining Resilience for Healthcare Professionals- a Delphi Study

Background: The concept of resilience is widely discussed in healthcare literature. There are various definitions and causal mechanisms underpinning the phenomenon of resilience.Aim: The aim of this study was to clarify this by exploring healthcare professionals' views on the meaning of resilience within their workplace settings. Design: A three-round Delphi survey.Methods: Based on a literature search, 41 'stem statements' related to resilience were constructed. This list was refined, extended, and restricted by a panel of experts.Results: The panel agreed on eight elements that best represented their perception of factors that impact either positively or negatively the level of resilience for UAE healthcare professionals.Conclusions: This consensus-based approach for the assessment of the level of resilience of HCP working in the UAE health system represents a first step toward the development of national guidelines for optimizing the health and wellbeing of healthcare professionals in the UAE.

Cultural competence in critical care nurses and its relationships with empathy, job conflict, and work engagement: a cross-sectional descriptive study

BACKGROUND

Cultural competence is more important than ever for nurses today; therefore, it may be helpful to learn more about it and examine how it relates to empathy, job conflict, and work engagement. The purpose of this study was to determine (a) the level of cultural competence, empathy, job conflict, and work engagement; (b) the relationship between cultural competence, demographic information, and main variables; (c) the predictors of cultural competence among critical care nurses.

METHODS

A multicenter, descriptive cross-sectional study was conducted in Iran from August to October 2022. Through convenience sampling, 153 critical care nurses from three hospitals participated. The research tool consisted of five parts: Demographic information questionnaire, Cultural Competence Questionnaire, Jefferson Scale Empathy, Dobrin Job Conflict, and Utrecht Work Engagement, which were collected by paper self-report. Descriptive statistics, the correlation between variables, and linear regression were used to analyze the data.

RESULTS

Among critical care nurses (response rate 79.27%), the mean (SD) scores for cultural competence, empathy, job conflict, and work engagement were 74.05 (7.96), 83.44 (29.17), 11.00 (2.38), and 43.69 (16.33), respectively. There was a significant correlation between cultural competence and age (r = 0.46, p = 0.001), marital status (r = 0.27, p = 0.004), academic degree (r = 0.44, p = 0.001), work experiences (r = 0.43, p = 0.001), empathy (r = 0.50, p = 0.001), and job conflict (r=-0.16, p = 0.049). Academic degree (β = 0.36, p < 0.001) and empathy (β = 0.26, p < 0.001) were significant explanatory variables that predict cultural competence.

CONCLUSION

In Iranian critical care nurses, cultural competence and job conflict were moderate, empathy was good, and work engagement was poor. There was a significant relationship between cultural competence, age, marital status, academic degree, work experiences, empathy, and job conflict. Academic degree and empathy predict cultural competence.

Worrying About Finances During COVID-19: Resiliency Enhances the Effect of Worrying on Both Proactive Behavior and Stress

Amidst the COVID-19 pandemic and resulting economic instability, many people are contending with financial insecurity. Guided by Conservation of Resources Theory (Hobfoll, American Psychologist 44:513-524, 1989; Hobfoll et al., Annual Review of Organizational Psychology and Organizational Behavior 5:103-128, 2018), the current research explores the consequences of experiencing financial insecurity during a pandemic, with a focus on individuals who report relatively higher rates of financial insecurity, performance challenges, and stress during such experiences: working parents (American Psychological Association, 2022). This research also examines the role that personal resources, in the form of trait resiliency, play in the relationships between financial insecurity and behavioral and psychological outcomes including worrying, proactive behaviors, and stress. In a study of 636 working parents and their children, we find that financial insecurity heightens worrying, underscoring the threatening nature of the loss or anticipated loss of material resources. Worrying, in turn, promotes proactive behaviors at work-an effect that is more pronounced among high-resiliency individuals. However, worrying is also associated with elevated stress among high-resiliency individuals, providing support for a trait activation perspective (rather than buffering hypotheses) on ongoing, uncontrollable adversities. Taken together, our results help to (1) illuminate the impact of financial insecurity on work and well-being, (2) reveal a mechanism (i.e., worrying) that helps explain the links between financial insecurity and work and personal outcomes, and (3) expand our knowledge of the implications trait resiliency has for both psychological and behavioral reactions to ongoing crises.

Proposing a Robust Model to Reduce Employees’ Turnover Intentions in an Ethical Leadership Framework: Empirical Evidence from the Healthcare Sector

Employee turnover is expensive and disruptive for an organization. Studies have already mentioned that the economic cost of turnover is huge, ranging from 90% to 200% of the existing employee’s salary. With an increase in turnover rate, the social fabric of an enterprise may be disrupted. Additionally, organizations with an increasing turnover are expected to lose intangible knowledge and skills, operational effectiveness, customer satisfaction, and product or service quality. In a healthcare context, an increasing turnover rate has more consequences than other sectors because the healthcare sector worldwide is already identified as a sector facing resource scarcity. Exacerbating the situation, current evidence suggests that employee turnover has been increasing globally in the healthcare sector. The literature suggests that an ethical leadership style may reduce employees’ likelihood of quitting an organization. However, such literature is sparse in healthcare, especially from the perspective of a developing economy in the Global South, which is more resource-deficient than the Global North. To fill this knowledge gap, this study investigates the relationship between ethical leadership style and turnover intentions in the healthcare context of the Global South. This study also tests the mediating effect of intrinsic motivation and psychological contract fulfillment in the above-proposed relationship. Furthermore, the conditional indirect effect of resilience is also tested. The data are collected from the hospital employees through a self-administered questionnaire. The hypothesized relationships are tested through structural equation modeling. The empirical evidence indicates that ethical leadership reduces employees’ turnover intentions significantly. The results further confirm the mediating and moderating effects of intrinsic motivation, psychological contract fulfillment, and resilience. These results have different theoretical and practical implications for the healthcare sector. The results especially highlight the role of ethical leaders in a hospital to deal with the challenge of turnover, which has been rising worldwide.

Job Demands, Resources and Burnout Among Polish Nurses During the Late Wave of COVID-19 Pandemic: The Mediating Role of Emotional Labor

Objective

Burnout has been recognized as a serious health problem. Nurses as a professional group are at a high risk of burnout occurrence, especially when facing burden associated with the COVID-19 pandemic. Despite evidence that higher job demands lead to burnout, there is less known about the indirect effect of job demands and resources on burnout via surface acting. Using the JD-R framework, this study examined how job demands and resources affected burnout among Polish nurses and whether these relationships are mediated by surface acting and moderated by coping with the workload.

Materials and Methods

A sample of 270 nurses from the biggest hospital in Southern Poland filled out an online questionnaire at the time between the fourth and the fifth wave of the COVID-19 pandemic in Poland. The Polish adaptations of Oldenburg Burnout Inventory (OLBI), Organizational Constraints Scale (OCS), Interpersonal Conflict at Work Scale (ICAWS), Areas of Worklife Survey (AWS), and Emotional Labor Scale (ELS) were used. Mediation and moderation analyses were carried out in the SPSS macro-PROCESS.

Results

Surface acting partially mediated the positive association between organizational constraints and interpersonal conflict at work and burnout, as well as the negative association between the perceived organizational support and burnout. Coping with workload moderated the direct effect of organizational constraints on burnout via surface acting.

Conclusion

The findings enrich the knowledge of the mediating and moderating mechanisms to explain the association between job demands, resources and burnout among nurses. There have been proposed interventions concerning increasing organizational support, effective emotional regulation of management education and psychological training regarding adequate coping strategies which could help reduce or prevent the occurrence of burnout in this professional group.

Systematic Review of Burnout in US Nurses

Nurses experience high levels of burnout, and this has become a major factor in recruitment and retention of nurses. Several factors have been associated with burnout, but it is not clear which factors are the most significant predictors. Understanding the most prevalent factors that are associated with burnout will allow for the development and implementation of interventions to ameliorate and/or reduce burnout in the nursing workforce.

Hair Cortisol, Perceived Stress, and the Effect of Group Dynamics: A Longitudinal Study of Young Men during Compulsory Military Training in Lithuania

Previous research shows a nonlinear dependency between hair cortisol concentrations and perceived stress levels. This may be due to stress being targeted at the individual level despite it also being a social phenomenon which is often affected by group dynamics. Therefore, the objective of this study was to determine the influence of perceived stress on the hair cortisol level, considering the impact of the variables of group dynamics (interpersonal, task, and norm cohesion). Information was collected on 11 groups of, in total, 112 young men in three phases of time during their compulsory military training (covering nine months in total). The classification and regression tree (C&RT) method was used to predict hair cortisol concentrations in groups. The results show that the variability of the hair cortisol level in young men groups can be explained by perceived stress only when the groups were in formation process (47.7% normalised importance in Model 1) and when the groups were working on their final tasks (37.80% normalised importance in Model 3); meanwhile, the importance of perceived stress in explaining hair cortisol concentrations is low when the group is in a routine period of a group life-span (28.9% normalised importance in Model 2). Interpersonal cohesion (normalised importance 100% in Model 1 and 80.0% in Model 3) and task cohesion (normalised importance 78.6% in Model 2) were the most important predictors in the study area. These results point to the importance of the elements of group dynamics when it comes to explaining the nature of hair cortisol as accumulated stress biomarkers in young men.

The reliability and validity of the compulsory citizenship behaviors (CCBs) scale: Six-step R-based psychometrics protocol among nurses in Turkey

PURPOSE

This study aims to assess the validity and reliability of the compulsory citizenship behaviors (CCBs) scale among Turkish nurses.

METHODS

The sample of this cross-sectional study consisted of 530 Turkish hospital nurses. We performed a six-step protocol to test the validity of the scale.

FINDINGS

The scale formed a unidimensional scale with good homogeneity (H = 0.79) and reliability (α = 0.94). The confirmatory factor analysis indicated that the five-item single factor measurement model of the scale well fit the data (GFI = 0.98, CFI = 0.99, TLI = 0.98, SRMR = 0.02, RMSEA = 0.10).

PRACTICAL IMPLICATIONS

The Turkish version of the CCBs scale satisfactorily met psychometric criteria in Turkish nurse samples and is recommended for further research.

Resilience Training for Nurses: A Meta-analysis

Nurses frequently face stressful situations during work, which makes resilience an essential quality of their personality to cope with professional stress and to prevent burnout. Resilience can be improved by training and practice. To analyze the effect of resilience training in nurses, studies reporting the changes in resilience before and after resilience training were identified by conducting the literature search in electronic databases. Meta-analyses of standardized mean differences (SMDs) between postintervention and preintervention scores of resilience and other related variables were performed. Thirteen studies (576 nurse participants) were included. Resilience training improved the resilience scores of the participants (SMD, 0.58; 95% confidence interval [CI], 0.23-0.94; P = .001), whereas there was no improvement in the resilience scores of nurses who did not participate in resilience training (SMD, -0.13; 95% CI, -0.54 to 0.27; P = .523). The stress (SMD, -0.60; 95% CI, -0.80 to -0.40; P < .00001), anxiety (SMD, -0.50; 95% CI, -0.80 to -0.20; P = .001), depression (SMD, -0.43; 95% CI, -0.67 to -0.19; P < .0001), and burnout (SMD, -1.01; 95% CI, -1.25 to -0.76; P <˂ .0001) scores of the participants were also decreased after resilience training. In conclusion, resilience training improved the resilience scores of nurses, which was also associated with improvements in stress, depression, anxiety, and burnout scores. However, because of the variations in training contents and measuring tools, only generalized assessments could be made.

Perceived Stress and Resilience among Nurses Working in a Selected Hospital at Mangalore

Objective A minimum amount of stress is essential for a successful life. When it goes beyond the limit, it affects overall well-being. There is a need to modify the environment, feelings, and physical factors of an individual to promote resilience. This study aimed to assess and find the relationship between perceived stress and resilience among nurses working in a selected hospital.

Materials and Methods The investigators used the descriptive correlation design and, through the nonprobability sampling method, selected 65 nurses. Data was collected using the demographic variables, perceived stress scale, and the Connor–Davidson resilience scale.

Results and Discussion The investigators found a moderate level of stress (61.5%) with intermediate resilience (73.8%) among the nurses and noted a weak correlation between perceived stress and resilience (calculated value is 0.226 and the p-value is 0.071). There was an association found between the frequency of night duty, education level, and perceived stress.

Conclusion Our study showed that most of the nurses had a moderate level of stress with intermediate resilience. The unmarried nurses were more resilient, with a moderate level of stress than the married.

The nurses' occupational stress components and outcomes, findings from an integrative review

AIM

To identify, evaluate and summarize the components, factors and outcomes of nurses' occupational stress published between 2009-2019.

DESIGN

Integrative literature review.

METHODS

A literature search was conducted on PubMed, CINAHL and PsycINFO databases for articles published in English, between 2009-2019.

RESULTS

The review included 132 studies. Most studies were conducted in the Confucian Asia and Anglo countries, but a growing number of studies were done in other countries. Almost all studies used a quantitative design, and changes in the use of scales indicated an increasing attention to career-related components. Factors were categorized into sociodemographic, work environment and personal resources. Sociodemographic factors were inconsistent across countries. Outcomes were categorized into health status, capability, affective and behavioural responses to work, and organizational performance with generally consistent results. Model validation studies showed the non-linear or non-direct associations between stress and outcomes.

Is all conflict the same? The role of perceived intensity in understanding its effects

While interpersonal conflict at work continues to draw attention, researchers have rarely considered the role that conflict intensity plays in amplifying individuals' affective reactions to it. Hence, this study examines conflict intensity as a moderator of the relationship between interpersonal conflict and perceived stress, physical symptoms, and job satisfaction, through negative affect. A total of 306 employees from various industries participated in this cross-sectional study. Supporting and expanding an emotion-centered model of conflict, results indicated that the indirect effects of conflict on the study's outcomes were higher when participants perceived the conflict to be of medium and high-level intensity.

Building nurse resilience in the workplace

AIMS

The aims of the study were 1) to replicate the research based on the pilot study; 2) to increase resilience in nurses working on all units at four hospitals and 3) to determine which interventions were preferred and most effective.

BACKGROUND

Work stress mediates resilience and resilience moderates work stress. Resilience building activities in the literature are often time consuming, complex and done outside work hours. This study investigated use of portable, accessible and brief interventions by nurses to decrease stress and increase resilience during work hours.

METHODS

This study used a cross sectional, longitudinal, repeated measures survey design. The study took place in October 2018 to January 2019. Toolkits included written instructions for completing the study protocol, and six activities. Nurses completed surveys at baseline, at 10 time points over a four- to six-week period, and at study conclusion.

RESULTS

Connor-Davidson Resilience Scale-10 instrument scores showed resilience increased significantly at four weeks and the effect continued at three months (p < .02). Self-reported stress levels decreased over the study period and nurses self-selected to continue use of the interventions.

CONCLUSION

The interventions used during work hours decreased self-reported stress and increased resilience. Nurse leaders may easily adopt these options to promote a less stressed workforce. Resilience can increase the ability of nurses to tolerate high stress in the workplace, which may decrease burnout and turnover. In the pandemic, resilience is even more important as hospitals struggle to retain nurses.

Exploring Strategies to Build Resiliency in Nurses During Work Hours

OBJECTIVE

This pilot study investigated increasing nurse resiliency utilizing a toolkit of stress-reducing interventions on medical-surgical units at 4 hospitals.

BACKGROUND

Resiliency-building activities are time consuming and undertaken outside work hours. Although the activities show a positive impact on resilience, researchers investigated whether similar results could be achieved where nurses experience work stress.

METHODS

This quasi-experimental pretest and posttest interventional study used a within-subjects design. Provided toolkits included written instructions to carry out the study. Nurses completed surveys at baseline, at 10 time points over a 6-week period, and at study conclusion.

RESULTS

The Connor-Davidson Resilience Scale-10 scores increased significantly at follow-up (P < .02). Self-reported stress levels decreased over the 10 shifts with continued use of the interventions.

CONCLUSION

Using stress-reducing interventions during work decreased stress and increased resiliency, thereby offering nurse leaders additional options to promote a healthy workforce at the bedside.

Gabapentinoid misuse, abuse and non-prescribed obtainment in a United States general population sample

Background Reports of gabapentinoid (gabapentin and pregabalin) misuse are on the rise, but few studies have assessed this within the general US population. Objective Describe lifetime misuse/abuse/non-prescribed obtainment of gabapentinoids and descriptive characteristics associated with such actions in a US general population sample. Setting This cross-sectional questionnaire was administered online by Qualtrics^® research panel aggregator via quota-based sampling. Methods Data were collected from a sample of respondents that mirrored the general US population aged 18-59 years with regards to age, geographic region, ethnicity, income, and education level, based on most recent census data. Misuse/abuse/non-prescribed obtainment was collectively defined as use of a gabapentinoid for reasons other than a diagnosed medical condition, using with the intention of altering one's state of consciousness, or obtaining without a prescription. A multivariable logistic regression model was created to predict misuse/abuse/non-prescribed obtainment of gabapentinoids, incorporating relevant covariates. Main outcome measure Proportion of sample indicating lifetime misuse/abuse/non-prescribed obtainment of gabapentinoids. Results Among 1,843 respondents, 121 (6.6%) reported gabapentinoid misuse/abuse/non-prescribed obtainment. Specifically, 2.1% (n = 39) and 1.5% (n = 27) of respondents for gabapentin and pregabalin, respectively, met study criteria for abuse. Opioids were the most common medication co-administered with gabapentinoids (among 50-70% of respondents) for misuse/abuse. Previous treatment for addiction (OR: 2.61, 95% CI: 1.32-5.14, p = 0.005) and the total attitudinal risk score (OR: 1.14, 95% CI: 1.09-1.19, p < 0.001) were associated with gabapentinoid misuse/abuse/non-prescribed obtainment. Conclusion Among those surveyed, 6.6% reported previous gabapentinoid misuse/abuse/non-prescribed obtainment, providing one of the first estimates within a nationally distributed, US general population sample.

Self-compassion mediates the association between conflict about ability to practice end-of-life care and burnout in emergency nurses

INTRODUCTION

End-of-life care (EOLC) is necessary for patients who are not expected to live long. Nurses have positive attitudes toward EOLC, but they encounter difficulties in practice. That situation creates conflict, which can affect burnout. It is essential to manage nurses' conflict about their ability to practice EOLC by enhancing their individual strengths. Focusing on the role of self-compassion may help to prevent burnout related to the conflict about ability to practice EOLC.

OBJECTIVE

The study aim was to assess the mediating effect of self-compassion on the association between conflict about ability to practice EOLC and burnout.

METHODS

A correlational study was conducted with emergency department nurses who practiced EOLC. Self-report measures of conflict about ability to practice EOLC, burnout, and self-compassion were obtained.

RESULTS

Negative aspects of self-compassion mediated the relationship among conflict, emotional exhaustion, and depersonalization (burnout). Self-compassion did not mediate the association between conflict and reduced personal accomplishment (burnout).

CONCLUSIONS

Negative aspects of self-compassion mediated the relationship between conflict and burnout (excluding reduced personal accomplishment). To prevent burnout, it is necessary to screen for nurses with low self-compassion and to provide opportunities to change their cognitive recognition and disclose their conflicts.

Nurse resilience: A concept analysis

Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.

Physical activity and personal factors associated with nurse resilience in intensive care units

AIM AND OBJECTIVES

To assess intensive care nurses' resilience and identify associated personal factors and physical activity behaviours using a job demands-recovery framework.

BACKGROUND

Currently, there is inconsistent evidence as to whether nurse resilience is associated with personal factors or with physical activity at work or during leisure time.

DESIGN

A cross-sectional study was conducted with nurses from four intensive care units in Auckland, New Zealand.

METHODS

An online survey was conducted to collect nurses' personal information and assess their resilience levels using the Connor-Davidson Resilience Scale 25. Participants were nurses working at least 32 hr fortnightly and providing direct patient care. Physical activity was objectively measured using a pair of accelerometers worn on the back and thigh over four consecutive days (two workdays followed by two nonworkdays). Bivariable and multivariable regression were used to identify personal factors and physical activity behaviours associated with resilience (followed the STROBE checklist).

RESULTS

A total of 93 nurses were included in the study. The participants' average resilience level was low. Resilience was positively associated with the objectively measured physical job demands factors: occupational physical activity, moderate-to-vigorous physical activity at work and dynamic standing at work. Resilience was negatively associated with one objectively measured recovery factor: sleep during leisure time. In multivariable modelling, being married and moderate-to-vigorous physical activity at work were positively associated with resilience, while not having religious beliefs and sleep during leisure time were negatively associated with resilience.

CONCLUSIONS

Resilient nurses have a greater tolerance to high physical activity at work and lower sleep duration during leisure time. Strategies are needed to improve intensive care nurses' resilience levels.

RELEVANCE TO CLINICAL PRACTICE

Results may help managers gain a better understanding of the ICU nurses' characteristics associated with resilience, leading them to develop strategies for improving ICU nurse resilience.

Evidence-Based Resilience Intervention for Nursing Students: a Randomized Controlled Pilot Trial

Nursing students report chronic stress, and burnout is common. One factor related to lower burnout is resilience, though little research has studied resilience interventions in nursing students. This study had two objectives: 1) to examine the effects of a pilot resilience intervention, and 2) to investigate student attitudes about the intervention. This was a randomized controlled trial that took place from January 2017 - June 2017 at a Midwest university in the United States. First-year nursing students (N = 27) were randomly assigned to the intervention (N = 14) or control (N = 13) group. The intervention group participated in a five-week resilience intervention. Both groups completed three online surveys (before, immediately after the intervention, and three months later). Using Wilcoxon signed-rank tests to compare pre- and post-intervention scores, neither group reported significant changes in resilience or the burnout facet of cynicism. The burnout facets of exhaustion and professional efficacy significantly decreased in the intervention group, but not the control group. Participants reported satisfaction with the intervention, though most wanted more hands-on activities. This resilience intervention may be valuable for reducing burnout in nursing students, but interventions should first conduct a needs assessment.

Novice nurses' sleep disturbance trajectories within the first 2 years of work and actual turnover: A prospective longitudinal study

BACKGROUND

Novice nurses experience radical changes in their sleep-wake cycle and sleep difficulties after exposure to a rotating shift work schedule. The link between workplace hardship and employee turnover may be dependent on factors at the individual level, e.g., individual health. Nurses with sleep disturbance are more vulnerable to stressful stimuli and lack resilience at work compared with those without sleep disturbance.

OBJECTIVES

To classify novice nurses according to sleep disturbance trajectories during the first 2 years of work, to compare turnover rates according to trajectory classification, and to compare levels of sleep disturbance between stayers and leavers within each trajectory class.

DESIGN

Prospective longitudinal design.

SETTINGS

A tertiary hospital in Seoul, South Korea.

PARTICIPANTS

A total of 465 newly graduated nurses who started work between September 2014 and December 2015.

METHODS

Data were collected 6 times within the first 2 years of work (on the first day of orientation before ward placement, at 6 weeks after starting work, and at 6, 12, 18, and 24 months of work). Sleep disturbance was assessed using the General Sleep Disturbance Scale. Turnover information was retrieved from the hospital's administrative data system to determine whether anyone had left the hospital at each data collection point. Unconditional latent growth curve analysis was performed to identify latent classes of trajectories of sleep disturbance among novice nurses during the first 2 years of work.

RESULTS

The 2-year trajectories of sleep disturbance were classified into two distinct groups: the high symptomatic group (Class 1: 57.4%) and the low symptomatic group (Class 2: 42.6%). In comparison with Class 2, Class 1 consistently showed a higher turnover in each period. In Class 1, leavers who left the hospital at the next measurement point tended to report more severe sleep disturbance at prior measurements. This pattern was also observed for the overall sample. However, in Class 2, an inconsistent pattern between stayers and leavers was observed.

CONCLUSIONS

This study identified two distinct classes of sleep disturbance among novice nurses during the first 2 years of work. Given that many nurses experience sleep problems at pre-employment and during the early career period, a comprehensive approach to address this issue should be implemented in nursing schools and hospitals. The basic nursing curriculum should include self-care management strategies for sleep difficulties to ensure retention at work. At-risk nurses should receive organizational support and early monitoring to prevent the adverse effects of poor sleep.

An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities

BACKGROUND AND PURPOSE

The Health Risk Screening Tool (HRST) is a 22-item instrument specifically designed to assess the health risk of persons with developmental disabilities. The predictive validity of the HRST was investigated by examining its ability to predict mortality.

METHODS

The sample consisted of 12,582 people with an intellectual or developmental disability residing in Georgia (U.S.). Data were analyzed using survival analysis (Kaplan-Meier estimate and Cox regression) and a binary logistic regression.

RESULTS

All models supported the prognostic value of the six-level health risk classification. The Kaplan-Meier procedure showed clear separation among functions. The Cox proportional hazard regression revealed that hazard is inversely related to the health risk level, even after controlling for potential confounding by gender, ethnicity, and race.

CONCLUSIONS

The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.

Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses

Aims

Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions.

Design

The study used an observational cohort design.

Methods

Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013–September 2014.

Results

Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work‐life imbalance; only conflicting job demands, and lack of control related to professional commitment directly.

Conclusion(s)

To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events.

Impact

Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention.

Conflict Experienced by Nurses Providing End-of-life Care in Emergency Departments in Japan

Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.

Is higher resilience predictive of lower stress and better mental health among corporate executives?

Objective

To assess the impact of resilience, the ability to withstand and bounce back from adversity, on measures of well-being, self-reported stress, and mental health diagnoses.

Methods

This study was a cross-sectional survey of participants seen at an executive health practice at Mayo Clinic, Rochester, Minnesota, from January 2012 through September 2016. Participants completed an anonymous survey that included demographic information and 3 validated survey instruments—the 10-item Connor-Davidson Resilience Scale (CD-RISC), the 12-item Linear Analogue Self-Assessment Scale (LASA), and the 14-item Perceived Stress Scale (PSS). Self-reported history of mental health diagnoses was also collected. CD-RISC scores were used to stratify participants into lower (<30), medium (30–34), or higher (≥35) resilience categories. Participants’ LASA scores, PSS scores, and self-reported mental health diagnoses were compared among resilience categories.

Results

Of the 2,027 eligible participants, 1,954 met the study inclusion criteria as currently employed corporate-sponsored executive or business professionals (self-designated) who completed the CD-RISC survey. Most participants (62.5%) were aged 40 to 59 years. The majority were male (78.3%), white (95.3%), educated (86.2%), and in a committed relationship (89.7%). Among participants, 41.7% reported higher resilience, 34.3% had medium resilience, and 24.0% had lower resilience. The quality of life and overall LASA scores were positively associated with higher resilience (P < .001). PSS scores and self-reported mental health diagnoses were negatively associated with higher resilience (P < .001). These associations remained significant after adjusting for patient characteristics.

Conclusions

In this cross-sectional survey of a large cohort of corporative executives, the lower-resilience cohort had a 4-fold higher prevalence of depression and an almost 3-fold higher prevalence of anxiety compared with the higher-resilience cohort. High resilience was positively associated with well-being and negatively associated with perceived stress. Our findings suggest that higher resilience in the executive workplace environment is associated with better mental health, reduced stress, and greater well-being.

How to improve performance and prevent burnout in safety representatives

BACKGROUND

The present work is part of a greater research project, aimed to examine Safety Representatives' (SRs) role, twenty years after the appointment of this figure.

OBJECTIVES

The study aims to investigate the role of some personal and organizational dimensions in the promotion of SRs' well-being, in terms of reducing burnout and improving performance.

METHODS

The study involved 455 SRs operating in North East Italy. They completed a self-report questionnaire, regarding conflicts with co-workers, ethical conflict, training satisfaction, work engagement, performance, and burnout.

RESULTS

Structural equation models show that work engagement partially mediates (γ=-0.52, p<0.001; β=0.23, p<0.01) the relationship between conflict with co-workers and performance (γ=-0.26; p<0.01), as well as partially mediating (γ=0.14, p<0.05; β=0.23; p<0.01) the relationship between training satisfaction and performance (γ=0.21, p<0.001). Moreover, it totally mediates the relationship between conflict with co-workers and burnout (γ=-0.52, p<0.001; β=-0.40, p<0.001), as well as totally mediating the relationship between training satisfaction and burnout (γ=0.14, p<0.05; β=-0.40, p<0.001). Finally, ethical conflict is positively associated with burnout (γ=0.047, p<0.001).

CONCLUSIONS

This study provides useful information about the improvement of SRs' well-being, highlighting the importance of their involvement in this role.

When safety climate is not enough: Examining the moderating effects of psychosocial hazards on nurse safety performance

AIM

To examine the association between components of safety climate and psychosocial hazards with safe work behaviours and test the moderating effects of psychosocial hazards on the safety climate-safety performance relationships.

BACKGROUND

The effects of a strong safety climate on safety performance are well cited, however, the conditions that have an impact on this relationship warrant attention. While the psychosocial hazards commonly reported by nurses are predictors of well-being and job attitudes, evidence suggests that these may also place boundaries on the effects of safety climate on safe work practices.

DESIGN

This study used a cross-sectional design to collect data from 146 nurses.

METHODS

Participants were recruited through convenience sampling and snowball sampling methods in 2017. Nurses completed an online questionnaire and received a $5 e-gift card as compensation. SPSS v.23 and PROCESS v3.0 were used to analyse the data.

RESULTS/FINDINGS

A strong safety climate was positively associated with nurses' safety performance. While psychosocial hazards did not predict safety performance, they did moderate the safety climate-performance relationship. High levels of perceived stressors weakened the association between promoting two-way safety communication, the use and implementation of procedures to promote safe work practices and management's endorsement of health and safety with safe work performance.

CONCLUSION

The positive effects of safety climate on nurses' safety performance are contingent on the levels of psychosocial hazards nurses experience. When aiming to improve safety performance among nurses, it is important for efforts to also focus on the psychosocial conditions of the work environment.

Promoting emotional intelligence and resilience in undergraduate nursing students: An integrative review

OBJECTIVE

To synthesize the evidence that explored resilience and emotional intelligence in undergraduate nursing students.

BACKGROUND

Nursing is a demanding profession that offers unique challenges. Emotional intelligence and resilience are traits that can allow nursing students to effectively respond to challenges in professional placements and future practice.

DESIGN

An integrative review incorporating both quantitative and qualitative research designs.

DATA SOURCE

Studies in the English language were identified through a systematic search in electronic databases: CINAHL, PubMed, ERIC, Scopus and PsycINFO. No restriction dates were used and the search was up until November 1, 2017.

REVIEW METHODS

Methodological quality was assessed using the Critical Appraisal Skills Programme checklist for qualitative research and the Newcastle-Ottawa Quality Assessment Scale for quantitative research. Data analysis was conducted based on the integrative review method.

RESULTS

Fourteen articles were included. A positive relationship was found between resilience and performance in undergraduate studies including professional experience placements. While some studies observed an important role for emotional intelligence for nursing students, there is currently insufficient evidence to conclude that emotional intelligence improves nursing students' communication, academic success and retention.

CONCLUSION

Developing skills, such as resilience, as part of nursing programs allows students to be better prepared to deal with the unique challenges in nursing practice.

The impact of defendants' race in competency to stand trial referrals

In the United States, competency to stand trial (CST) evaluations ensure that criminal defendants are capable of participating in their defenses, thus ensuring an important legal right. However, some research has suggested that the CST process may be impacted by legally irrelevant factors such as a defendant's race and cultural background. However, the majority of researchers examined factors that are predictive of CST recommendations and decisions. Few studies have focused on potential racial discrepancies in attorney referrals for CST evaluations and whether they are exacerbated by professional experience. The current study examined potential racial disparities in referrals for CST evaluations among 322 law students and 102 attorneys. Participants were randomly assigned to read vignettes describing either African American or Caucasian defendants who varied in their fitness to stand trial. The participants were asked to indicate whether they would refer the client for a CST evaluation and to describe their reasoning. The results indicated that both law students and attorneys were generally more likely to refer unfit rather than fit defendants, indicating an understanding of the legal criteria. Law students displayed a racial bias, only when referring the defendants who were unfit due to the lack of a rational understanding of the relevant legal case, χ²(1) = 4.90, p = 0.03, Φ = 0.13. Fitness condition was the only significant predictor of attorney referrals. The generally encouraging results indicated that professional experience did not increase racial biases.