Protecting emergency room nurses from burnout: The role of dispositional mindfulness, emotion regulation and empathy

The mediator role of mindfulness in the relationship between the listening skills and anger management skills of emergency health care professionals

BACKGROUND

Effective communication plays a crucial role in establishing strong relationships and providing essential support in clinical situations. This study was conducted to investigate the mediator role of mindfulness in the relationship between the listening skills and anger management skills of healthcare professionals working in the emergency department (ED).

METHOD

This was a cross-sectional study, which was conducted with 230 emergency department healthcare professionals (EHCPs) working in adult EDs in Turkey. Sociodemographic Characteristics Data Collection Form, Mindful Attention Awareness Scale (MAAS), Listening Skills Assessment Scale (LSAS), and Anger Management Scale (AMS) were used for data collection. Descriptive statistics included frequency and percentage; t test and ANOVA test were used for statistical analyses, as was "Process Macro 3.5 Model 4", which was used to study the effect of mediator variables.

RESULTS

The participants had a mean MAAS score of 57.71 ± 12.38, a mean LSAS score of 45.36 ± 6.23, and a mean AMS score of 17.93 ± 3.39. There were significant positive correlations between LSAS and MAAS (r = 0.197, p < 0.001), between AMS and MAAS (r = 0.233p < 0.001), and between AMS and LSAS r = 0.24p < 0.001). In addition, the process model analysis results supported that MAAS had a partial mediator role in the correlation between LSAS and AMS, and that its indirect effects were predicted by LSAS and AMS. It was determined that 5.75 % of total change on AMS was predicted by LSAS (F = 13.918; p < 0.001).

CONCLUSION

The results of this study indicate that as the mindfulness level of EHCPs increases, their listening and anger management skills increased. Therefore, reinforcing mindfulness by integrating mindfulness interventions into in-service training and applying strategies that promote EHCPs' listening skills and anger management skills would make it possible to provide quality health care with employees who are more efficient in conflict management and enjoy a higher level of satisfaction.

Effects of standardized mindfulness programs on burnout: a systematic review and original analysis from randomized controlled trials

According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully managed. It is characterized by emotional exhaustion, cynicism toward work, and a lack of personal accomplishment at work. Recent WHO guidelines on mental health suggest that mindfulness could have beneficial effects in a professional environment, but to the best of our knowledge, there is currently no study that has made a large inventory of research focused specifically on the effects of standardized programs on burnout. Which professional populations have already been studied? What are the characteristics of the programs? Have studies shown a significant effect and on what indicator?

Objective

To assess the effects of standardized programs of mindfulness on burnout, we carried out a systematic review using an exhaustive inventory of the international literature based on randomized controlled trials (RCTs).

Methods

The articles were selected according to PRISMA recommendations. The Embase, PubMed/MEDLINE, EBSCOhost, HAL databases were searched with the keywords "mindfulness," "burnout," and "randomized" in the title and abstract of each article. The data were all collected in an Excel spreadsheet and analyzed in pivot tables, which were then presented in graphs and maps.

Results

A total of 49 RCTs were thus selected, the majority of which were of good methodological quality, of American origin (43% of studies), concerned professionals in the health sector (64% of participants included), and mostly women (76%). The RCTs assessed the effects of 31 different mindfulness programs, mostly with the Maslach Burnout Inventory (78% of RCTs). More than two-thirds of RCTs (67%) showed a significant beneficial effect on burnout measurement indicators, with emotional exhaustion being the most impacted component.

Conclusion

This systematic review shows that mindfulness-based interventions could be approaches of choice to prevent emotional distress of burnout. Further studies are still needed to determine which type of program is best suited to impact the two other components of burnout.

Professional burnout of nurses and the level of rationing of nursing care: an observational preliminary study

BACKGROUND

Nurses are one of the professional groups most exposed to experiencing professional burnout. Professional burnout has a negative impact on the quality of nursing care, including causing care rationing. Therefore, it is very important to understand the determinants of both professional burnout and care rationing, as well as their mutual relationships. The aim of the study was to understand the impact of professional burnout among nurses on the level of rationing of nursing care.

METHODS

The study was conducted among 100 nurses at the Głogów County Hospital (Poland) from November 14, 2011, to November 18, 2022. The following Polish version of the standardized research tools were utilized: the Basel Extent of Rationing of Nursing Care- Revised (BERNCA-R) questionnaire and the Oldenburg Burnout Inventory (OLBI). Additionally, a survey designed by the authors was employed.

RESULTS

The BERNCA-R significantly correlates (p < 0.05) and positively (r > 0) with OLBI (disengagement), resulting in a higher degree of care rationing. The average overall BERNCA-R score was 1.56 points (SD = 0.62), indicating that the frequency of care rationing among respondents ranged from "never" to "rarely." Among participants in the OLBI questionnaire, 63% of respondents had a moderate level of work exhaustion, 36% had a high level of work exhaustion, and 1% had a low level of work exhaustion. In turn, 58% of respondents had a moderate level of disengagement, 38% had a high level of disengagement, and 4% had a low level of disengagement. Moreover, a statistically significant association with the BERNCA-R score concerning the workplace (ward) and participation in training on preventing professional burnout was shown.

CONCLUSIONS

The rationing of nursing care was found to be at a low level. The higher the level of disengagement, the greater the level of care rationing was observed. In conservative units, nurses demonstrated a higher level of care rationing. Nurses' expectations regarding the reduction of professional burnout include, among other things, higher remuneration, an increase in the number of staff, and an improvement in the work atmosphere.

The effect of emotion regulation on empathic ability in Chinese nursing students: The parallel mediating role of emotional intelligence and self-consistency congruence

AIM

This study aims to explore the influence of emotion regulation on empathic ability among undergraduate nursing students, as well as the mediating role of emotional intelligence and self-consistency congruence.

DESIGN

A cross-sectional study was employed to examine the relationship between the emotion regulation and empathic ability in Chinese nursing students.

METHODS

A total of 761 undergraduate nursing students were surveyed using the Interpersonal Reactivity Index (Chinese version), the Gross Emotion Regulation Questionnaire, Wang and Law's Emotional Intelligence Scale and the Self-Harmony Scale.

RESULTS

There was a significant positive correlation between emotion regulation, empathic ability and self-harmony. Significant positive correlations were also found between emotion regulation, empathic ability and emotional intelligence. Mediation analysis revealed that self-harmony and emotional intelligence partially mediated the predictive relationship between emotion regulation and empathic ability, with self-harmony showing a more significant mediating effect.

CONCLUSION

The findings suggest that emotion regulation among undergraduate nursing students indirectly influences their empathic ability through parallel mediating effects of self-harmony and emotional intelligence.

Mindfulness in ward nurses: A concept analysis

AIM

Mindfulness has been widely used with all kinds of people, such as students, educators or patients. However, there have been no studies explicitly targeting ward nurses. The aim of this study is to explore the concept analysis of mindfulness in ward nurses.

DESIGN

A concept analysis.

METHODS

An electronic literature search of MEDLINE, Google Scholar, PubMed, Cambridge Online Dictionary and EBSCO on mindfulness was conducted over a ten-year period of Peer-reviewed scholarly articles published in English. The Walker and Avant's framework was used for this paper.

RESULTS

Eleven articles in total were included in this study. Three attributes of mindfulness in ward nurses were identified as in the present moment, paying attention and being receptive. The consequence of mindfulness in ward nurses lead to positive changes, which included improving well-being, decreased burnout, anxiety and depression. An exploration of mindfulness in ward nurses was developed. The findings of this paper can be used in ward nurses, research and administration.

Burnout and secondary traumatic stress in staff working with people with intellectual disabilities: The role of adverse childhood experiences, resilience and trauma-informed organisational climate

BACKGROUND

There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities.

METHOD

Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma-informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used.

RESULTS

81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma-informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout.

CONCLUSIONS

Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma-informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress.

The "Why" in Mental Health, Stigma, and Addictive Behaviors: Causal Inferences in Applied Settings

Mental health problems, broadly understood, are highly prevalent [...].

The role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses: a multicenter cross-sectional study in China

BACKGROUND

A high turnover rate in nursing has become a global concern. Mental health issues may increase the turnover intention of nurses and lead to turnover behaviors. However, very little is known about the role of bidirectional associations between emotional exhaustion and depression/anxiety on turnover intention. This study aimed to examine the associations among depression, anxiety, emotional exhaustion and turnover intention, and to test the role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses.

METHODS

An online multicenter cross-sectional study was conducted in Hunan Province, China, from December 2021 to February 2022. The questionnaire collected data from the Turnover Intention Scale, the Emotional Exhaustion Scale, the Patient Health Questionnaire-2, and the Generalized Anxiety Disorder Scale-2, as well as sociodemographic information. Data analysis was performed by univariate analysis, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling.

RESULTS

The average turnover intention score among Chinese nurses was 14.34 ± 3.75. The prevalence of depression and anxiety was 25.9% and 22.3%, respectively. Depression (r = 0.378, P < 0.001), anxiety (r = 0.391, P < 0.001), and emotional exhaustion (r = 0.532, P < 0.001) were positively associated with turnover intention. Emotional exhaustion partially mediated the associations between depression/anxiety and turnover intention, with both mediating effects accounting for 60.7%. The mediating ratios of depression/anxiety on the associations between emotional exhaustion and turnover intentions were 17.6% and 16.5%, respectively.

CONCLUSIONS

Depression, anxiety, and emotional exhaustion showed significant positive effects on turnover intention among nurses. Emotional exhaustion played a partial mediation role between depression/anxiety and turnover intention, while depression/anxiety played no significant mediation role between emotional exhaustion and turnover intention.

FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention

BACKGROUND

Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress.

OBJECTIVE

To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade.

MATERIALS AND METHODS

We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis.

RESULTS

Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster.

CONCLUSION

FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.

The Impact of Work-Related Problems on Burnout Syndrome and Job Satisfaction Levels among Emergency Department Staff

Burnout syndrome is caused by a number of factors, including personal, organizational, and professional problems. The purpose of this study was to investigate burnout and satisfaction levels among emergency department staff in the context of professional activity issues. We studied a sample of 184 participants working in the emergency department. Participants signed an informed consent form, completed a socio-demographic questionnaire and the MBI-HSS (MP) questionnaire to assess burnout, a JSS (Job Satisfaction Survey) to assess their professional satisfaction, and the AWS (AWS of work survey) questionnaire on work aspects. The questionnaires were completed between November 2022 and March 2023. The study group was aged between 24-64 years old, most of the subjects being female. The study found that 30.2% of emergency medical staff are at high risk of burnout. Emotional exhaustion is indirectly proportional to workload, interpersonal relationships, and rewards. Emotional exhaustion is a direct result of work experience. While participants expressed ambivalence and dissatisfaction with the work environment, they were satisfied with the nature of their work. This study found that job-related factors such as social support and feedback are significant predictors of employee well-being and reducing the risk of burnout. Emotional exhaustion was negatively correlated with job satisfaction, while personal accomplishment was positively correlated with job satisfaction. Depersonalization was associated with job dissatisfaction with operating conditions and coworkers. The study also identified differences in burnout and related constructs among healthcare professionals, with resident physicians reporting higher levels of personal accomplishments and paramedics reporting relatively low levels of emotional exhaustion. The findings suggest that tailored interventions addressing job demands and resources are critical in improving employee well-being and reducing burnout.

The relationship between emotional intelligence and organizational commitment among nurses working in governmental hospitals in Jordan

INTRODUCTION

Nurses' emotions and feelings in response to their environment and their ability to manage their emotions can significantly affect several aspects of their job. In Jordan, studies are still investigating whether emotional intelligence is significantly related to organizational commitment.

AIM

To investigate whether a significant relationship exists between emotional intelligence and organizational commitment among Jordanian nurses working in governmental hospitals in Jordan.

METHODS

The study used a descriptive cross-sectional correlational design. A convenience sampling method was used to recruit participants working in governmental hospitals. A total of 200 nurses participated in the study. A participant information sheet developed by the researcher was used to obtain the participants' socio-demographic characteristics, the Emotional Intelligence Scale (EIS) developed by Schutte and colleagues, and the Organizational Commitment Scale developed by Meyer and Allen were utilized for data collection.

RESULTS

Participants had high levels of emotional intelligence (M, SD = 122.3, 14.0) and moderate levels of organizational commitment (M, SD = 81.6, 15.7). Emotional intelligence had a significant, positive relationship with organizational commitment (r = 0.53, p < 0.01). Male nurses, widowed nurses, and nurses with higher postgraduate qualifications demonstrated significantly higher levels of emotional intelligence and organizational commitment than female nurses, single nurses, and nurses with undergraduate degrees (p < 0.05).

CONCLUSION

Participants in the current study were highly emotionally intelligent and moderately committed to their organizations. Policies supporting the implementation of interventions to improve organizational commitment and maintain a high level of emotional intelligence should be developed and promoted by nurse managers and hospital administrators, as well as decision-makers should magnet the nurses with postgraduate degrees at clinical sites.

Supporting students with empathy: the association between empathy and coping strategies in pre-clinical medical students

How medical students cope with stress predicts their mental health and academic/clinical performances, making the promotion of functional copy strategies a relevant outcome for medical educators. Empathy has been reported to be connected with coping. This study wanted to explore the most used coping strategies and whether gender differences existed, and to investigate whether and to what extent empathy affected coping in a sample of pre-clinical medical students. In a cross-sectional study design, the Interpersonal Reactivity Index (IRI) and the Coping Orientations to the Problems Experienced - New Italian Version (COPE-NIV) were administered to 398 (53% females) Italian second-year medical students. T-tests and multiple regression analyses were used to explore gender differences and the association between IRI and COPE-NIV scores, respectively. Problem Orientation obtained the highest mean score, whereas Avoidance the lowest one. Females outscored males on Social Support (t = 4.95, p < .001) and Transcendent Orientation (t = 4.04, p < .001). After controlling for gender, Empathic Concern was positively associated with Social Support (β = 0.223, p = .001) and Transcendent Orientation (β = 0.234, p = .001). Perspective Taking was positively and negatively associated with Positive Attitude (β = 0.248, p < .001) and Transcendent Orientation (β = − 0.180, p = .008), respectively. Personal Distress was negatively related to Problem Orientation (β = − 0.250, p < .001). Educational and psychological counselling interventions targeting empathy should be implemented in the pre-clinical years to equip medical students to cope functionally with the emotional distress linked to medical school.

What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis

Research on healthcare shows that the relationship between empathy and burnout is complex. The aim of this systematic review and meta-analysis is to clarify the link between different empathic components and burnout components in healthcare professionals. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. The search strategy was applied in PubMed, PsycINFO, CINAHL, Scopus, and Medline, from January 1990 to January 2021. Population included nurses and doctors. Key inclusion criteria were articles addressing the relationship between different components of empathy and professional performance and wellbeing or burn out, or studies using burnout and empathy measures with validity support from commonly accepted sources of evidence. Risk of bias was assessed using the Mixed Methods Appraisal Tool. From 1159 references identified, 22 studies were included in the systematic review, and 5 studies in the meta-analysis. Empathic Concern was significantly correlated with Depersonalization and Personal Accomplishment. Moreover, the links between Perspective Taking, Depersonalization and Personal Accomplishment were statistically significant. In conclusion, exploring and understanding the complex links between empathy and burnout could help healthcare professionals as well as institutions to reduce the risk of suffering burnout.

Prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses: A cross-sectional study

AIM

To explore the prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses.

BACKGROUND

Because of prolonged and continual contact with suffering, deaths, and grief, hospice nurses may be vulnerable to emotional burdens and have difficulty maintaining their professional quality of life.

METHODS

A cross-sectional study was conducted. A total of 478 hospice nurses were selected from 24 medical institutions in Sichuan province. Demographic, work-related information and work-related trauma questionnaire, the Chinese version of the Interpersonal Reactivity Index, the Chinese version of the Emotion Regulation Questionnaire, and the Chinese version of the Professional Quality of Life Scale for Nurses were used for collecting data.

RESULTS

The mean scores of compassion satisfaction, secondary traumatic stress, and burnout were 34.89 ± 6.21, 26.35 ± 5.24, and 24.49 ± 5.01, respectively. Job satisfaction, perspective-taking, empathic concern, working in tertiary hospitals, and adopting cognitive reappraisal strategy were positively associated with compassion satisfaction, while personal distress was a negative factor, all variables explaining 50.7 % of the variance. Higher burnout was found among nurse who had higher personal distress, worked in secondary or primary hospitals, worked >8 h per day and caring for >10 dying patients last month. In addition, job satisfaction, social support, perspective-taking, empathic concern, and cognitive reappraisal were identified as significant protectors, explaining 50.1 % of the variance. We also found that lower job satisfaction, higher personal distress, higher expressive suppression, lack of social support, senior nurses, and cared for >10 dying patients last month, were positively related to secondary traumatic stress. However, cognitive reappraisal had negative associations. These seven factors explained 32.0 % of the variance.

CONCLUSIONS

Hospice care has specific characteristics and hospice nurses may suffer from more work-related stressors compared with other nurses. Our study may provide clues to help nursing administrators identify hospice nurses who are at higher risk of compassion fatigue and design targeted interventions focused on potential risk factors and protectors to improve hospice nurses' compassion satisfaction, while reducing compassion fatigue.

Mediating effects of emotion regulation between socio-cognitive mindfulness and empathy in nurses: a cross-sectional study

Background

Acknowledging the under-examined research of socio-cognitive mindfulness and Gross’s emotion regulation strategies in nursing, this study investigated the relationships between socio-cognitive mindfulness, emotion regulation (i.e., reappraisal and suppression), and empathy among nurses. It also explored the mediating effects of emotion regulation.

Methods

A cross-sectional quantitative study was conducted in a sample of 245 nurses from two university hospitals in South Korea. Convenience sampling was used to collect data between August 3 and September 29, 2020. Participants completed the questionnaire measuring their socio-cognitive mindfulness, emotion regulation, and empathy. Structural equation modeling and path analysis were conducted for data analysis.

Results

Socio-cognitive mindfulness positively influenced emotion regulation of reappraisal (β = 0.404, p < 0.01) and empathy (β = 0.402, p < 0.01), but negatively influenced emotion regulation of suppression (β = −0.149, p < 0.05). Reappraisal positively influenced empathy (β = 0.341, p < 0.01), whereas suppression negatively influenced empathy (β = −0.127, p < 0.05). Importantly, emotion regulation of reappraisal mediated the association between socio-cognitive mindfulness and empathy (a X b = 0.107, p < 0.01).

Conclusion

The findings indicate that socio-cognitive mindfulness is effective in improving empathy among nurses by enhancing reappraisal. This study can provide a foundation for developing socio-cognitive mindfulness or emotion regulation programs to improve empathy among nurses, which would ultimately lead to better nursing performance by increasing patient satisfaction.

The Impact of Burnout Syndrome on Job Satisfaction among Emergency Department Nurses of Emergency Clinical County Hospital "Sfântul Apostol Andrei" of Galati, Romania

Background and Objectives: Burnout syndrome is caused by a number of factors, including personal, organizational, and professional problems. Data from the literature reported a strong relationship between burnout syndrome and job satisfaction among emergency medical personnel. Materials and Methods: We studied a sample of 80 nurses working in the Emergency Department of Emergency Clinical County Hospital "Sfântul Apostol Andrei" of Galati Romania. Participants signed an informed consent and then completed a socio-demographic questionnaire and the MBI-HSS (Maslach Burnout Inventory-Human Services Survey) questionnaire to assess the level of burnout and JSS (Job Satisfaction Survey) to assess the level of professional satisfaction. The aim of this study was to measure the levels of burnout and satisfaction among nurses in the Emergency Department as well as the relationship between these two variables and a group of selected socio-demographic characteristics. Results: This study found that 36.25% of nurses reported a high level of burnout. Additionally, emotional exhaustion is directly proportional to professional experience and age. Participants also reported a sense of ambivalence and satisfaction with the workplace, but were satisfied with the nature of their work. Conclusions: The results of this study suggest the relationship between variables and this could be used to implement psychoactive intervention strategies at both individual and organizational levels, which could lead to a decrease in burnout levels. Burnout is a predictor of job satisfaction for Emergency Department nurses. Personal achievement was relatively commensurate with the nature of the work. Additionally, the increase in burnout among nurses is directly proportional to the nature of the work.

"Jumping into the COVID-19 arena": The professional transition into clinical practice of new graduate nurses in Italy at time of COVID-19

AIMS AND OBJECTIVES

To evaluate the impact of the professional transition of new graduate nurses during the COVID-19 pandemic.

BACKGROUND

The transition from the role of student to the professional role can be challenging for new graduate nurses for the acquisition of higher autonomy and responsibility. The COVID-19 pandemic impacted the quality of the professional transition.

DESIGN

This was a cross-sectional observational study following the Strengthening and Reporting of Observational Studies in Epidemiology checklist.

METHODS

One hundred and two nurses who graduated in three consecutive sessions (November 2019-pre-pandemic, March 2020-pandemic outbreak, and November 2020-2nd wave) in a north Italian university located in the most affected Italian region by the COVID-19 pandemic, completed an online survey assessing well-being, risk of burnout, resilience, perceived stigma, strengths and limitations and quality of the professional transition. The study was performed between March and May 2021.

RESULTS

81.4% of participants described the professional transition as worse than expected, and new graduate nurses who worked in COVID-19 settings reported a more difficult transition to professional life. No differences emerged in burnout, mental well-being and perceived stigma between new graduate nurses who worked in COVID-19 settings and those who did not. Similarly, no differences emerged amongst the three graduated cohort sessions. The most commonly mentioned challenges faced during the transition were organisational aspects, suddenly acquired autonomy and lack of suitable coaching.

CONCLUSION

New graduate nurses reported a challenging academic-professional transition, in particular, those who worked in COVID-19 settings. The mid- and long-term impact of experiencing an academic-professional transition in COVID-19 settings should be assessed and monitored.

RELEVANCE TO CLINICAL PRACTICE

The professional transition of new graduate students should be adequately planned and monitored, new graduates should be assisted to develop realistic expectations about the transition, and an adequate coaching period should be guaranteed all the more during health emergencies.

Cognitive Emotion Regulation Strategies Predict Burnout in Geriatric Nursing Staff

OBJECTIVES

Burnout contributes to high turnover rates, medical errors, and poor patient satisfaction in geriatric nursing staff. Nurses' cognitive emotion regulation (ER) strategies are emerging as an important personal resource related to burnout that are modifiable with intervention. This study examined the association between cognitive ER strategies and burnout among geriatric nursing staff.

METHODS

Participants were 54 nurses (RNs, LPNs, CNA/UWs) with a mean age of 43.1 years (SD = 12.2), majority female (96.3%), and racially diverse: Black (20.4%), White (63.0%), and Other (13.0%).

RESULTS

After controlling for CVs, cognitive ER strategies accounted for unique variance in depersonalization, but did not account for unique variance in emotional exhaustion or personal accomplishment. Rumination was associated with greater depersonalization, and greater refocus on planning was associated with lower depersonalization.

CONCLUSIONS

Findings suggest that depersonalization may be most impacted by ER; however, other ER strategies may be important that were not included in the current study (e.g., experiential avoidance, mindfulness). Future research is needed with additional ER strategies and larger samples.

CLINICAL IMPLICATIONS

Findings support the use of person-centered interventions, such as cognitive-behavioral and mindfulness-based techniques, to improve stress management and decrease depersonalization.

Spotlight on noncognitive skills: Views from nursing students and educators

BACKGROUND

Noncognitive skills have a considerable role in influencing nursing students' performance in clinical and educational settings. Understanding how nursing students and educators perceive noncognitive skills is important given the broad classifications of noncognitive competencies.

OBJECTIVE

This study sought to examine nursing students' and educators' perception of noncognitive skills.

DESIGN

This study adopted a descriptive qualitative approach.

SETTING

This study was conducted virtually via Zoom in one university in Singapore.

PARTICIPANTS

Purposive sampling through a maximum variation technique was used to select 35 nursing students and 12 educators.

METHODS

Semistructured interviews were conducted through eight virtual face-to-face focus group discussions. Interviews were audio- and videorecorded and transcribed verbatim. Data were analysed through thematic analysis.

RESULTS

The participants stated that individual and interpersonal skills contribute to one's noncognitive skills. Two themes emerged from the participants' narratives: (1) the ability to manage oneself and (2) social interactions with others. The first theme describes the various individual characteristics such as growth mindset, adaptability, resilience, and emotional regulation. The second theme describes the importance of empathy and meaningful relationships as types of non-cognitive skills.

CONCLUSIONS

The findings of this study provide the basis for the development of noncognitive assessment tools by educators. In addition, they pave the foundation for the curation of future programs that promote the noncognitive skills of nursing students. Hospital-based educators may use these findings to curate suitable programs for improving the noncognitive abilities of nurses.

Factors influencing mindfulness among Jordanian nurses: A cross-sectional study

BACKGROUND

Mindfulness has been associated with various work-related variables. Studies examining mindfulness antecedents in nurses are scarce.

AIM

The current study aimed to examine if work-related factors, psychological variables, and selected demographics predict mindfulness among Jordanian nurses.

METHODS

A cross-sectional study was conducted to collect data from 173 nurses currently employed in three major referral hospitals. A demographic questionnaire and instruments to collect data about nursing mindfulness, depression, stress, work-family conflict, and family-work conflict were used.

RESULTS

The bivariate analysis showed that all study variables combinations were significant except for the correlation between income and mindfulness. The best fit model showed that only four variables significantly contributed to the model: depression, stress, family-work conflict, and educational level. These variables explained 57 percent of the variance in mindfulness in our sample.

CONCLUSIONS

Depression, stress, family-work conflict, and educational levels contributed to mindfulness levels in Jordanian nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should be aware of the factors that may affect their employees' mindfulness levels and target these factors through the application of evidence-based interventions to improve nurses' levels of mindfulness, which in turn will mitigate the negative impact of lower levels of mindfulness.

Emotional intelligence as a mediator between attachment security and empathy in pre-clinical medical students: A multi-center cross-sectional study

OBJECTIVE

To explore the association of emotional intelligence (EI) and attachment security (AS) with empathy dimensions in medical students by examining the mediating role of EI.

METHODS

In a cross-sectional design, the Interpersonal Reactivity Index (IRI), the Emotional Quotient Inventory (EQ-i), the Attachment Style Questionnaire (ASQ), and demographic questions were administrated to second-year medical students of two medical schools in Northern Italy.

RESULTS

253 medical students (56.13% female), aged 19-29, participated in this study. AS positively correlated to Empathic Concern (r = 0.17, p = 0.008) and Perspective Taking (r = 0.24, p < 0.001), and negatively to Personal Distress (r = -0.33, p < 0.001). Individuals with the same level of AS and a higher score on EQ-i had a higher score (β = 0.072, p = 0.033) on empathy latent factor (at the basis of Empathic Concern and Perspective Taking) and a lower score (β = -0.290, p < 0.001) on Personal Distress than those with a lower EQ-i score.

CONCLUSION

This study shows that EI completely mediated the relationship between AS and empathy dimensions among medical students.

PRACTICE IMPLICATIONS

EI training and workshop should be considered when designing educational interventions and programs to enhance empathy and decrease interpersonal distress in medical students.

"A Qualitative Evaluation Of The Hot Debrief/Follow-Up Initiative: Implications Of Readily Identifying Positive Outcomes In An Australian Emergency Department"

AIM

To gain insight into how emergency department nurses and doctors perceive the experience of being offered the opportunity to request a patient follow-up as part of a structured debrief initiative.

BACKGROUND

An increased prevalence of burnout and compassion fatigue amongst emergency clinicians is being recognised globally. A wellbeing initiative has been implemented within a large public hospital emergency department to combat these phenomena.

METHOD

A qualitative research approach using semi-structured interviews were carried out to explore the participants' views relating to the debrief/follow-up initiative.

RESULTS

A total of 17 face-to-face semi-structured interviews were conducted. This research highlighted a number of common themes including the participants understanding and perception of the follow up initiative, the barriers and enablers of effective implementation, and the perceived benefits of following up on patient outcomes in the emergency setting. This research identified unanimous support for the initiative. No negative implications relating to the initiative were identified.

CONCLUSIONS

This study indicates the positive impacts of employing a deliberate and formalised approach to enabling staff to access follow-up information about the patients for whom they provide life-giving care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Unit Managers should consider the findings of this research and understand the crucial role that nursing leadership can play in fostering the design and implementation of similar initiatives.

Analysis of the Effect of Rational Emotional Intervention Combined with Hierarchical Management Mode on Improving the Psychological Stress of Emergency Nurses and Trainee Nurses

Purpose

To explore the effect of rational emotional intervention combined with hierarchical management mode on improving the psychological stress of emergency nurses and trainee nurses.

Methods

50 emergency nurses who worked or practiced in our hospital from June 2019 to May 2021 were selected as the research object. From June 2019 to May 2020, our hospital adopted the traditional management mode. From June 2020 to May 2021, our hospital adopted the rational emotional intervention combined with hierarchical management mode. The psychological state, work stress, stress response, job burnout, and sleep quality of emergency nurses were compared before and after intervention.

Results

Compared with before intervention, the scores of self-rating anxiety scale and self-rating depression scale, the work stress scores, the Maslach burnout inventory score, the Pittsburgh sleep quality index score of emergency nurses decreased after intervention (P < 0.05). Compared with before intervention, the stress coping scores of emergency nurses increased after intervention (P < 0.05).

Conclusion

The rational emotional intervention combined with hierarchical management mode can improve the psychological pressure of emergency nurses and trainee nurses, reduce job burnout, improve stress coping ability, and improve sleep quality.

The Relationship between Mindfulness and Job Burnout of Chinese Preschool Teachers: The Mediating Effects of Emotional Intelligence and Coping Style

Preschool teachers’ job burnout has many adverse effects on their career development; although some studies have examined the influencing factors of teachers’ burnout, less were explored from the perspective of individual factors. This study aimed to examine the relationship between mindfulness and job burnout of preschool teachers, and the mediating effects of emotional intelligence and coping style. A total of 394 preschool teachers in China filled in questionnaires measuring mindfulness, emotional intelligence, coping style, and job burnout. The findings suggested that: (1) mindfulness was negatively related to job burnout; (2) emotional intelligence and negative coping style played independent mediating effects between mindfulness and job burnout; and (3) emotional intelligence and positive coping style played a chain mediating effect between mindfulness and job burnout. The results revealed the mechanism of mindfulness on preschool teachers’ job burnout, which is of great significance for the psychological intervention of preschool teachers in the future.

Emergency Department Nurses' Experiences of a Mindfulness Training Intervention: A Phenomenological Exploration

Purpose: The purpose of this study was to explore emergency care nurses' experiences of an intervention to increase compassion and empathy and reduce stress through individual mindfulness training delivered via workshops and a smartphone application. We also explored how the nurses felt about the practical and technical aspects of the intervention. Design: Qualitative interview study. Method: Individual interviews were conducted with eight of the 56 participants in the intervention study and used phenomenological analysis to illuminate how they made sense of their lived experiences of mindfulness training. Findings: Three themes illuminated the nurses' experiences: becoming aware, changing through mindfulness, and gaining the tools for mindfulness through workshops and the mobile application. The first two themes expressed personal experiences, whereas the third expressed experiences of the practical and technical aspects of the intervention. Most nurses found the mobile application easy to use and effective. Conclusions: Emergency care nurses can feel that the awareness and changes that come with mindfulness training benefit them, their colleagues, and the patients for whom they care. The findings also provide insights into the challenges of practicing mindfulness in a busy emergency care setting and into the practical aspects of using a smartphone application to train mindfulness.

"I love the job…" Thriving in nursing: A qualitative interview study with framework analysis

BACKGROUND

Burnout is a well-known issue among nurses in critical care settings, including emergency nurses. There are decades of research indicating that emergency nurses experience burnout in their work. However, many nurses have long careers in emergency settings, which suggests that burnout is not the only outcome for nurses. Thriving may also be part of nurses' experiences. The Model of Thriving at Work includes external factors (autonomy, climate of trust and respect, and information sharing) and internal factors (knowledge, personal outlook, and relationships). Thriving is characterized by the concepts of vitality and ongoing learning. Previous researchers suggest that thriving fits with some nurses' experiences, based on validated questionnaires. However, thriving has not been investigated among nurses using interview approaches.

AIMS

This article explores nurses' experiences of thriving and assesses the fit of Spreitzer et al.'s Model of Thriving at Work with nurses' experiences.

STUDY DESIGN

Qualitative interview study, using framework analysis.

METHODS

Eleven nurses, from a single site, completed semi-structured interviews. These interviews explored nurses' workplace experiences, both positive and negative.

RESULTS

Participants reported experiences that fit with the Model of Thriving at Work, consisting of vitality, ongoing learning, and external and internal factors. Nurses hesitated to describe themselves in positive ways, referring instead to being 'not burnt out'. Nurses could, however, readily identify qualities of thriving in others, and viewed those nurses as aspirational. In addition to the Model, participants highlighted their emotional burden, workload, and ethical issues as important contributors to thriving. The Model could potentially be expanded to include these factors.

CONCLUSIONS

Thriving at work could be part of a range of emergency nurses' workplace outcomes. External and internal factors contribute to thriving. Healthcare leaders could support thriving among emergency nurses by fostering a positive work environment.

Effects of mobile-based mindfulness meditation for mental health of nurses: a protocol for systematic review and meta-analysis

INTRODUCTION

Existing studies have shown that mobile-based mindfulness meditation (MMM) can have a certain impact on nurses' mental health problems, but its specific effect and the effect on specific mental health problems such as stress, anxiety, depression, mindfulness, well-being and resilience are not clear.

METHODS AND ANALYSIS

This study protocol follows the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines. Electronic search through PubMed, Web of Science, EBSCO, Cochrane Library, CINAHL, PsycINFO, ERIC, Embase and three Chinese databases namely CNKI, Wan Fang and Chinese Biology Medicine disc. The inclusion criteria follow the PICO principle, which is defined translate the question into a searchable and answerable question . P (patient/population): clinical characteristics of patients; I (intervention or exposure): treatment measures or exposure factors of concern; C (comparison): control measure.; O (outcome): outcome indicator of concern. Registered nurses, preregistered nurses, midwives and nursing students will all be included, studies using MMM as intervention to improve mental health of nurses, compared with waitlist controls or traditional methods groups, outcomes assessment of stress, anxiety, depression, mindfulness, well-being and resilience will meet the inclusion criteria. Studies designed randomised controlled trails (RCTs) of quasiexperimental and written in English or Chinese will be eligible. Search time was from inception of each database to July 2022. Two reviewers screen and assess studies for inclusion and extract data independently; any dispute will be settled through discussion. If the discussion still fails, the third author will make a decision. For RCT, risk of bias will be assessed using Cochrane risk-of-bias tool for randomised trials (RoB 2), and for non-RCT studies, risk of bias in non-randomised studies of interventions (ROBINS-I) tool will be performed. Meta-analysis will be performed using RevMan software if sufficient number of comparable studies are retrieved.

ETHICS AND DISSEMINATION

This is a study protocol of meta-analysis; no primary data will be collected, and no ethics assessment is required. The study results will be presented in a peer-reviewed scientific publication.

PROSPERO REGISTRATION NUMBER

CRD42021277932.

Neural activation during emotional interference corresponds to emotion dysregulation in stressed teachers

Teacher stress and burnout has been associated with low job satisfaction, reduced emotional wellbeing, and poor student learning outcomes. Prolonged stress is associated with emotion dysregulation and has thus become a focus of stress interventions. This study examines emotional interference effects in a group of teachers suffering from high stress and to explore how individual differences in cognitive control, emotion dysregulation, and emotion recognition related to patterns of neural activation. Forty-nine teachers suffering moderate-high stress participated in an emotional counting Stroop task while their brain activity was imaged using functional magnetic resonance imaging. Participants viewed general or teacher specific words of either negative or neutral valence and were required to count the number of words on screen. Behavioural and neuroimaging results suggest that teachers are able to control emotional responses to negative stimuli, as no evidence of emotional interference was detected. However, patterns of neural activation revealed early shared engagement of regions involved in cognitive reappraisal during negative task conditions and unique late engagement of the hippocampus only while counting teacher-specific negative words. Further, we identified that greater emotion dysregulation was associated with increased activation of regions involved in cognitive control processes during neutral word trials. Teachers who showed slower emotion recognition performance were also found to have greater activation in regions associated with visual and word processing, specifically during the teacher specific negative word condition of the task. Future research should explore emotion regulation strategy use in teachers and utilise temporally sensitive neuroimaging techniques to further understand these findings.

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

Dispositional Mindfulness and Post-traumatic Stress Symptoms in Emergency Nurses: Multiple Mediating Roles of Coping Styles and Emotional Exhaustion

Objective

To explore the relationships between dispositional mindfulness (DM) and their post-traumatic stress symptoms (PTSS) of emergency nurses, and the mediating effects of coping styles and emotional exhaustion (EE).

Methods

A cross-sectional survey study was conducted to collect data on DM, coping styles, EE, and PTSS among 571 emergency nurses from 20 hospitals in Chongqing, China. Correlation and structural equation models (SEMs) were used to evaluate the relationship among variables.

Results

Emergency nurses with lower dispositional mindfulness, higher emotional exhaustion and preference for negative coping (NC) revealed more PTSS. The effect of NC on PTSS was partially mediated by emotional exhaustion. Negative coping and emotional exhaustion played concurrent and sequential mediating roles between dispositional mindfulness and PTSS.

Conclusion

This study has made a significant contribution to existing literature. It was suggested to develop interventions aimed at enhancing mindfulness, reducing negative coping strategies, and alleviating emotional exhaustion, which may be effective at reducing or alleviating post-traumatic stress symptoms of emergency nurses.

The association between dispositional mindfulness and empathy among undergraduate nursing students: A multicenter cross-sectional study

The aim of this study was to explore the role of gender, age, and academic year in shaping dispositional mindfulness (DM) and the association between DM facets and empathy dimensions in a sample of undergraduate nursing students. In a multicenter cross-sectional study design, the Five Facet Mindfulness Questionnaire (FFMQ), the Interpersonal Reactivity Index (IRI), and socio-demographic questions were administrated to a convenience sample of Italian nursing students. 622 nursing students (82.2% female) participated in the study (response rate = 86.15%). Females had higher levels of Acting with Awareness (p < .001, d = .54) and lower levels of Non-reacting (p < .001, d = .52) facets of DM than males. Older students displayed higher scores on the Observing (r = .112, p = .005) and on the Non-reacting (r = .187, p < .001) FFMQ subscales than younger ones. No statistically significant differences in DM levels between the three academic years were found (ps > .202). After controlling for socio-demographic factors, DM facets were generally positively related to Perspective Taking (βs from .131 to .208, ps < .007) and Empathic Concern (βs from −.156 to .189, ps < .001), whereas negatively related to Personal Distress (βs from −.141 to −.261, ps < .001). Nursing students with higher levels of DM were more able to consider others’ cognitive perspective and to feel compassion, and were less emotionally distressed when facing tense interpersonal situations. Tailored mindfulness interventions might be useful to foster functional empathy within nursing undergraduate programs.

Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA

OBJECTIVE

Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the experiences and perspectives of emergency personnel responding to the opioid crisis in NH, with a focus on their views toward people who use opioids.

METHODS

Thirty-six emergency personnel (emergency department clinicians, n = 18; emergency medical service providers, n = 6; firefighters, n = 6; and police officers, n = 6) in 6 New Hampshire counties were interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids. Directed content analysis was used to identify themes in the transcribed, semistructured interviews. The results were reviewed for consensus.

RESULTS

Several categories of themes were identified among emergency personnel's accounts of their overdose response experiences and perspectives, including varied degrees of compassion and stigma toward people who use opioids; associations between compassion or stigma and policy- and practice-related themes, such as prehospital emergency care and the role of emergency departments (EDs); and primarily among personnel expressing compassion, a sense of professional responsibility that outweighed personal biases.

CONCLUSIONS

Despite the magnitude of the ongoing opioid crisis, some emergency personnel in New Hampshire have sustained or increased their compassion for people who use opioids. Others' perspectives remain or have become increasingly stigmatizing. The associations of compassion and stigma with various policy- and practice-related themes warrant further investigation.

“Care left undone” and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies

Objective

To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care.

Background

Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided.

Method

Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the ‘Care Left Undone’ Scale, and ad hoc questionnaire for demographic variables.

Results

The mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies.

Conclusion

Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

Effect of Hierarchical Nursing Management in Patients with Hypertension Complicated with Cardiovascular and Cerebrovascular Risk Factors

Hierarchical management is an essential component of nurse post management and an unavoidable tendency in nursing education. According to their existing condition, various hospitals around the country have actively tested the hierarchical usage and management model of clinical nurses, with some success. The application impact of hierarchical nursing care in patients with hypertension complicated by cardiovascular and cerebrovascular risk factors is the focus of this research. In a hospital, 300 patients with hypertension complicated by cardiovascular and cerebrovascular risk factors were chosen. All patients were split into two groups using the coin-throwing random method: the observation group received hierarchical nurse management and the control group received regular nursing management, with 150 cases in each group. The two groups' blood pressure, blood lipids, blood glucose, poor habits, rehospitalization rate, and cardiovascular and cerebrovascular problems were also examined. At the same time, the patients' poor mood and quality of life were assessed before and after the intervention. In the control group followed up for 1 year, the blood pressure compliance rate was 44.88%, the blood lipid compliance rate was 28.65%, the blood glucose compliance rate was 45.00%, the smokers with bad lifestyle habits were 26.57%, the overweight and obese were 23.5%, the high sodium was 31.67%, the rehospitalization rate was 15.48%, and the incidence of cardiovascular and cerebrovascular complications was 43.00%. The observation group's blood pressure, blood lipids, and blood sugar compliance rates rose substantially (P = 0.05) as compared to the control group. The occurrence of poor luck living habits, the rate of rehospitalization, and the incidence of cardiovascular and cerebrovascular complications were significantly reduced (P < 0.05). Before nursing intervention, there was no significant difference in the bad mood scores SAS, SDS, and quality of life between the two groups of patients (P > 0.05); after nursing intervention, compared with the control group, the observation group's bad mood scores were significantly reduced, physical factors, psychological factors, and total scores all increased significantly, and the difference was statistically significant (P < 0.05).

The role of difficulties in emotion regulation in predicting empathy and patient-centeredness in pre-clinical medical students: a cross-sectional study

While empathy and patient-centeredness (PC) are considered core variables in high-quality healthcare education and care, research suggests that empathy and PC decrease during the clinical years of study and that impairments in empathy and PC may be related to difficulties in emotion regulation. There is a growing interest in identifying the psycho-social variables that sustain and foster empathy and PC in medical students throughout their education. This study explored whether and to what extent emotion dysregulation predicted empathy and PC in medical students controlling for gender. Three hundred ninety-eight pre-clinical medical students enrolled at a university in northern Italy completed the Difficulties in Emotion Regulation Scale (DERS), the Interpersonal Reactivity Index (IRI) and the Patient-Practitioner Orientation Scale - 8 Items - Italian version (PPOS-8-IT). All statistically significant correlation coefficients between DERS, IRI and PPOS-8-IT scores were negative (rs from -.130 to -.336, ps ≤ 01), except for IRI Personal Distress and IRI Fantasy Scale that were mainly positively related to DERS scores (rs from .130 to .305, ps ≤ .01). Hierarchical multiple-regression analyses showed that DERS scores accounted for a significant amount of additional variance in both IRI and PPOS-8-IT components above and beyond gender. Emotion dysregulation was positively associated with Personal Distress (βs from .135 to .250, ps ≤ .007), whereas Empathic Concern, Perspective Taking, and the PC components were negatively predicted by emotion regulation difficulties (βs from -.131 to -.309, ps ≤ .005). Female students showed higher levels of all empathy and PC measures than males (ts from -3.49 to -5.54, ps ≤ 001) except for Perspective Taking. Tailored educational approaches that provide medical students with emotion regulation strategies implemented along the pre-clinical curriculum may sustain empathy and PC and equip students to appropriately and functionally face the emotional and interpersonal aspects of the clinical internship experience.

Care of patients with mental health issues in the emergency department: a quality improvement project

Mental health issues have increased significantly over the past decade in the US and emergency departments (EDs) often serve as a safety net to protect and support patients with mental health issues. However, many EDs in the US are not equipped to provide the level of advanced care that patients experiencing a mental health crisis require. This article describes a quality improvement project conducted in an ED in Colorado, US, to identify and address deficiencies in the care provided to patients with mental health issues. The care of patients with mental health issues in the ED can be enhanced through measures such as implementing a validated suicide risk assessment tool, reducing ligature risks, improving the physical environment and training staff in de-escalation techniques.

Burnout, Compassion Fatigue and Psychological Flexibility among Geriatric Nurses: A Multicenter Study in Spain

Nurses working at nursing homes are one of the most vulnerable populations for suffering burnout and compassion fatigue. In Spain, the concept of compassion fatigue and psychological flexibility related to stress in geriatric nurses has not been fully explored until now. It is important to analyze their situation in order to design robust coping and management strategies. The aim was to analyze the relationship between burnout, compassion fatigue and psychological flexibility in geriatric nurses in Spain. Participants included 291 nurses from 97 centers in 51 cities across Spain. Psychological flexibility (AAQ-II), burnout (MBI) and compassion fatigue (ProQOL) were evaluated. Responses were recievced from 281 nurses (91% women), with an average of 7.6 years of work experience. The MBI results were average (26.71), and the ProQOL scores were average for compassion fatigue (40.2%) and high for compassion satisfaction (70.3%), whereas for AAQ-II, the mean score was 37.34 (SD 4.21). The correlation was significant and negative for flexibility, burnout and compassion fatigue, and positive for compassion satisfaction. The ANOVA indicated a significant association between all variables (p < 0.05). We can conclude that geriatric nurses suffer from medium levels of burnout and compassion fatigue, together with high levels of psychological flexibility, which appears to act as a stress reliever, supporting compassion satisfaction.

Curbing nurses' burnout during COVID-19: The roles of servant leadership and psychological safety

AIMS

This study examines the role of servant leadership through the mechanism of psychological safety in curbing nurses' burnout during the COVID-19 pandemic.

BACKGROUND

During the COVID-19 pandemic, studies have shown an increased level of stress and burnout among health care workers, especially nurses. This study responds to the call for research to explore the mechanisms of servant leadership in predicting nurses' burnout by employing the perspective of conservation of resources theory.

METHODS

Through a cross-sectional quantitative research design, data were collected in three waves from 443 nurses working in Pakistan's five public sector hospitals. Data were analysed by employing the partial least squares path modelling (PLS-PM) technique.

RESULTS

Servant leadership (β = -0.318; 95% CI = 0.225, 0.416) and psychological safety (β = -0.342; CI = 0.143, 0.350) have an inverse relationship with nurses' burnout and explain 63.1% variance.

CONCLUSIONS

Servant leadership significantly reduces nurses' burnout, and psychological safety mediates this relationship.

IMPLICATIONS FOR NURSING MANAGEMENT

Human resource management policies in health care must emphasize training nursing leaders in servant leadership behaviour.

Burnout among nurses: a multicentric comparative study

OBJETIVO

to identify and compare burnout levels between Portuguese, Spanish and Brazilian nurses.

METHOD

quantitative, descriptive, correlational, comparative and cross-sectional study conducted using a sample of 1,052 nurses working in hospitals and primary care centers. A sociodemographic questionnaire and the Maslach Burnout Inventory were applied to nurses in Porto, Portugal (n=306), Oviedo, Spain (n=269) and S. Paulo, Brazil (n=477). Data analysis was performed using descriptive, inferential and multivariate analysis.

RESULTS

approximately 42% of the nurses showed moderate/high levels of burnout, with no differences found between countries (Portugal and Brazil 42%, Spain 43%). Only depersonalization showed differences between countries, presenting Spain the highest level and Portugal the lowest one. Comparative analysis showed higher burnout levels in young nurses and those working by shifts. Considering job schedules, burnout was associated to shift work in Portugal, while in Spain and Brazil it was associated with fixed schedules.

CONCLUSION

these results suggest that this syndrome among nurses is a global phenomenon. The daily stressors and higher demands of the nursing profession are crucial in the preparation of nurses to deal with complex situations, to avoid burnout, and to reduce the negative impact on nurses' health and on the quality of care they provide.

["Care left undone" and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies]

OBJECTIVE

To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care.

BACKGROUND

Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided.

METHOD

Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the 'Care Left Undone' Scale, and ad hoc questionnaire for demographic variables.

RESULTS

The mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies.

CONCLUSION

Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

The Mindfulness and the Emotional Regulation Skills in Italian Nurses During the COVID-19 Pandemic: A Descriptive Survey-Correlational Study

Purpose: To analyze the differences in mindfulness level and emotional regulation skills, as cognitive reappraisal and expressive suppression subdimensions, according to sex and years of work experience in a sample of Italian nurses directly involved in the care of coronavirus disease 2019 (COVID-19) patients. Then, correlations were also performed in order to evidence relationships between the mindfulness tendency and the emotional regulation skills, both in cognitive reappraisal and expressive suppression, too. Design of study: Descriptive correlational study. Methods: In June 2020, an online questionnaire was administered. Data relating to sex and years of work experience, the Mindfulness Attention Awareness Scale (MAAS), and the Emotion Regulation Questionnaire (ERQ) in the cognitive reappraisal and expressive suppression subdimensions were collected. Findings: Two hundred nurses were enrolled. Males recorded higher MAAS values compared to females (p = .001). No significant differences were registered in the MAAS scores according to years of work experience and regarding the ERQ subscales according to sex and work of experience, too. Also, any correlations were reported between MAAS and ERQ subscales. Conclusions: Future training on the basic principles of mindfulness and Emotion Regulation were considered a priority in nurses to better self-modulate their own beings, particularly during the pandemic period.

The Relationship between Mindfulness and Emotional Intelligence as a Protective Factor for Healthcare Professionals: Systematic Review

Emotional intelligence is an essential trait and skill for healthcare professionals. Mindfulness meditation has proved to be effective in increasing the wellbeing of those who practice it, leading to better mental health, self-care and job satisfaction. This paper aims to identify the recent evidence on the relationship between mindfulness and emotional intelligence among healthcare professionals and students. A systematic review was conducted including the databases PubMed, Cinhal, PsycINFO and Web of Science. The main variables were emotional intelligence skills and mindfulness practice. Data were extracted according to the following outcomes: authors, year of publication, country, study design, participants, mindfulness training intervention, tools used in data collection and main results. The following inclusion criteria were applied: peer-reviewed articles; published in English or Spanish; published between 2010 and 2020; quantitative methodology; a study population of healthcare professionals or students; the relationship with the aim of the study. The Joanna Briggs Institute criteria were followed for assessing the methodological quality of the selected studies. Three researchers were involved in the review. After the selection process, 10 studies were selected out of the 197 references initially identified. These studies revealed a positive relationship between mindfulness and emotional intelligence, particularly the capacity to regulate emotions. Furthermore, mindfulness is negatively related to emotional exhaustion. Training interventions based on mindfulness have proved to be useful in promoting emotional balance, emotional awareness, emotional acceptance, emotion recognition, expressive suppression and a reduction in emotional exhaustion. This study could serve as a basis for further research on the benefits of emotional intelligence and practicing mindfulness for the bio-psycho-social welfare of healthcare professionals.

Relationship between Emotional Intelligence, Sleep Quality and Body Mass Index in Emergency Nurses

Nurses have long working hours with high psychological burdens. In addition, in the emergency department, nurses are required to quickly adapt emotionally. The aim of this study was to describe and relate emotional intelligence (EI) skills of emergency nurses, their body mass index (BMI) and sleep quality. For this purpose, a cross-sectional was carried out in which the perceived emotional intelligence test and the Pittsburgh sleep quality index were applied. Sixty-two emergency nurses (48 women and 14 men) participated. The results indicated that the majority of them present adequate levels of EI, with no differences by gender. Younger nurses showed a better ability to feel, express and understand emotional states than the older ones, while the ability to regulate emotional states occurred in the opposite way. Nurses who have been working for several years showed a better ability to regulate emotions than those with less experience. Those who were overweight grade II and obese type I expressed their feelings better, also the regulation of emotional states decreased as weight increased. Finally, it has been observed that the quality of sleep of emergency nurses is significantly altered, and that this lack of sleep may affect their ability to process emotions.

Empathy, Affect and Personality as Predictors of Engagement in Nursing Professionals

BACKGROUND

It seems that personality traits affect engagement and the quality of professional life, which is mediated by the emotional and affective states of nursing personnel. Therefore, the objectives of this study were to analyze the relationships between the components of empathy, affect, personality, and engagement, find personality profiles, identify the variables with the most explanatory value, and analyze the mediating role of the variables susceptible to intervention in the relationship between personality and the components of engagement.

METHODS

A sample of 1268 nurses completed the Utrecht Work Engagement Scale, 10-item Big Five Inventory, Basic Empathy Scale, and Positive and Negative Affect Schedule.

RESULTS

Empathy, affect, and personality influence engagement factors in nurses. The vigor and absorption factors of engagement showed a positive relationship with empathy, positive affect, and all of the Big Five personality factors except neuroticism with which the relationship was negative. Personality affected the vigor, dedication, and absorption factors of engagement, and cognitive empathy mediated this relationship.

CONCLUSIONS

This study shows the need to continue investigating the factors that affect and mediate in engagement of nursing professionals.

An Exploratory Cross-Sectional Study on the Relationship between Dispositional Mindfulness and Empathy in Undergraduate Medical Students

There is a growing interest in identifying the psychological variables that promote and sustain empathy in medical students during their studies. Dispositional mindfulness has been shown to be empirically associated with socio-demographic characteristics and empathy among the general population. This research aimed to assess dispositional mindfulness in a sample of undergraduate medical students and to investigate its association with gender, age, and empathy. Hypotheses: It is hypothesized that male medical students would show, on average, higher dispositional mindfulness than their female counterparts, and that older students would exhibit higher dispositional mindfulness than younger ones. Dispositional mindfulness was also expected to be positively associated with the ability to feel compassion for others and to adopt their perspective, and negatively associated with the personal distress in tense interpersonal settings. Method: An exploratory cross-sectional study was conducted. Data were gathered from a large sample (N = 933) of Italian non-meditating second- and fifth-year medical students. Dispositional mindfulness and empathy were assessed using the Five-Facet Mindfulness Questionnaire and the Interpersonal Reactivity Index, respectively. Gender and age differences in dispositional mindfulness scores were calculated by analyses of variance, whereas hierarchical multiple regression models were used to assess the association between dispositional mindfulness and empathy scores. RESULTS Female medical students were more able to Act with Awareness than males, whereas males had higher levels than females of Describing and Nonreactivity to their feelings. When compared to their older counterparts, younger students scored higher on Observing and lower on Nonreactivity facets. Dispositional mindfulness facets correlated differently with both emotional and cognitive empathy dimensions, beyond the effects of gender and age. Medical students who displayed higher dispositional mindfulness appeared to be less emotionally distressed in tense interpersonal settings and more able to take others' cognitive perspective. Conclusions: The findings support the notion that dispositional mindfulness is related to empathy and may have implications for the design of mindfulness-based training for use in the medical educational setting. Tailored interventions that cultivate specific dispositional mindfulness facets may be implemented along the medical curriculum to prevent the emotional distress in tense interpersonal settings and to sustain the cognitive capability to take others' viewpoints among medical students.

Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study

Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses' key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses' professional role and anticipated changes imposed on them and their work with the EMR implementation; and (2) Stuck in the middle, revealed nurses' expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.

Perceived Stress, Personality Traits, and State of Victim's Consciousness: Impact on Tourniquet Application Time and Effectiveness

INTRODUCTION

One of the main avoidable causes of combat-related injury death is extremity hemorrhage. Even with regular training, failure to properly apply a tourniquet is common. In this study, we sought to assess if rescuer's stress and personality traits, along with victim's state of consciousness, had a role to explain tourniquet application failure.

MATERIALS AND METHODS

Eighty-seven soldiers completed a sociodemographic and personality questionnaire (perceived stress, active altruism, mindfulness, and empathy) during a forward combat casualty care course. Then, they underwent a leg hemorrhage simulation on a randomly conscious or unconscious victim. Tourniquet application time and effectiveness (using popliteal artery Doppler) were recorded.

RESULTS

Tourniquet application effective rate was 37% and soldiers with higher levels of perceived stress were at greater risk of failure, especially on a conscious victim. Participants who deployed overseas and those who have undergone combat rescue training were significantly quicker to apply a tourniquet. Altruist and empathetic caregivers were slower to apply the tourniquet while mindful ones were faster.

CONCLUSIONS

Combat-related injuries, even simulated, not only involve the rescuer's technical skills but also their ability to deal with stressful external stimuli. Tourniquet application speed seems to be influenced by perceived stress and personality traits of the rescuers. Frequent failures justify repeated training, and one way to pursue improvement could be to develop a personalized pedagogy adapting to the needs of the students according to their current skillset but also their perceived stress and personality determinants. In the pedagogical process (planning, goal setting, teaching, and evaluating), the state of consciousness of the victim seems to be a parameter that needs to be accounted for, but further studies are required to accurately describe its influence.