The moderating effect of burnout on professionalism, values, and competence of nurses in Saudi Arabia amidst the COVID-19 pandemic: A structural equation modeling approach

Examining the link between intensive care unit nurses' burnout and perceived quality of life: a multicenter cross-sectional study

BACKGROUND

Intensive care unit (ICU) nurses are pivotal in ensuring high-quality care to patients with life-threatening conditions in the healthcare sector. These nurses operate in high-pressure environments that demand constant vigilance, technical proficiency, and emotional resilience. The challenging nature of their work can predispose them to burnout, a syndrome marked by emotional exhaustion, cynicism, and a low sense of personal accomplishment. Therefore, we investigated the relationship between burnout and perceived quality of life (QoL) among ICU nurses.

METHODS

A cross-sectional design was employed, with 265 ICU nurses in the Hail Region, Saudi Arabia, participating in this study. Two self-report scales (23-item Burnout Assessment Tool and 15-item Quality of Life Scale) were used to collect data from March to June 2024. Statistical analysis included descriptive statistics and Pearson correlation coefficients to explore the relationship between burnout levels and QoL dimensions.

RESULTS

The findings indicated a high prevalence of burnout, with 73.2% of nurses reporting high to very high levels of burnout. The overall QoL score was moderate, averaging 64.46 out of 105. Significant negative correlations were observed between burnout and all measured dimensions of QoL (p = 0.01). These dimensions include material and physical well-being (-0.303, p = 0.01), relationships with other people (-0.337, p = 0.01), and personal development (-0.381, p = 0.01).

CONCLUSION

The study underscores a significant inverse relationship between burnout and QoL among ICU nurses. The data highlight the urgent need for targeted interventions to reduce burnout and improve the personal well-being of nurses. This will not only enhance the quality of patient care but also ensure the sustainability of the healthcare system.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship on quality of care in Chinese nurses

AIMS

This study aimed to investigate how clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship impact the quality of care that is provided by nurses in public hospitals.

BACKGROUND

Clinical pathways are recommended as a form of quality improvement by broader healthcare systems and are widely used in the world. Nurses are the most involved group of healthcare professionals in the implementation of clinical pathways in public hospitals. So, it is important to investigate how their satisfaction with the process affects the quality of care they provide and influencing factors.

METHODS

This descriptive cross-sectional study surveyed nurses practicing across seven tertiary public hospitals in Sichuan Province, China, online. The survey consisted of a questionnaire for the general characteristics of the participants and four Chinese maturity scales validated by previous studies: clinical pathway implementation satisfaction scale, work engagement scale, hospital-patient relationship perception scale, and quality of care scale. The bootstrap method was used to test a moderated mediation model using Hayes' PROCESS macro models 4 and 8. We followed STROBE guidelines to prepare the study report.

RESULTS

A total of 880 nurses filled out the questionnaires, 821 of which were regarded as valid. Clinical pathway implementation satisfaction had a positive effect on quality of care (B = 0.873, P < 0.001). Work engagement played a mediation role between nurses' clinical pathway implementation satisfaction and the quality of care (effect = 0.080, Boot 95% CI = [0.023, 0.142]). This mediation model was moderated by the hospital-patient relationship (P < 0.01).

CONCLUSION

Clinical pathway implementation satisfaction may enhance the quality of care by work engagement of nurses. Moreover, a good hospital-patient relationship can enhance the positive impact of nurses' satisfaction on work engagement and health service quality.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Public hospital managers need to pay attention to nurses' evaluation of and perceptions toward clinical pathway implementation and then take corresponding measures to improve their satisfaction to enhance the quality of care. At the same time, the government, society, and hospitals also need to foster good hospital-patient relationships to ensure that nurses have a high level of work engagement that aids in providing high-quality care services.

Relationship between job demands, work engagement, emotional workload and job performance among nurses: A moderated mediation model

AIM

To explore the mediating effect of work engagement and the moderated mediating effect of emotional workload on the relationship between job demands and job performance among nurses.

BACKGROUND

Nurses work in a high-demand situation that could affect their job performance. However, previous studies have reported an inconsistent relationship between job demands and job performance. The underlying mechanism of how job demands influence job performance remains unclear.

METHODS

An online cross-sectional survey was conducted with a convenience sample of 893 nurses from 14 cities in Sichuan Province between November and December 2021. Data were collected using the Job Demands Scale, Job Performance Scale, Utrecht Work Engagement Scale, and emotional workload subscale of the Questionnaire on the Experience and Evaluation of Work. Bootstrap and simple slope methods were used to test a moderated mediation model using Hayes' PROCESS macro. The STROBE reporting guidelines were utilized.

RESULTS

Job demands had a positive effect on job performance, and this effect was mediated by work engagement. Emotional workload moderated the indirect relationship between job demands and job performance. Specifically, the positive effect of job demands on job performance via work engagement was attenuated in nurses with a high emotional workload.

CONCLUSION

This study sheds light on the complex relationship between job demands and job performance. Work engagement and emotional workload deserve more attention to improve nurses' performance.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Policymakers and nurse managers should make efforts to develop and implement strategies to foster nurses' work engagement, reduce their emotional workload, and further help nurses efficiently deal with job demands.

What Determines Healthcare Workers to Seek Professional Psychological Support? A Cross-Sectional Study

AIM

Although healthcare workers often experience significant mental health challenges, their willingness to seek professional psychological help remains relatively low. However, the factors associated with healthcare workers' psychological help-seeking remain unclear. This study aims to identify the determinants of professional psychological help-seeking intention among healthcare workers based on the theory of planned behaviour.

DESIGN

Cross-sectional study.

METHODS

A questionnaire, incorporating demographic information and latent variable items, was developed and employed on 403 healthcare workers through online and offline surveys from December 2022 to January 2023 using convenience sampling. Structural equation modelling was applied to test the research hypotheses.

RESULTS

The model explained 46.9% of the variance in help-seeking intention. Subjective norm had the strongest total association with help-seeking intention. Attitude towards help-seeking behaviour, subjective norm and perceived behavioural control were directly positively related to help-seeking intention. Moreover, self-stigma, public stigma, perceived barriers and perceived risk were indirectly associated with help-seeking intention mediated by attitude towards the behaviour and perceived behavioural control. Of the four constructs, public stigma showed the most significant indirect relation to behavioural intention.

CONCLUSION

Healthcare workers' intention to seek psychological support is associated with multiple interacting factors, particularly subjective norm and public stigma. Targeted interventions addressing individual and systemic barriers are essential to create a supportive environment for healthcare workers to access mental health services.

IMPACT

This study identified key barriers and facilitators to healthcare workers seeking psychological support, which can assist authorities in enhancing mental health services and implementing tailored intervention strategies, thereby promoting help-seeking behaviour among healthcare workers. Moreover, our research reinforces the applicability of the theory of planned behaviour in explaining healthcare workers' intention to seek professional psychological support.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Intensive and critical care nurses patient safety, care quality, professional self-efficacy, and missed nursing care: Structural equation model analysis

BACKGROUND

Globally, nurses' patient safety, care quality, and missed nursing care are well documented. However, there is a paucity of studies on the mediating roles of care quality and professional self-efficacy, particularly among intensive and critical care unit (ICCU) nurses in developing countries like the Philippines.

AIM

To test a model of the interrelationships of patient safety, care quality, professional self-efficacy, and missed nursing care among ICCU nurses.

METHODS

A cross-sectional, correlational design study was used. ICCU nurses (n = 335) were recruited via consecutive sampling from August to December 2023 and completed four validated self-report scales. Spearman Rho, structural equation modeling, mediation, and path analyses were utilized for data analysis.

RESULTS

The emerging model demonstrated acceptable fit parameters. Patient safety positively influenced care quality (β = .34, p = .002) and professional self-efficacy (β = .18, p = .011), while negatively affecting missed nursing care (β = -.34, p = .003). Care quality positively and negatively influenced professional self-efficacy (β = .40, p = .003) and missed nursing care (β = -.13, p = .003), respectively. Professional self-efficacy indirectly impacted missed nursing care (β = -.32, p = .003). Care quality (β = -.10, p = .003) and professional self-efficacy (β = .13, p = .003) showed mediating effects between patient safety and missed nursing care.

LINKING EVIDENCE TO ACTION

ICCU nurses' care quality and professional self-efficacy are essential mediating factors that can bolster patient safety practices, hence reducing missed nursing care. Therefore, healthcare organizations, nurse managers, and policymakers should cultivate care quality and self-efficacy by creating support programs and providing a positive practice environment. Nurses and nurse supervisors could directly observe missed nursing care in the ICCU to understand its underreported causes.

Linking patient safety, caring behaviours and professional self-efficacy with missed nursing care among Filipino emergency room nurses: A structural equation model study

AIMS

To investigate the interrelationships of patient safety, caring behaviours, professional self-efficacy and missed nursing care among emergency room nurses.

DESIGN

Cross-sectional, correlational study.

METHODS

Filipino emergency room nurses (n = 345) participated via convenience sampling from September 2023 to January 2024. Four validated self-report scales were used to collect data and were analysed using Spearman rho, covariance-based structural equation modelling, mediation and path analyses.

RESULTS

The emerging model of study variables displayed satisfactory fit indices. Patient safety directly influenced caring behaviours and professional self-efficacy, while negatively influencing missed nursing care. Caring behaviours directly and indirectly affected professional self-efficacy and missed nursing care, respectively. Professional self-efficacy negatively influences missed nursing care. Finally, caring behaviours and professional self-efficacy were significant mediators between the association of patient safety and missed nursing care.

CONCLUSION

Caring behaviours and professional self-efficacy of emergency room nurses demonstrated mediating effects that can potentially improve patient safety practices thereby minimizing unfinished or missed nursing care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and healthcare organizations should commit to consistently maintain a workplace culture that fosters patient safety, caring behaviours and professional self-efficacy to minimize avoidable injuries and omitting nursing care tasks.

REPORTING METHOD

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Effectiveness of Individual-Based Strategies to Reduce Nurse Burnout: An Umbrella Review

Aims

This umbrella review aims to comprehensively synthesize and analyze the findings of available systematic reviews on the effectiveness of individual-based strategies for reducing nurse burnout occurring in hospital-based settings.

Methods

Following JBI guidelines, an umbrella review was conducted to integrate the effectiveness of various strategies to reduce burnout. Systematic reviews were searched in the Embase, MEDLINE (Ovid), Cochrane Library, CINAHL (EBSCO), Scopus, and WOS databases. Inclusion criteria included studies published in any language from database inception to April 2023. Eligibility assessment involved two independent reviewers who evaluated titles, abstracts, and full texts. The systematic reviews were critically evaluated using JBI SUMARI. The results were narratively synthesized and grouped by strategy.

Results

Eleven systematic reviews were included, covering the years 2012 to 2021. The appraisal tools varied, though all included reviews were of high quality. The strategies were categorized into three domains: mental health (51%), physical activities (26%), and professional competence (13%). The interventions most identified were mindfulness-based stress reduction for mental health, yoga for physical activities, and professional competence education. These individual-based strategies were shown to effectively eliminate emotional exhaustion (72.7%), depersonalization (44%), and occupational stress (78%) among nurses in hospital-based settings.

Conclusion

Mental health, physical activities, and professional competence are strategies to reduce nurse burnout. Implementing these approaches in healthcare settings can improve emotional exhaustion, depersonalization, and occupational stress of nurses.

Risk and prediction of job burnout in responding nurses to public health emergencies

BACKGROUND

In public health emergencies, nurses are vulnerable to adverse reactions, especially job burnout. It is critical to identify nurses at risk of burnout early and implement interventions as early as possible.

METHODS

A cross-sectional survey of the hospitals in Xiangyang City was conducted in January, 2023 using stratified cluster sampling. Anonymized data were collected from 1584 working nurses. The Impact of Events Scale-Revised (IES-R) and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) were used to evaluate the post-traumatic stress disorder (PTSD) and burnout of nurses in public health emergencies. Logistic regression analysis was established to screen for risk factors of burnout, and a nomogram was developed to predict the risk of burnout. A calibration curve and the area under the receiver operating characteristic (ROC) curve were used to validate the nomogram internally.

RESULTS

This study showed that only 3.7% of nurses were completely free of PTSD during a public health emergency. We found that PTSD varied by age, marital status, procreation status, length of service, employee status, and whether working in the ICU. The nurses aged 30 ~ 40 years old, single, married without children, non-regular employees, worked for less than three years or worked in the ICU had higher levels of PTSD. Regarding the prevalence of burnout, 27.4%, 48.5%, and 18.6% of nurses had a high level of emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA), respectively. There, 31.1% of nurses had more than two types of job burnout. The number of night shifts, the type of hospital, marital status, and the severity of PTSD were all associated with higher rates of exhaustion among nurses. As a graphical representation of the model, a nomogram was created and demonstrated excellent calibration and discrimination in both sets (AUC = 0.787).

CONCLUSIONS

This study confirmed the PTSD and burnout are common problems for in-service nurses during public health emergencies and screened out the high-risk groups of job burnout. It is necessary to pay more attention nurses who are single and working in general hospitals with many night shifts, especially nurses with severe PTSD. Hospitals can set up nurses' personal health records to give timely warnings to nurses with health problems, and carry out support interventions to relieve occupational stress.

Moral courage, burnout, professional competence, and compassion fatigue among nurses

BACKGROUND

Moral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. However, moral courage remains an unexplored concept among middle eastern nurses.

AIM

This study investigated the mediating role of moral courage in the relationship between burnout, professional competence, and compassion fatigue among Saudi Arabian nurses.

RESEARCH DESIGN

Correlational, cross-sectional design following the STROBE guidelines.

PARTICIPANTS AND RESEARCH CONTEXT

Convenience sampling was used to recruit nurses (n = 684) for four government hospitals in Saudi Arabia. Four validated self-report questionnaires (Nurses' Moral Courage Scale, Nurse Professional Competence Scale-Short Form, Maslach Burnout Inventory, and Nurses Compassion Fatigue Inventory) were used to collect data between May to September 2022. Spearman rho and structural equation modeling analyses were employed to analyze the data.

ETHICAL CONSIDERATIONS

The ethics review committee of a government university in Ha'il region, Saudi Arabia, approval this study (Protocol no.: H-2021-012; Approved: 08/022,021). Participants were fully explained the study aims, and consent was voluntarily secured.

RESULTS

The emerging model showed that burnout had a direct and positive influence on compassion fatigue, while professional competence had a direct, negative effect on compassion fatigue. Moral courage had a small and direct but negative influence on compassion fatigue. Mediation analyses also indicated that moral courage significantly mediated the indirect effects of burnout and professional competence on compassion fatigue.

CONCLUSION

Moral courage can be a crucial aspect in preserving the psychological and mental health of nurses, particularly under stressful conditions. Therefore, it is advantageous from an organizational and leadership standpoint to implement measures such as programs and interventions to foster moral courage among nurses.

Nursing students' perceived stress, social support, self-efficacy, resilience, mindfulness and psychological well-being: A structural equation model

Nursing students' stress, protective factors (e.g. resilience, social support, mindfulness and self-efficacy) and psychological well-being (PWB) have been well reported in the literature. However, the interactions of these variables were scarcely examined in the latter part of the COVID-19 pandemic and in the context of a developing country. This cross-sectional correlational study complying with STROBE guidelines tested a hypothetical model of the interrelationships of nursing students' stress, protective factors and PWB using structural equation modelling (SEM). Nursing students (n = 776) from five nursing schools in the Philippines were conveniently recruited from September 2022 to January 2023. Six validated self-report scales (Perceived Stress Scale, Multi-dimensional Scale of Perceived Social Support, Generalized Self-Efficacy Scale, Connor-Davidson Resilience Scale, Mindful Attention Awareness Scale, and Psychological Wellbeing Scale) were used to collect data. SEM, mediation analyses and path analyses were used for data analysis. The emerging model demonstrated acceptable model fit parameters. Stress negatively impacted protective factors, while all the protective factors positively influenced PWB. Social support mediated the influence of stress on resilience, mindfulness and PWB. Resilience is a significant mediator of stress, self-efficacy, social support and PWB. Mindfulness mediated the influence of stress, social support and self-efficacy on PWB. Finally, self-efficacy had a mediating role between resilience and mindfulness. Nursing institutions and nurse educators can use the proposed model as their basis for empirical and theoretical evidence in creating programmes that will strengthen nursing students' protective factors, thus reducing stress while improving PWB and learning outcomes.

Development and Validation of the Nursing Care and Religious Diversity Scale (NCRDS)

(1) Background: In response to the impact of religious intervention on health outcomes and the importance of documenting how nurses experience the spiritual need of 392 hospitalized patients, it is vital to provide the nursing profession with instruments to evaluate these spiritual aspects. This study describes the development and validation of the Nursing Care and Religious Diversity Scale (NCRDS); (2) Methods: A two-step design was used for NCRDS translation and psychometric validation. The tool design was developed in the first step, while the psychometric characteristics were tested in the second step. An inductive study was conducted to test the validity and reliability of the NCRDS tool. The overall sample consisted of 317 nurses; (3) Results: The final instrument comprised 25 items in five dimensions. The construct validity indicated five dimensions. The face and content validity were adequate. Test-retest reliability displayed good stability, and internal consistency (Cronbach's α) was acceptable (0.83); (4) Conclusions: Initial testing of the NCRDS suggested that it is a valid and reliable instrument to evaluate individuals in religious diversity, with five dimensions for evaluating the meaning of spirituality and individual belief, the religious healthcare environment, educational adequacy, spiritual and religious needs, and religious plurality.

Psychometric testing of the nurse professional competence scale Arabic version: An exploratory and confirmatory factor analyses

AIM

To translate the Nurse Professional Competence Scale-Short Form English version into Arabic and psychometrically validate its properties among Saudi citizen nurses.

BACKGROUND

Evaluating nurses' professional competence is vital in delivering safe, cost-effective care and developing healthcare systems. However, psychometrically reliable and validated nurse competence scales in Arabic-speaking countries remain scant.

DESIGN

A descriptive cross-sectional design adhering to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

METHODS

Participant nurses (n = 598) were conveniently recruited from four government-owned hospitals and completed the Arabic-translated 35-item Nurse Professional Competence Scale-Short Form. We used Spearman's rank-order correlation, exploratory factor analysis, Kaiser-Meyer-Olkin test, and confirmatory factor analysis to analyze the data.

RESULTS

After exploratory factor analysis and reliability analyses, several items of the Arabic-translated 35-item Nurse Professional Competence Scale-Short Form were omitted due to high inter-item correlations and low factor loading difference. The Arabic version of the Nurse Professional Competence Scale-Short Form was reduced to 21 items, consisting of a three-factor structure: Professional Care Pedagogics, Holistic Value-Based Care, and Direct Nursing Care. Results also demonstrated that the revised three-factor structure had good overall scale reliability, good subscale internal consistencies, and acceptable construct validity using the confirmatory factor analysis.

CONCLUSION

The 21-item Nurse Professional Competence Scale-Short Form Arabic version is a useful scale, having demonstrated construct validity and reliability. Therefore, nurse managers in Arabic-speaking nations could assess their nurses' professional competence using the 21-item Nurse Professional Competence Scale-Short Form Arabic version to develop proactive programs that enhance professional competence.

How nursing students' risk perception affected their professional commitment during the COVID-19 pandemic: the mediating effects of negative emotions and moderating effects of psychological capital

Nurses play a pivotal role in the delivery of medical services. Professional commitment is crucial for nursing professionals' long-term, healthy, and sustainable development. However, nursing students' professional commitment levels are currently unsatisfactory in China, especially given that the COVID-19 pandemic has posed unprecedented challenges to the profession. Therefore, studies investigating the professional commitment levels of nursing students and the underlying influencing factors are urgently required. This study explored how nursing students' risk perceptions, negative emotions, and psychological capital affected their professional commitment during the COVID-19 pandemic. A cross-sectional study was conducted among nursing students using risk perception, professional commitment, negative emotions, and psychological capital scales. An analysis of 1142 Chinese nursing students suggested that nursing students' risk perception positively impacted professional commitment and that negative emotions mediated this association. Importantly, psychological capital moderates the mediating effect of negative emotions and can buffer the negative emotions caused by risk perception. This study demonstrated that effective intervention strategies should be implemented in multiple dimensions such as education, individual, public and society to improve the professional commitment of nursing students.

Nursing students' nomophobia, social media use, attention, motivation, and academic performance: A structural equation modeling approach

AIM

To investigate the interrelationships of nomophobia, social media use, attention, motivation, and academic performance among nursing students.

BACKGROUND

There is a preponderance of studies about nursing students' nomophobia, social media use, and academic performance. However, the mediating role of motivation and attention between nomophobia and academic performance remains a blind spot in nursing literature.

DESIGN

Cross-sectional design and structural equation modeling (SEM) approach.

METHOD

Students from five nursing institutions in the Philippines were recruited via convenience sampling (n = 835). We used STROBE guidelines in reporting this study. Three self-report instruments (Motivational Strategies for Learning Questionnaire [MSLQ], Media and Technology Usage and Attitude Scale [MTUAS], and Nomophobia Questionnaire [NMP-Q]) were used to collect data. SEM, mediation analyses, and path analyses were used for data analysis.

RESULTS

The emerging model afforded acceptable model fit indices. Nursing students' nomophobia positively influenced social media use whereas negatively impacting motivation and attention. Social media use, motivation, and attention directly affect academic performance. Path analyses depicted that motivation and attention mediated the indirect effect of nomophobia on academic performance. Motivation mediated the indirect impact of nomophobia on attention. Finally, attention mediated the indirect effect of motivation on academic performance.

CONCLUSION

Nursing institutions and educators can use the proposed model in developing guidelines for evaluating nomophobia and regulating social media use in the academic and clinical context. These initiatives could support nursing students' transition from school to practice while assisting them in maintaining their academic performance.

Filipinos' COVID-19 vaccine hesitancy comments in TikTok videos: A manifest content analysis

OBJECTIVES

Vaccine hesitancy is one of the top 10 threats to world health. The ongoing pandemic highlighted this health threat. The COVID-19 vaccine hesitancy remains underreported in the Philippines. Thus, this study aimed to describe and analyze the comments of Filipinos in TikTok videos about COVID-19 vaccine hesitancy.

DESIGN

Manifest content analysis.

SAMPLE

A total of 25 TikTok videos and their comments (n = 4564) were analyzed.

METHODS

We collected data between July 2021 and October 2021. Bengtsson's approach to content analysis was utilized to analyze the data. Data were validated using member-checking and intercoder reliability.

RESULTS

This study afforded three themes of COVID-19 vaccine hesitancy: (a) fear and mistrust (subthemes: influence of Dengvaxia vaccine, the influence of people who refuse to be vaccinated, lack of trust in the government, lack of trust in healthcare workers, doubts on vaccines' effectiveness), (b) misinformation and disinformation (subthemes: misbeliefs, insufficient knowledge), and (c) adamant attitudes (subthemes: unwillingness to be vaccinated, picky on vaccine brand).

CONCLUSION

Our study established Filipinos' diverse reasons for COVID-19 vaccine hesitancy. TikTok, as a social media platform, is used for COVID-19 vaccine discussions and the dissemination of misinformation. To prepare for the next pandemic or public health disaster, the government, HCWs, and the public must efficiently convey timely, accurate health information and dispel misinformation on social media platforms.