Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and Medical Errors

The influence of anxiety and depression on critical care nurses' performance: A multicenter correlational study

BACKGROUND

Anxiety and depression among critical care nurses (CCNs) negatively affect performance because of association with clinical medical errors, ineffective communication, absenteeism from work, and burnout.

OBJECTIVES

The aim of this study was to investigate the prevalence of anxiety and depression and their associated factors as well as their impact on the CCNs' performance in Hail city, Saudi Arabia.

METHODS

A cross-sectional correlational study was conducted among 262 CCNs from April to June 2023.

RESULTS

The mean scores of anxiety and depression were significantly higher among male and Saudi CCNs than among their counterparts (p < 0.05). CCNs caring for patients in a ratio of 1:5 or more had significantly higher anxiety scores than those with lower nurse-to-patient ratios (p = 0.004). CCNs who were working night shifts had significantly higher mean scores of anxiety (p = 0.005) and lower mean scores of performance (p = 0.041) than their counterparts. Borderline anxiety and depression were prevalent among 43.1% and 38.5% of CCNs, respectively. In contrast, abnormal anxiety and depression were prevalent among 8.8% and 5.7% of CCNs, respectively. CCNs' mental, general, and total performance showed a significant negative correlation with both anxiety ([r = -0.247, p <0.001], [r = -0.183, p = 0.003], and [r = -0.172, p = 0.005], respectively) and depression (r = -0.287, p <0.001), (r = -0.207, p <0.001), and (r = -0.180, p = 0.003), respectively.

CONCLUSIONS

Anxiety and depression levels are significantly higher among male, Saudi CCNs, higher nurse-to-patient ratios, those who work night shifts than among their counterparts. Less than half of CCNs experience borderline anxiety and/or depression that had significantly negative correlation with their performance. Anxiety and depression in shift nurses may be treated by reducing workload, causes of stress during night shifts, and giving practical coping mechanisms for typical nurse job pressures.

Prevalence and Determinants of Anxiety and Depression Among Healthcare Workers in Liaoning Province, China

Purpose

To assess the anxiety and depression and their predictors among healthcare workers in Liaoning Province, China.

Methods

In order to explore the influencing factors and prevalence of anxiety and depression among healthcare workers, a cross-sectional research design was used to survey 500 healthcare workers using the 14-item Hospital Anxiety Depression Scale (HADS), the Rosenberg Self-Esteem Scale (RSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Survey of Perceived Organizational Support (SPOS).

Results

About 47.12% of the healthcare workers suffered from anxiety and 71.63% suffered from depression. In our study, we found that the health status (OR: 0.540, 95% CI: 0.298-0.976), self-esteem (OR: 0.395, 95% CI: 0.251-0.619), PSS (OR: 0.621, 95% CI: 0.388-0.994), organizational support (OR: 0.533, 95% CI. 0.333-0.854) were protective factors for healthcare workers suffering from anxiety, and resistance to COVID-19 (OR: 1.703, 95% CI: 1.082-2.681) was a risk factor for healthcare workers suffering from anxiety, while good quality of life (OR: 0.385, 95% CI: 0.206-0.719) self-esteem (OR: 0.187, 95% CI: 0.110-0.317), and PSS (OR: 0.475, 95% CI: 0.267-0.847) were protective factors for healthcare workers suffering from depression, and at the age of 35-40 years (OR: 2.475, 95% CI: 1.140-5.369) and resistance to COVID-19 (OR: 2.219, 95% CI: 1.313-3.751) were risk factors for healthcare workers suffering from depression.

Conclusion

The anxiety and depression status of healthcare workers in China is poor, and hospital administrators should take positive measures to support healthcare workers and give positive expectations to alleviate negative emotions such as anxiety and depression.

The use of mHealth apps to improve hospital nurses' mental health and well-being: A systematic review

BACKGROUND

Nursing well-being has become a heightened focus since the COVID-19 pandemic. Nurses are leaving the profession early in their careers or retiring sooner than expected. Those who remain in the workforce report higher levels of burnout, anxiety, depression, and exhaustion. There is concern that there may be a shortage of at least half a million nurses by 2030.

AIMS

This systematic review aimed to investigate the evidence of using a mental health promotion mHealth app to improve the mental health of hospital nurses.

METHODS

A systematic search was conducted in CINAHL Plus with Full Text, MEDLINE with Full Text, Professional Development Collection, Psychology and Behavioral Sciences Collection, Sociological Collection, PsycInfo, Embase, and PubMed with search dates of January 2012-November 15, 2022. The mHealth intervention needed to be asynchronously delivered through a smartphone with hospital nurse participants to be included in this review.

RESULTS

Of the 157 articles screened for this review, six were included. Primary outcome variables were anxiety, burnout, coping, depression, self-efficacy, stress, well-being, and work engagement. Intervention types included mindfulness-based interventions (MBIs), cognitive behavioral therapy (CBT), stress inoculation therapy (SIT), psychoeducation, and stress management. Anxiety, depression, well-being, and burnout improved with MBIs; depression improved with CBT; and anxiety and active coping improved with SIT.

LINKING EVIDENCE TO ACTION

This review demonstrated promising findings in using mHealth apps to improve the mental health of hospital nurses. However, more randomized controlled trials with larger sample sizes may reveal which type of mHealth app and how much exposure to the intervention is more effective in improving specific mental health symptoms. Longitudinal follow-up is also recommended to study sustainability of the mental health improvements.

Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis

BACKGROUND

Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care.

AIM

This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period.

METHODS

A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis.

RESULTS

Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients.

CONCLUSION

Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19

BACKGROUND

Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied.

OBJECTIVES

To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout.

METHODS

This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables.

RESULTS

Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms.

CONCLUSIONS

Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.

Quality of life of critical care nurses and impact on anxiety, depression, stress, burnout and sleep quality: A cross-sectional study

OBJECTIVES

To investigate how anxiety, depression, stress, burnout, and sleep quality impact on Quality of life of critical care nurses.

BACKGROUND

Several studies reported that critical care nurses are exposed to a high risk of anxiety, depression, burnout, stress, and sleep quality, but we do not know the impact of critical care nurses.

DESIGN

A cross-sectional study.

METHODS

We have included all critical care nurses working in the intensive care unit for at least six months. Data were collected from December 1, 2021, to March 18, 2022. We evaluated the critical care nurses using the Depression Anxiety Stress Scale (DASS), Maslach Burnout Inventory scale, Pittsburgh Sleep Quality Index and Nurse Quality of Life. The primary endpoint is Quality of Life. Associations were tested using multivariate modelling.

RESULTS

A total of 140 critical care nurses were included. Multivariate regression showed the relation between emotional QoL and emotional exhaustion and DASS total score [OR = 0.14; 95% CI (0.03-0.73); p = 0.019 and OR = 3.64; 95% CI (1.07-12.32); p = 0.038, respectively]. Personal accomplishment and DASS total score have a direct relationship on quality of work-life [OR = 0.21; 95% CI (0.05-0.82); p = 0.024 and OR = 4.18; 95% CI (1.01-17.33); p = 0.049, respectively].

CONCLUSIONS

The physical quality of life is not optimal in critical care nurses, while burnout and the DASS score directly impact the emotional and work-life quality of life.

IMPLICATIONS FOR CLINICAL PRACTICE

Our research has highlighted the importance of detecting the quality of life of critical care nurses. The nurses should take proper care of their health by adopting the right health behaviours to create correct work conditions and increase the quality of care for critically ill patients.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

LINKING EVIDENCE TO PRACTICE

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

Experiences of Minority Frontline Healthcare Workers During the COVID-19 Pandemic

Minority healthcare worker (MHW) experiences during the COVID-19 pandemic has received little attention in the published literature compared to their majority counterparts. This study describes healthcare systems, mental health, and advocacy challenges that MHWs experienced during the pandemic in the United States. A descriptive cross-sectional design was used to gather data from a convenience sample (n = 74) of MHWs who identified as registered nurses, advanced nurse practitioners, physicians, pharmacists, nursing assistants, dentists, and respiratory therapists. Data were imported into SAS Version 9.4 (Cary, NC) for analysis. Responses to each survey question were tabulated, and percentages of participants responding in the affirmative to each health system, mental health, and advocacy question were displayed. Findings indicate the pandemic both exacerbated old and imposed new challenges. Health systems should offer both tangible and intangible or emotional resources that support resilience; build an inclusive work environment that would consider the experiences and knowledge of MHWs; implement and sustain workplace changes that support and promote self-advocacy without fear of retribution; and increase research on MHWs to inform effective and culturally relevant interventions for challenges experienced by MHWs.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Psychometric evaluation of the Chinese version of the Positive Health Behaviours Scale for clinical nurses: a cross-sectional translation

BACKGROUND

Occupational health is essential for nurses in clinical nursing practice. However, there is no specific tool for measuring the health behaviour of clinical nurses in China. This study aimed to translate the Positive Health Behaviours Scale into Chinese and validate its psychometric properties among clinical nurses.

DESIGN

A cross-sectional design with repeated measures.

METHODS

A total of 633 clinical nurses were recruited by convenience sampling from hospitals in Liaoning Province, China. After obtaining the authorization of the original author, the PHBS was translated into Chinese by the Brislin back-translation method. Item analysis was completed to evaluate item discrimination, and the Delphi method was adopted to analyse content validity. Exploratory factor analysis and confirmatory factor analysis were conducted to explore and validate the underlying factor structure. Internal consistency and test-retest reliability were calculated to evaluate reliability.

RESULTS

A total of 29 items were retained in the item analysis, and the content validity index of the translated scale was 0.956. In the EFA, four common factors were extracted (nutrition, physical activity, relaxation and behaviours related to mental health and preventive behaviours), explaining 60.81% of the total variance. The results of the CFA were as follows: χ2/df = 1.363, GFI = 0.902, NFI = 0.909, IFI = 0.974, TLI = 0.971, CFI = 0.974, RMSEA = 0.034, and RMR = 0.023. The results of the EFA and CFA showed that the translated scale had good structural validity. Cronbach's α coefficient, the split-half reliability and the test-retest reliability of the Chinese version of the PHBS were 0.928, 0.953 and 0.891, respectively. At the same time, the translated scale had good reliability.

CONCLUSIONS

The Chinese version of the PHBS for clinical nurses had good psychometric properties. The results of the questionnaire survey effectively and comprehensively reflect the level of health behaviours in clinical nurses, which provides a scientific reference for determining the intervention target.

The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic

OBJECTIVES

The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error.

METHODS

Pharmacist ( N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error.

RESULTS

The response rate was 6.4% ( N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months.

CONCLUSIONS

Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Responding to the impact of COVID-19 on the mental health and well-being of health workers in LMICs

The COVID-19 pandemic has worsened mental health among health workers around the world. With a projected global shortage of 10.2 million health workers by 2030, further exacerbated by COVID-19, taking action to support health worker mental health needs to be an integral component of investments to overcome this gap and build resiliency of systems for the future. Health workers are functioning in highly stressful environments at great personal risk to provide services that improve quality of life and save lives. To reduce burnout and early exits from the workforce, health workers must be protected and equipped to work in supportive environments, manage stress, and access mental health services when needed. This article explores the impact of COVID-19 on health worker mental health and proposes actions for health systems and workplaces to support health workers which draw on available evidence and examples of USAID-supported partner activities.

Kindness Isn't Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace

The healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviors, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modeling positive behaviors as well as the deterrence of negative behaviors, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.

Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study

INTRODUCTION

With the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue.

METHODS

A cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021.

RESULTS

The overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10).

CONCLUSION

Monitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.

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

OBJECTIVE

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The state of mental health, burnout, mattering and perceived wellness culture in Doctorally prepared nursing faculty with implications for action

BACKGROUND

Depression, anxiety, and burnout are an epidemic in the nursing profession. Unlike nurses in clinical settings, little is known about the mental health of doctorally prepared nursing faculty in academic settings, especially when separated by degree type (Doctor of Philosophy in Nursing [PhD] vs. Doctor of Nursing Practice [DNP]) and clinical or tenure track.

AIMS

The study aims were to: (1) describe the current rate of depression, anxiety, and burnout in PhD and DNP-prepared nursing faculty and tenure and clinical faculty across the United States; (2) determine if differences exist in mental health outcomes between PhD and DNP-prepared faculty and tenure and clinical faculty; (3) explore whether wellness culture and mattering to the organization influence faculty mental health outcomes; and (4) gain insight into faculty's perceptions of their roles.

METHODS

An online descriptive correlational survey design was used with doctorally prepared nursing faculty across the U.S. The survey was distributed to faculty by nursing deans and included: demographics; valid and reliable scales for depression, anxiety, and burnout; an assessment of wellness culture and mattering; and an open-ended question. Descriptive statistics described mental health outcomes; Cohen's d was used to determine effect sizes between PhD and DNP faculty for the mental health outcomes; and Spearman's correlations tested associations among depression, anxiety, burnout, mattering, and workplace culture.

RESULTS

PhD (n = 110) and DNP (n = 114) faculty completed the survey; 70.9% of PhD faculty and 35.1% of DNP faculty were tenure track. A small effect size (0.22) was found, with more PhDs (17.3%) screening positive for depression than DNPs (9.6%). No differences were observed between tenure and clinical track. Higher perceptions of mattering and workplace culture were associated with less depression, anxiety, and burnout. Identified contributions to mental health outcomes yielded five themes: lack of appreciation, role concerns, time for scholarship, burnout cultures, and faculty preparation for teaching.

LINKING EVIDENCE TO ACTION

Urgent action must be taken by college leaders to correct system issues contributing to suboptimal mental health in both faculty and students. Academic organizations need to build wellness cultures and provide infrastructures that offer evidence-based interventions to support faculty well-being.

The Mediating Effect of General Self-Efficacy Between Occupational Stress and Negative Emotion Among Psychiatric Nurses

The current study investigated occupational stress, anxiety, and depression among psychiatric nurses and explored the intermediary role of general self-efficacy between occupational stress, anxiety, and depression. In November 2020, 171 psychiatric nurses completed a self-report questionnaire. Spearman's correlation analysis was used to determine the relationship between the four variables and the bootstrap method was used to test the intermediary hypothesis. Results showed that 35.1% of psychiatric nurses had health risk stress. Among participants, detection rates of anxiety and depression were 24% and 46.8%, respectively. There was a positive correlation between occupational stress and anxiety (r = 0.577, p < 0.05) and depression (r = 0.653, p < 0.05). There was a negative correlation between general self-efficacy and anxiety (r = -0.358, p < 0.05) and depression (r = -0.500, p < 0.05), and general self-efficacy had a significant mediating effect between occupational stress and depression. However, the mediating effect of general self-efficacy on anxiety was not significant. Nurse managers should be aware of the importance of nurses' general self-efficacy and self-confidence. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 33-39.].

Associations among infection prevention professionals' mental/physical health, lifestyle behaviors, shift length, race, and workplace wellness support during COVID-19

BACKGROUND

COVID-19 added stress to infection prevention professionals' (IPs) work-life that may have impacted their well-being. This study aimed to describe IPs' mental and physical health and lifestyle behaviors during the pandemic and their associations with IP role, perceived worksite wellness support, shift length, and race and/or ethnicity.

METHODS

A random sample of Association for Professionals in Infection Control and Epidemiology members (6,000) were emailed a survey assessing mental and physical well-being, lifestyle behaviors, and perceived worksite wellness support.

RESULTS

A total of 926 IPs responded (15% response rate). Few met guidelines for sleep (34.1%), physical activity (18.8%), and fruit and vegetable consumption (7.3%). Rates of depression, anxiety, and burnout were 21.5%, 29.8%, and 65%. Front line and practicing IPs and IP administrators and directors had more negative mental health impacts than IPs in other roles. IPs with organizational wellness support were less likely to report negative COVID-19 impacts. IPs working 9-11+ hours/day were more likely to report worsening physical and mental health due to COVID-19. There were no significant differences in odds of negative COVID-19 impacts on lifestyle behaviors between white and racial and ethnically diverse IPs.

CONCLUSIONS

IPs who worked shorter shifts and had more organizational wellness support had better well-being outcomes. Organizations must fix system issues that result in poor health and invest in workforce wellness.

Prevalence and associated factors of self-reported medical errors and adverse events among operating room nurses in China

Background

In recent decades, the prominence of medical errors (MEs) and adverse events (AEs) is fueled by several studies performed across the world. Correspondingly, a high prevalence of medical errors and adverse events have been reported. Operating room nurses (ORNs) were indispensable members of the operating process, and any kind of MEs or AEs from ORNs may cause serious results and even death to the patients. However, to the best of our knowledge, the prevalence and associated factors of MEs and AEs were never reported among ORNs in China, which is the largest country in population and health services quantity in the world.

Methods

This is a cross-sectional study, which was conducted among ORNs in China, and 787 valid questionnaires were analyzed in this study. MEs, AEs, gender, age, married status, religious belief, academic degree, manager or not, working years, working hours/week, physical disease, and mental health were evaluated in this study. MEs were evaluated by eight questions about the occurrence of eight kinds of MEs for the ORNs. For ORNs with MEs, further questions about clinical harm to the patients were interviewed, which analyzed AEs. Kessler 10 was used to evaluate the ORNs' mental health. Logistic regression was conducted to examine the factors associated with MEs and AEs.

Results

The prevalence of MEs and AEs was 27.7 and 13.9% among ORNs, respectively. The most frequent MEs that occurred among ORNs were from surgical instruments (9.1%), disinfection (9.0%), equipment and consumables (8.9%), and specimen management (7.8%). MEs were positively associated with lower working years, poor mental health, and physical disease. The physical disease was positively associated with AEs.

Conclusion

The prevalence of perceived MEs and AEs was at a higher level than other kinds of nurses. Fresh ORNs with physical and mental health problems were the risk population for MEs, and ORNs with physical disease were at a higher risk for AEs. All the findings implied that MEs and AEs were an important issue for ORNs, and ORNs with physical and mental health problems should be paid attention to control MEs and AEs.

Building and sustaining a culture of innovation in nursing Academics, Research, Policy, and Practice: Outcomes of the National Innovation Summit

Healthcare in America faces multiple major challenges, highlighting the critical need for innovative solutions to systemic problems. Nursing is uniquely positioned to lead innovation in healthcare. Nurses represent the largest segment of the healthcare workforce, have the greatest exposure to system failures, and must develop workarounds and solutions for the numerous daily gaps in healthcare delivery. However, multiple barriers limit nurses' ability to engage in the essential work of innovating the future of healthcare. With the goal of bringing attention and urgent action to the need for innovation at all levels of nursing and healthcare, experts in innovation from The Ohio State University gathered nationally recognized nursing leaders in the format of an Innovation Summit to identify gaps in and barriers to innovation in healthcare along with solutions. Using a collaborative process, experts at the Summit identified and developed initial solutions to identified gaps and barriers to innovation across four key areas, which for the purpose of the Summit, we have designated four pillars: Academics, Research, Policy, and Practice. The experts believed that a focus on instilling innovation in all four pillars is necessary to improve healthcare and nursing which will ultimately improve the quality and safety of healthcare as well as population health outcomes. Over the next year, this expert panel of innovation leaders will continue to refine its recommendations and action plans to accelerate innovation in the nursing profession. This article describes the vision, process, and initial outcomes of this National Innovation Summit.

Workplace Exposures and Prescription Drug Misuse Among Nurses

OBJECTIVE

This study examined the association between workplace exposure and prescription drug misuse in nurses.

BACKGROUND

Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse.

METHODS

Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression.

RESULTS

Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse ( P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index.

CONCLUSIONS

Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.

A Systematic Review of Nursing Practice Workarounds

BACKGROUND

Nursing practice workarounds (NPWs) are a significant problem for health care organizations. Identified NPWs serve as a catalyst for innovation to improve efficiency, patient safety, and system design. To date, a systematic review of NPW literature has not been performed.

OBJECTIVES

The aim of this systematic review was to synthesize evidence of NPW definitions, context, and prevention strategies, utilizing previous research to develop a framework that examines the current state of this phenomenon and implications for clinical practice, while highlighting the need for future research.

METHODS

A systematic review of the literature was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Academic Search, Ovid MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar databases were reviewed for eligible studies from 2013 to 2020. Results were further screened and sorted by relevance and scored for quality.

RESULTS

Thirteen studies were included. Studies lacked the use of theory, and NPW definitions were varied. Nursing workarounds occurred most frequently when implementing new technology (46%) and when administering medications (31%). Contributing factors were workplace stressors and obstructions in workflow environment. Workaround prevention strategies include open communication and a proactive approach addressing conditions, situations, and processes. Overall study quality was low.

DISCUSSION

This systematic review provides valuable information for critical care nurses and administrators regarding NPW. Implications for practice include the need for proactive and open communication between nurses and administrators when new technology and/or patient care processes require NPW. Administrative considerations include process and environmental improvement strategies to remove perceived workflow barriers. Future research to examine causes and consequences of NPW is needed to identify interventions for NPW prevention. Specific nursing considerations include workload, staffing and time constraints, and impacts of work-related stress levels. Critical care nursing processes should be examined for common NPW challenges. Interventions developed to address these challenges should then be tested to further advance evidence-based critical care nursing care.

Trends in mental health indicators among nurses participating in healthy nurse, healthy nation from 2017 to 2021

BACKGROUND

American healthcare workers face unprecedented stress and trauma in the workplace during COVID-19, putting nurses at increased risk for poor mental health. Examining trends of mental health from before and during COVID-19 can illuminate the toll of the pandemic on nurses well-being.

METHODS

Nurses enrolled in Healthy Nurse, Healthy Nation receive a prompt to take an annual survey (n = 24,289). Mental health was assessed by active diagnoses of anxiety and depressive disorder, and feeling sad, down or depressed for two or more weeks in the past year. Logistic regression models were used to calculate predictive probabilities of health outcomes in year 4 (May 1, 2020 - April 30, 2021) compared to years 1-3 (each from May 1 to April 30), controlling for age, sex, race/ethnicity, and nurse type. Models were also stratified by work setting and nurse type.

RESULTS

In year 4, nurses had a 19.8% probability of anxiety disorder, significantly higher than year 3 (16.3%, p < .001), year 2 (13.7%, p < .001), and year 1 (14.0%, p < .001). Similarly, nurses had a 16.7% probability of depression disorder in year 4, significantly higher than year 2 (12.9%, p < .001) and year 1 (13.9%, p < .01). Year 4 nurses had a 34.4% probability of feeling sad, down or depressed for two weeks, significantly higher than previous years (year 1 = 26.8%, year 2 = 25.9%, year 3 = 29.7%, p < .001). Trends in probabilities of mental health indicators were similar among each nurse type and work setting. Nurses in medical/surgical work settings and those with licensed practical nurse and licensed vocational nurse titles consistently had the highest probability of poor mental health.

LINKING ACTION TO EVIDENCE

In 2020-2021, nurses faced challenges unlike any experienced in previous years. Unsurprisingly, nurses reported increased instances of poor mental health indicators. Positive disruptive strategies are needed to systemically change organizational culture and policy to prioritize and support nurses' well-being.

The Association between Mental Health Symptoms and Quality and Safety of Patient Care before and during COVID-19 among Canadian Nurses

(1) Background: While the association between nurse mental health and quality and safety of patient care delivery was well documented pre-pandemic, fewer research studies have examined this relationship in the context of COVID-19. This study examines the impact of various mental health symptoms experienced by nurses on quality and safety before and during the COVID-19 pandemic; (2) Methods: A secondary analysis of cross-sectional survey data from 4729 and 3585 nurses in one Canadian province between December 2019 and June-July 2020 was conducted. Data were analyzed using between group difference tests and logistic regression; (3) Results: Compared to pre-COVID-19, during COVID-19 nurses reported a higher safety grade, a greater likelihood of recommending their units for care and lower quality of nursing care. Most mental health symptoms were higher during COVID-19 and higher levels of mental health symptoms were correlated with lower ratings of quality and safety both pre- and during COVID-19; (4) Conclusion: Mental health symptoms have implications for nurses’ quality and safety of patient care delivery, with the association between mental health symptoms and quality and safety following a dose–response relationship before and during COVID-19. These findings suggest that it is worthwhile for nurse mental health symptoms to be included as hospital level performance metrics.

Associations Among Nurses' Mental/Physical Health, Lifestyle Behaviors, Shift Length, and Workplace Wellness Support During COVID-19: Important Implications for Health Care Systems

Work cultures supportive of wellness and shorter shift length have been associated with better mental/physical health outcomes in nurses, but how the coronavirus disease-19 (COVID-19) pandemic impacted such outcomes is not known. This study's aims were to (1) describe the mental/physical health, well-being, and healthy lifestyle behaviors of nurses during the pandemic; (2) explore the pandemic's impact on their health and healthy lifestyle behaviors; and (3) determine the associations of perceived workplace wellness support and shift length with nurses' health, well-being, and healthy lifestyle behaviors. A cross-sectional descriptive design was used with 264 nurses associated with Trusted Health. Nurses completed a survey containing valid and reliable scales measuring depression, anxiety, burnout and quality of life, perceived wellness culture, and healthy lifestyle behaviors. Results indicated that more than 50% of nurses had worsening mental/physical health relating to the pandemic. Compared with nurses whose workplaces provided little/no wellness support, nurses with workplaces that supported their wellness were 3 to 9 times as likely to have better mental/physical health, no/little stress, no burnout, and high quality of life. Nurses who worked longer shifts had poorer health outcomes. These findings indicate that workplace wellness support and shorter shifts positively impacted nurse mental/physical health and professional quality of life amidst the pandemic.

Reductions in anxiety, depression and insomnia in health care workers using a non-pharmaceutical intervention

The COVID-19 pandemic has caused significant medical and psychological challenges worldwide, and not only exceeded the capacity of hospitals and intensive care units but also an individuals' ability to cope with life. Health-care workers have continued to provide care for patients despite exhaustion, fear of transmission to themselves and their family, illness or death of friends and colleagues, and losing many patients. They have also faced additional stress and anxiety due to long shifts combined with unprecedented population restrictions, including personal isolation. In this study, we study the effect of an app-based Yoga of Immortals (YOI) intervention on mental health of healthcare workers. In this study, the health care workers were digitally recruited, and their psychological parameters were measured using validated questionaries. The participants were randomly grouped into control and test groups. The validated psychological measures were the Patient Health Questionnaire-8 (PHQ-8), Insomnia Severity Index (ISI) and generalized anxiety disorder (GAD-7) scales. The digital YOI intervention significantly reduced the anxiety, depression symptoms, and insomnia in healthcare workers of all age groups. In contrast, there was no improvement in the control group. This study details the effectiveness of an app-based YOI intervention in healthcare workers.

The state of mental health and healthy lifestyle behaviors in nursing, medicine and health sciences faculty and students at Big 10 Universities with implications for action

BACKGROUND

High rates of mental health conditions and poor healthy lifestyle behaviors are reported in nurses, other clinicians, and health science students but have not been compared across different professions.

PURPOSE

The purpose of this study was threefold: (1) describe rates of mental health problems and healthy lifestyle behaviors across the Big 10 health professional faculty and students, (2) compare the health and healthy lifestyle behaviors of the Big 10 health sciences faculty and students across health sciences' professions, and (3) identify factors predictive of depression, stress, and anxiety.

METHODS

Faculty and students from eight health science colleges at the Big 10 Universities responded to the study survey, which included: demographics, healthy lifestyle behavior questions, and three valid/reliable mental health scales. Descriptive statistics described the findings and multiple linear regression identified factors associated with mental health conditions.

RESULTS

Eight-hundred and sixty-nine faculty and 1087 students responded. Approximately 50% of faculty and students reported 7 h of sleep/night, a third achieved 150 min of physical activity/week; 5.5%-9.9% screened positive for depression; and 11.5%-25.5% had anxiety. Age, sleep, and physical activity were associated with lower depression and anxiety.

CONCLUSIONS

University leadership must build wellness cultures that make healthy lifestyle behaviors easy to engage in and enhance mental well-being.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT

For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Rate of Medical Errors Higher Among Critical Care Nurses in Poor Health

Supportive work environments may lessen risk.

Evidence-Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model

BACKGROUND

The Advancing Research and Clinical practice through close Collaboration (ARCC^© ) Model is a system-wide framework for implementing and sustaining evidence-based practice (EBP) in hospitals and healthcare systems. The model involves assessing organizational culture and readiness for EBP in addition to the development of a critical mass of EBP mentors who work with point-of-care clinicians to facilitate the implementation of evidence-based care. Determining how the various components of the ARCC^© Model relate to one another is important for understanding how EBP culture and mentorship impact EBP implementation, nurses' job satisfaction, and intent to stay.

AIMS

The current study aimed to test a model that could explain the relationships and direct pathways among eight key variables in the ARCC^© Model: (1) EBP culture, (2) mentorship, (3) knowledge, (4) beliefs, (5) competency, (6) implementation, (7) nurses' job satisfaction, and (8) intent to stay.

METHODS

Structural equation modeling was used to test relationships among the variables in the ARCC^© Model with data obtained from an earlier cross-sectional descriptive study with 2,344 nurses from 19 hospitals and healthcare systems across the United States.

RESULTS

The final structural equation model found that EBP culture and mentorship were key variables that positively impacted EBP knowledge, beliefs, competency, implementation, job satisfaction, and intent to stay among nurses.

LINKING EVIDENCE TO ACTION

As described in the ARCC^© Model, establishing a strong sustainable EBP culture along with a critical mass of EBP mentors is crucial for the development of EBP competency and consistent implementation of evidence-based care by nurses. A strong EBP culture along with EBP mentorship also can result in higher job satisfaction and intent to stay. Implementation of the ARCC^© Model is a key strategy in assisting systems to reach health care's Quadruple Aim.