"A Two-Edged Sword": Paternalistic Leadership and Nurses Performance: A Moderated Mediation Model

Background: The study investigates the impact of paternalistic leadership on the performance of nurses. Furthermore, it looks into the role of self-efficacy as a mediator in the relationship between paternalistic leadership and performance. It also looks into the role of power distance as a moderator. Methods: The study used a quantitative survey-based research approach, with questionnaire responses collected over time. Initially, 315 Chinese nurses were surveyed about their views on paternalistic leadership, self-efficacy, and power distance. While their supervisors were called after 6 weeks for a dyadic answer, they were asked to offer their thoughts on their performance. The AMOS 22 software was used for confirmatory factor analysis (CFA), while the SPSS 22 software was employed for descriptive statistics, such as the correlation and regression analysis. Results: The findings demonstrated that paternalistic leadership had a beneficial impact on performance. Furthermore, the role of self-efficacy as a mediator and power distance as a moderating mediator in this relationship has been evidenced. Conclusion: The results suggest that paternalistic leadership has a good impact on nurse performance. Furthermore, self-efficacy as a mediator explains the association between paternalistic leadership and nursing performance adequately. Furthermore, power distance appeared to be a powerful moderator, as the moderated mediation results revealed that in high-power-distant societies, such as China, self-efficacy enhances the link between paternalistic leadership and nursing performance. Limitations and future directions were also discussed.

Impact of thriving at work on eustress and distress: career growth as mediator

Purpose

Thriving at work can affect eustress and distress differently, so the main purpose of this study is to determine the impact of thriving at work on stress and to extend the existing literature on stress by examining the mediating mechanism of career growth, which is one of the functions of human resource development, in the relationship between thriving at work and stress. Person environment fit theory is used to explain the framework.

Design/methodology/approach

Data were collected from 179 employees of the hospitality sector of Pakistan to assess the impact of thriving at work on eustress and distress through the mediation of career growth. Structural equation modeling was used to test the hypotheses.

Findings

Results revealed thriving at work is positively related to eustress whereas it is negatively related to distress, and there is a positive association between thriving and career growth. Furthermore, career growth appeared as an effective explanatory mechanism for relationships between thriving at work and stress. Implications for managers are also discussed.

Originality/value

This study encompasses both positive and negative stressors. There are lots of studies available that examine thriving at work and stress, but the present study aims to examine the impact of thriving on both aspects of stress in the presence of career growth as the mediator in the hospitality sector of Pakistan. It also opens new avenues for research on P-E fit theory to gain benefit from the eustress of employees.

Impact of public health education on undue fear of COVID-19 among nurses: The mediating role of psychological capital

This study looked into the mechanism through which health education can reduce the fear of being infected with COVID-19 because health education helps individuals to improve their knowledge and attitudes towards a disease. The spread of COVID-19 has escalated the level of fear among public and nurses. Nevertheless, the mechanism that contributes to minimize the fear towards this pandemic remains unexplored. A cross-sectional survey was adopted to test the relationships among public health education, psychological capital, and fear of COVID-19. In total, 243 responses were obtained via online survey from nurses. The results revealed that public health education can reduce one's fear of COVID-19. Psychological capital emerged as a strong explanatory mechanism for the phenomenon. Drawing on spillover theory, public health education seems to reduce fear of COVID-19 with the mediating role of psychological capital. Limitations and future directions are at the end of this paper. The study outcomes revealed that organizations should focus on educating nursing staff to overcome fear of COVID-19. One way to induce positivity among nursing staff is by holding trainings.

Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements

BACKGROUND

Since arrhythmia induces irregular pulse waves, it is widely considered to cause flawed oscillometric brachial cuff measurements of blood pressure (BP). However, strong data are lacking. We assessed whether the agreement of oscillometric measurements with intra-arterial measurements is worse during arrhythmia than during regular rhythm.

METHODS

Among patients of three intensive care units (ICUs), a prospective comparison of three pairs of intra-arterial and oscillometric BP readings was performed among patients with arrhythmia and an arterial line already present. After each inclusion in the arrhythmia group, one patient with regular rhythm was included as a control. International Organization for Standardization (ISO) standard validation required a mean bias <5 (sd 8) mm Hg.

RESULTS

In 135 patients with arrhythmia, the agreement between oscillometric and intra-arterial measurements of systolic, diastolic and mean BP was similar to that observed in 136 patients with regular rhythm: for mean BP, similar mean bias [-0.1 (sd 5.2) and 1.9 (sd 5.9) mm Hg]. In both groups, the ISO standard was satisfied for mean and diastolic BP, but not for systolic BP (sd >10 mm Hg) in our ICU population. The ability of oscillometry to detect hypotension (systolic BP <90 mm Hg or mean BP <65 mm Hg), response to therapy (>10% increase in mean BP after cardiovascular intervention) and hypertension (systolic BP >140 mm Hg) was good and similar during arrhythmia and regular rhythm (respective areas under the receiver operating characteristic curves ranging from 0.89 to 0.96, arrhythmia vs regular rhythm between-group comparisons all associated with P>0.3).

CONCLUSIONS

Contrary to widespread belief, arrhythmia did not cause flawed automated brachial cuff measurements.

Risk factors for native kidney dysfunction in patients with abdominal multivisceral/small bowel transplantation

Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, particularly after intestinal transplant. In our study, we reviewed data on 33 multivisceral transplant (MVT)- and 15 isolated small bowel (ISB)-transplant patients to determine risk factors for kidney dysfunction. Kidney function was estimated by modified diet in renal disease (MDRD) and Schwartz formula for adults and children, respectively. Acute kidney injury (AKI) was defined as an increase in the serum Cr (sCr) greater than twofold. Kidney function declined significantly at one yr after transplantation with 46% of subjects showing an estimated GFR (eGFR) <60 mL/min. Patients with an episode of AKI were more likely to have reduced eGFR than those without AKI (p < 0.025). In linear regression analyses, age, pre-transplant sCr, eGFR at postoperative day (POD) 30, 90, 180, 270, and tacrolimus level at POD 7 showed significant correlation with one yr post-transplant eGFR (p < 0.05). Pediatric patients and patients with MVT had lesser decline in kidney function compared with adults or patients with ISB. In conclusion, risk factors for post-transplant kidney dysfunction in intestinal transplantation included age, pre-transplant sCr, AKI episode, eGFR at POD 30, 90, 180, 270, and tacrolimus level at POD 7.

Sleep Disorders in Patients with Breast Cancer Based on Polysomnographic Data

Background. Complaints of sleep disturbances are common in patients with breast cancer and may affect their quality of life. Insomnia, fatigue, and sleep fragmentation were previously reported in these patients. However, no studies reported polysomnographic data to elucidate the etiology of these symptoms. We hypothesized that patients with breast cancer will have considerable abnormalities on their monitored overnight sleep studies including sleep disordered breathing, periodic leg movement, and spontaneous arousals.Methods. Data from sleep studies were prospectively collected from cancer patients who undergo a sleep study at the MD Anderson Sleep Center and who consented to participate. All breast cancer patients who underwent a poylsomnogram between 1/30/2007 and 4/1/2009 and signed informed consent were identified. The prospectively collected data included demographics, breast cancer clinical data and treatment, as well as polysomnographic data.Results. Sixty-nine patients (68 female, 1 male) were identified with breast cancer. All patients underwent a formal sleep consultation. The median age was 56 (range: 38 to 75 years), and the median body mass index (BMI) was 33 kg/m2 (21 to 52).Tumor characteristics were as follows: 55 patients (80%) had invasive ductal carcinoma, 8 (12%) had invasive lobular carcinoma, 5 with ductal carcinoma in situ (7%), and 1 unknown (1%). ER/PR was positive in 44 patients (64%), and HER-2 positive in 9 patients (13%). Five patients (7%) had stage 0, 12 (17%) had stage I, 30 (44%) had stage II, 12 (17%) had stage III, and 10 (15%) had stage IV disease. Twenty-four patients (35%) had completed treatment, 10 patients (15%) were receiving chemotherapy, and 34 patients (50%) were receiving hormonal therapy.Fifty-one patients (74%) were referred for daytime sleepiness and fatigue, 11 (16%) for sleep apnea symptoms, 1 (1%) for pulmonary hypertension and 6 (9%) for insomnia. In 55 patients (81%), the median Epworth Sleepiness Score 12 (4 to 21) was consistent with excessive daytime sleepiness.Sleep fragmentation was noted in all patients with a median sleep efficiency of 86% (36% to 98%) and a median Arousal Index of 33 arousals/hour of sleep (7 to 118). Furthermore, the median percentages of delta sleep (deep sleep) and REM sleep were notably diminished at 1% and 13% respectively. Sleep disordered breathing was noted with a median Apnea Hypopnea Index (AHI) of 10 apneas and hypopneas/hour of sleep (0 to 68). Only 2 patients were noted to have significant periodic limb movements with arousals. There was no difference in these abnormalities between treatment groups (chemotherapy, hormonal therapy, or no treatment).Conclusions. This is the first report of polysomnographic data in breast cancer patients. Our data show that sleep disordered breathing (obstructive sleep apnea) is a cause of sleep disturbance in a number of these patients. Conversely, periodic leg movement was not common among these patients. Of interest, the high Arousal Index indicates a high frequency of spontaneous arousals not explained by apnea or hypopnea and these findings did not vary across treatment types. These findings show unique abnormalities in the sleep architecture of breast cancer patients that are provoking and warrant further study.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5036.

[Pregnancy and delivery in a patient with Willebrand's disease. Apropos of a case]

Willebrand's disease is the most frequent inborn coagulopathy and type 3 is its most severe form. Pregnancy and delivery are critical events in women with Willebrand's disease of type 3. Prophylactic treatment for delivery and early postpartum period is recommended. We report the management of pregnancy and successful delivery of a 32-year-old woman with type 3. Prophylactic treatment with 2000 IU of Willebrand's disease factor (WdF) was given twice a day during the delivery day and the day after, and 1000 IU per day during the next three days. The patient did not show any spontaneous metrorrhagia but anemia. No bleeding was observed in the newborn.

The epidemic of vitamin D deficiency

A 37-year-old woman was referred to our endocrine clinic for management of her long-standing hypothyroidism. Her main complaints were muscle aches and pains that started about a year ago. The symptoms progressed to generalized muscle weakness. She described difficulty in getting out of her chair and in climbing stairs. She had an extensive work-up done by her neurologist and rheumatologist, including nerve-conduction studies and a muscle biopsy. The evaluation was normal, and she was diagnosed with fibromyalgia. She had gastric bypass surgery in 1998 and lost 150 pounds since the operation. She also has had lactose intolerance and a compression fracture without trauma. Her weight was 314 pounds. She had proximal muscle weakness. The rest of her physical examination was normal. Serum laboratory values are listed in Table 1. Based on the laboratory values, she was diagnosed as having severe vitamin D deficiency. She was started on 50,000 IU of vitamin D2 (Ergocalciferol) once a week for 6 months. Now her 25 hydroxyvitamin D level is 40 ng/mL, and her muscle strength has improved.