Associations between maternal occupational exposures and pregnancy outcomes among Chinese nurses: a nationwide study

BACKGROUND

Several studies have provided evidence about adverse pregnancy outcomes of nurses involved in occupational exposure. However, the pregnancy outcomes among nurses in middle-income countries are not well demonstrated. The main aim of this study is to present the prevalence and influencing factors of pregnancy outcomes among female nurses in China.

METHODS

We included 2243 non-nurse health care workers, and 4230 nurses in this national cross-sectional study in China. Information on occupational exposures and pregnancy outcomes was collected using a face-to-face investigation. Odds ratios (ORs) were estimated through logistic regression.

RESULTS

The proportion of threatened abortion, spontaneous abortion, and stillbirth of female nurses was 2.6%, 7%, and 2.1%, respectively. We found an increased risk of threatened abortion among nurses with overtime work (OR = 1.719, 95% CI 1.158-2.550). The risk of threatened abortion and spontaneous abortion was elevated among nurses handling disinfectant (OR = 2.293 and 1.63, respectively). We found a nearly twofold increased risk of premature birth (OR = 2.169, 95% CI 1.36-3.459) among nurses handling anti-cancer drugs.

CONCLUSIONS

Our findings suggested that maternal occupational exposures might be associated with the risk of adverse pregnancy outcomes among female nurses in China. We recommend that policy-markers and hospital managers work together to reduce exposure to occupational hazards and improve pregnancy outcomes among female nurses.

The lived experiences of racial bias for Black, Asian and Minority Ethnic students in practice: A hermeneutic phenomenological study

AIM

This study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom.

BACKGROUND

Previous research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective.

DESIGN

A hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student's degree.

METHODS

A focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysis RESULTS: Three encompassing themes were identified which included a sense of not belonging, trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues.

CONCLUSIONS

Meaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap.

Taking a Stand Against Workplace Incivility

BACKGROUND

Workplace incivility is a common problem in nursing, and novice nurses are particularly vulnerable to incivility.

METHOD

Cognitive rehearsal training to defend against incivility was presented to resident nurses.

RESULTS

Three months after the educational intervention, 55% of nurses reported that they had witnessed incivility in the past month and 45% reported that they had responded to the incivility when it occurred.

CONCLUSION

Most of the nurses expressed that the training improved their ability to manage incivility. Responses to open-ended comments revealed that incivility adversely affects the workplace and that leaders also may benefit from education on incivility and cognitive rehearsal. [J Contin Educ Nurs. 2021;52(5):232-239.].

Nursing Experts, Hygienic Modernity, and Nation Building: The Case of Nursing in Ethiopia in the Post-Colonial Era

This is a tale in three parts. It begins with an exploration of the story of Princess Tsahai, daughter of Haile Selassie, and the highly successful British campaign led by suffragette E. Sylvia Pankhurst to bring British-style nursing and medicine to Ethiopia in the 1940s and 1950s. Second, it examines the role of foreign women, most notably Swedish missionary nurses, in building health services and nursing capacity in the country. Finally, it examines the way in which nursing brought together gendered notions of expertise and geopolitical pressures to redefine expectations for Ethiopian women as citizens of the new nation-state.

Methodology of Interdisciplinary Studies in Nursing Based on Islamic Documents

To meet the needs of people from various cultures, nursing research must be performed on the basis of these cultures. This research aims to invent interdisciplinary research method based on Islamic documents. This method is with three stages: first, to describe a desired concept; second, to define the concept from the viewpoint of humans. Finally, a nursing discipline is achieved on the basis of the human knowledge and its findings, and Islamic documents. Results of this research method assist nurses in offering nursing care with regard to Muslim's beliefs in addition to their culture and customs.

Effect of high-quality nursing on alleviating depression and anxiety in patients with thyroid cancer during perioperative period: A protocol for systematic review

BACKGROUND

This study will assess the effect of high-quality nursing (HQN) on alleviating depression and anxiety (DA) in patients with thyroid cancer (TC) during perioperative period (PPP).

METHODS

We will search the following electronic databases (MEDLINE, EMBASE, PsycINFO, Cochrane Library, CINAHL, Web of Science, CBM, WANGFANG, and CNKI) from inception to the present and other literature sources without language limitation. All potential randomized controlled trials reporting on effect of HQN on DA in patients with TC during PPP will be considered for inclusion. Two researchers will separately carry out study selection, data extraction, and study quality evaluation. Any different opinion will be solved by a third author through discussion. All statistical analysis will be performed by RevMan 5.3 software.

RESULTS

We will appraise the effect of HQN on DA in patients with TC during PPP through assessing outcomes of depression, anxiety, pressure, quality of life, and adverse events.

CONCLUSION

This study will provide evidence to determine whether HQN is effective or not on DA in patients with TC during PPP. OSF REGISTRATION:: osf.io/sb5r8.

Despite Challenges: Nursing Student Persistence

BACKGROUND

Seeking to improve nursing student retention in their small university, faculty conducted a literature review on attrition in nursing education and discovered it to be a significant global problem with nearly one third of qualified students discontinuing. Improved nursing student persistence could stem the growing worldwide nursing shortage. The existing research on retention indicates multi-faceted challenges and impacts but offers scant solutions or insight into student perspectives.

METHOD

The nursing faculty piloted a bridge course for the freshman cohort to develop intrinsic strengths for student persistence and begin soliciting student feedback using a mixed-methods phenomenological approach.

RESULTS

Faculty describe the bridge course framework and activities and present initial student responses.

CONCLUSION

The pilot bridge course serves as one step toward identifying challenges and interventions from students' perspectives to support persistence as a means of meeting nursing shortage demands. [J Nurs Educ. 2019;58(7):427-430.].

Incivility through the continuum of nursing: A concept analysis

AIM

The aim of this study is to explore the gap between incivility in the workplace and academia and develop a connection to the psychosocial distress effects on the victims.

BACKGROUND

While incivility in nursing has reached epidemic proportions in the past decade, the current definitions of incivility are limited to the workplace or academia and lack consideration of the consequences related to the social well-being of the victim.

DESIGN

Rodgers' evolutionary method was used in this study.

DATA SOURCE

Following the PRISMA guidelines, articles were reviewed from PubMed and CINAHL between 2008 to 2019. Twenty articles describing incivility faced by staff nurses, student nurses, academic faculty, and nursing administrators were included in the final analysis.

REVIEW METHODS

Inductive thematic analysis was used to determine the antecedents, attributes, and consequences of incivility in nursing.

RESULTS

Findings included a culture of incivility and power gradients as antecedents. The attributes of incivility were verbal or non-verbal behaviors that demean, dismiss, or exclude the individual. Consequences of incivility are psychosocial and physiological distress.

CONCLUSION

A broader definition of incivility may be appropriate. Further research is needed to determine interventions to mitigate the effects of incivility.

Identifying trends in nursing start-ups using text mining of YouTube content

This study uses YouTube content to explore trends in nursing start-ups. YouTube content can be used to understand the current trends regarding interest and awareness in various fields. The study was conducted in three stages: text mining, Delphi survey, and comparison. The frequency and degree centrality of keywords were analyzed in the text mining stage. In the Delphi survey, the 100 most frequent keywords were classified using a synthesis framework for nursing start-ups. In the comparison stage, the results of text mining and the Delphi survey were matched using a 2x2 matrix. Text mining identified “area,” “business,” “competence,” “idea,” and “success” as the most commonly used keywords. The keywords that showed the highest level of classification agreement in Delphi were “motivation,” “advice,” “obstacle,” “business,” “charisma,” and “result.” In the comparison using a 2x2 matrix, “dream,” “idea,” “opportunity,” “leadership,” “success,” “benefit,” and “satisfaction” emerged. The results indicate that interest in nursing start-ups develops at an early stage. In order to encourage nursing start-ups, it is necessary to strengthen business skills such as finance and budgeting, establish active policy support for such start-ups, and develop new nursing start-up items appropriate for the Fourth Industrial Revolution.

How do nurses acquire English medical discourse ability in nursing practice? Exploring nurses' medical discourse learning journeys and related identity construction

BACKGROUND

In Taiwan's hospitals, English medical discourse underpins nursing and medical practice. Much patient care work is done through language work, by both text and talk. This means that when nurses start their nursing careers in the hospital context, where English medical discourse is shared to produce knowledge and engage in practice, knowledge of medical discourse and the ability to use it are prerequisites. In the process of learning and using such specialist language, the formation of professional identities is assumed.

OBJECTIVES

This study aimed to explore nurses' learning journeys relating to medical discourse and the development of their professional identities.

METHODS

This research adopted a qualitative approach, using data from 10 nurses working in different hospitals in Taiwan.

RESULTS

The findings revealed that English medical discourse was employed in Taiwan's hospitals not only for fulfilling professional purposes but also for socialising nurses into the healthcare community. Nurses acquired it through interactions, small talk, relationships, discussions, and nursing tasks. Their professional identities were formed through engaging in meaningful nursing practice based on English medical discourse. However, in the learning process, they encountered difficulties in the areas of listening, speaking, and reading, which raised concerns about patient safety.

CONCLUSION

Sufficient support is needed to ease nurses' difficulties in learning. We propose having primary and secondary preceptors, establishing a mentorship policy, and creating a learning environment that is supportive of nurses' learning experiences.

Examining Predictors and Outcomes of Decent Work Perception with Chinese Nursing College Students

Drawing on the psychology of working theory (PWT), the present study was performed to evaluate the predictor session of the PWT and career exploration behavior with a sample of Chinese nursing college students from diverse backgrounds. The research employed a cross-sectional research design and 854 nursing students were recruited from one health vocational college situated in Northwest China. Structural equation modeling was utilized to conduct the analysis; confirmatory factor analysis and structural model testing were performed accordingly. Moreover, mediation analysis that used bias-corrected percentile bootstrapping method and moderation analysis were carried out in accordance. Overall, most of the proposed direct paths were significant, but the mediation results were mixed. Proactive personality simply moderated the impact of economic constraints on career adaptability. The results suggest that PWT is applicable to nursing college students and the model is generally supported in the Chinese context. It is the first empirical work that used this model among nursing college students and future decent work perceptions contributed another important antecedent of career exploration behavior. The practical implications based on these findings are provided as well.

The Canadian Nursing Students' Association and its Advocacy for a Culturally Competent Entry-to-Practice Exam

The Canadian Nursing Students' Association (CNSA) is the national voice of Canadian nursing students. Its goal is to increase the legal, ethical, professional and educational aspects of nursing, which are an integral part of the profession. The association is actively dedicated to the positive promotion of nurses and nursing as a whole. Since the implementation of the NCLEX-RN, CNSA has worked extensively to support nursing students as they write this entry-to-practice examination. On national and provincial platforms, CNSA has implored stakeholders to engage in an inclusive dialogue that results in increased support for nursing students with regard to the NCLEX-RN.

Nursing and midwifery research activity in Arab countries from 1950 to 2017

BACKGROUND

Nursing and midwifery research activity is an important indicator of the quality of healthcare services and the status of nursing profession. The main aim of this study was to assess the research activity in nursing and midwifery field in Arab countries.

METHOD

The current study implemented bibliometric method using Scopus database. The search strategy used country affiliation or journal name or keywords as a strategy to retrieve the required documents. The study period was from 1950 to2017. Analysis included a presentation of bibliometric indicators and VOSviewer mapping of the retrieved data.

RESULT

2935 documents were retrieved making up less than 1% of global nursing and midwifery research output. Of the retrieved documents, 25% were published in high rank (first quartile = Q1) journals. The majority (56.7%) of the retrieved documents were published in the last five years of the study period. The retrieved documents received an average of 6.9 citations per document with an h-index of 47. The total number of authors who took part in publishing the retrieved documents was 10,572, giving an average of 3.6 authors per article. Jordan ranked first in research output. Researchers from Jordan took part in over than one third (1023; 34.9%) of the retrieved documents. Lebanon (35.5%) ranked first in the percentage of documents published in Q1 journals. The United Arab Emirates ranked first in the percentage (67.4%) of publications with international authors. The most active journal involved in publishing nursing research from Arab countries was Life Science Journal (158; 5.4%). The University of Jordan was the most productive institution while the American University of Beirut ranked first in the percentage (36.9%) of documents published in Q1 journals. Author keyword analysis and10 most cited articles showed that non-communicable diseases and nursing education were the focus of nursing research in Arab countries.

CONCLUSIONS

Nursing and midwifery research activity in Arab countries has dramatically increased especially over the past five years. Despite this, nursing research is still in its infancy, lagging in quantity and quality compared to developed countries.

Determinants of compassion satisfaction, compassion fatigue and burn out in nursing: A correlative meta-analysis

BACKGROUND

Compassionate care is essential for better clinical and patient outcomes, but during healthcare provision it can be compromised by several factors. This study evaluates factors affecting compassion satisfaction, compassion fatigue and burnout in nursing.

METHODS

Literature search in electronic databases was followed by data extraction, conversion, and meta-analyses under random effect model. Correlation coefficients (r) reported by individual studies were first converted to z-scores for meta-analyses and the overall effect sizes were then back-transformed into r.

RESULTS

Eleven studies (4054 respondents; 64.34 [95% confidence interval: 38.82, 89.86] % response rate; age 39.81 [31.36, 48.27] years; 87.11 [79.48, 94.73] % females) were used for meta-analysis. There was a strong positive correlation between compassion fatigue and burnout (r = 0.59), whereas compassion satisfaction had weak negative correlation with compassion fatigue (r = -0.226) but moderate with burnout (r = -0.446). Stress and negative affect were moderately positively associated with compassion fatigue (r = 0.405) but weakly correlated with burnout (r = 0.119). Positive affect and personal/social factors had weak inverse relationship with burnout (r = -0.197). Positive affect also had a moderately positive relationship with compassion satisfaction (r = 0.396). Demographic or professional factors were not significantly related to compassion satisfaction, compassion fatigue, or burnout.

CONCLUSION

In nursing, a variety of stressful factors and negative affect promote compassion fatigue and burnout whereas positive affect is helpful in achieving compassion satisfaction.

UK district nursing: the crisis continues

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a new independent report that warns of the problems facing district nursing and its effect on the care home sector and acute NHS care.

Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom

Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia-related entries in patients' records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds of patients (n = 475, 64.5%, 95%CI 60.9-67.8%) received no physician-documented pain assessment during the 24-h study period. Just under one-third (n = 215, 28.6%, 95%CI 25.5-32.0%) received no nursing-documented pain assessment, and over one-fifth (n = 159, 21.2%, 95%CI 19.2-23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

The continuing quest for parity: HBCU nursing students' perspectives on nursing and nursing education

The benefits of a diverse nursing workforce are well-recognized, yet, the attainment of a sustainable, competent and diverse nursing workforce continues to be a global challenge. In this qualitative study, we describe nursing students' perceptions on nursing and nursing education at a Historically Black College/University (HBCU). Focus groups were conducted with 16 graduate and undergraduate nursing students. Four themes emerged: communication, lack of resources, support systems and professional socialization. Mentoring and civility were identified as factors important to enhance a diverse workforce.

Factors Associated with Nursing Activities in Humanitarian Aid and Disaster Relief

BACKGROUND

Although nurses play an important role in humanitarian aid and disaster relief (HA/DR), little is known about the nursing activities that are performed in HA/DR. We aimed to clarify the nursing activities performed by Japanese nurses in HA/DR and to examine the factors associated with the frequency of nursing activities.

METHODS

A self-administered questionnaire survey was completed by 147 nurses with HA/DR experience. The survey extracted information on demographic characteristics, past experience (e.g., disaster medical training experience, HA/DR experience), circumstances surrounding their dispatched to HA/DR (e.g., team size, disaster type, post-disaster phase, mission term), and the frequency of nursing activities performed under HA/DR. The frequency of nursing activities was rated on a 5-point Likert scale. Evaluation of nursing activities was conducted based on the "nursing activity score", which represents the frequency of each nursing activity. Factors related to the nursing activity score were evaluated by multiple logistic regression analysis.

RESULTS

Nurses were involved in 27 nursing activities in HA/DR, 10 of which were performed frequently. On analysis, factors significantly associated with nursing activity score were nursing license as a registered nurse (OR 7.79, 95% CI 2.95-20.57), two or more experiences with disaster medical training (OR 2.90 95%, CI 1.12-7.49) and a post-disaster phase of three weeks or longer (OR 8.77, 95% CI 2.59-29.67).

CONCLUSIONS

These results will contribute to the design of evidence-based disaster medical training that improves the quality of nursing activities.

Implementation of the Austrian Nursing Minimum Data Set (NMDS-AT): A Feasibility Study

BACKGROUND

An Austrian Nursing Minimum Data Set (NMDS-AT) has been developed to describe the diversity of patient populations and variability of nursing care based on nursing diagnoses, nursing interventions, and nursing outcomes. The aim of this study is to test the feasibility of using this NMDS-AT by assessing the availability of data needed for the NMDS-AT in routine nursing documentation, and to assess its reliability and usefulness.

METHODS

Data were collected in a general hospital from patient records of 20 patients representing 457 patient days. Availability of needed data was assessed by two raters in a chart review based on an NMDS-AT form. The interrater reliability (n=20) and intrarater reliability (n=5) was assessed using Cohen's kappa coefficient and intraclass correlation coefficient (ICC). Usefulness was assessed by verifying whether typical analysis questions can be answered by the documented NMDS-AT data.

RESULTS

In the 20 patient records, thirteen nursing diagnoses, 50 nursing interventions, and five nursing outcomes occurred, representing 68 (58.6%) of the overall 116 data elements of the NMDS-AT. The data were found at different data sources (e.g., electronic nursing record or paper-based fever chart) and in various forms (e.g., standardized or free text). The interrater reliability of the thirteen nursing diagnoses showed kappa values (percentage of agreement) ranging from 0.35 (85%) to 1.00 (100%). The 50 nursing interventions showed ICCs ranging from 0.03 to 1.00. All nursing outcomes showed an ICC of 1.00. The intrarater reliability showed 100% agreement. Performing typical analysis questions showed that the extracted NMDS-AT data are able to answer questions of clinical management, of policy makers, and of nursing science.

CONCLUSIONS

The NMDS-AT was found to be feasible: needed data was available in the analysed patient records, data extraction showed good reliability, and typical analysis could be performed and showed interesting results. Before the NMDS-AT can be introduced in healthcare institutions, the following challenges need to be addressed: 1. improve the quality of nursing documentation; 2. reduce fragmentation of documentation; 3. use a standardized nursing classification system; and 4. establish mappings between nursing classification systems and the NMDS-AT.

[Current status of dementia in admitions to national leprosariums nationwide]

The purpose of this study was to get an overview of the following aspects of people admitted to 13 national leprosariums in Japan: the prevalence of dementia, medical and nursing systems, and facilities and equipment. Subjects included 1733 people admitted to wards for patients or disabled people in these leprosariums. Subjects were examined for cognitive function using Nishimura's behavioral rating scale for the mental states of the elderly (NMS), and for the prevalence of behavioral and psychological symptoms of dementia (BPSD). We also investigated medical and nursing systems, facilities and equipment, and status of nursing education. The results showed that, 288 subjects (16.6%) had a diagnosis of dementia. According to the NMS, 47.5% of the subjects were categorized as mild to severe dementia, while cognitive dysfunction was observed in 63.5% if borderline cases were included. Non-specialist physicians managed 30.8% of the subjects in 4 institutions, and there were no certified nurses specialized in dementia management. Results from this study suggest that there is need for the placement of dementia specialists', improvement of specialized medical services, and human resource development of specialized nurses in leprosariums where many elderly people live.

Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 Benchmark Study

BACKGROUND

We previously published a formula to estimate the number of hand hygiene opportunities (HHOs) per patient-day using the World Health Organization's "Five Moments for Hand Hygiene" methodology (HOW2 Benchmark Study). HHOs can be used as a denominator for calculating hand hygiene compliance rates when product utilization data are available. This study validates the previously derived HHO estimate using 24-hour video surveillance of health care worker hand hygiene activity.

METHODS

The validation study utilized 24-hour video surveillance recordings of 26 patients' hospital stays to measure the actual number of HHOs per patient-day on a medicine ward in a large teaching hospital. Statistical methods were used to compare these results to those obtained by episodic observation of patient activity in the original derivation study.

RESULTS

Total hours of data collection were 81.3 and 1,510.8, resulting in 1,740 and 4,522 HHOs in the derivation and validation studies, respectively. Comparisons of the mean and median HHOs per 24-hour period did not differ significantly. HHOs were 71.6 (95% confidence interval: 64.9-78.3) and 73.9 (95% confidence interval: 69.1-84.1), respectively.

CONCLUSION

This study validates the HOW2 Benchmark Study and confirms that expected numbers of HHOs can be estimated from the unit's patient census and patient-to-nurse ratio. These data can be used as denominators in calculations of hand hygiene compliance rates from electronic monitoring using the "Five Moments for Hand Hygiene" methodology.

[Futile medical care and euthanasia in the opinion of professional nurses]

Futile medical care and euthanasia are hard to assess unequivocally and are becoming a frequent topic of social discussion. The problem requires both ethical and moral consideration as well as legal regulations. As a medical issue it has got both its supporters and opponents. The aim of the study was to evaluate of nurses' attitudes and knowledge concerning euthanasia and persistend therapy.

MATERIAL AND METHODS

The survey group included 183 nurses aged 30-58. The diagnostic method poll was applied, the technique used was a questionnaire.

RESULTS

Among the nurses participating in the survey, 83% is against providing futile medical care when it is known that it will not bring any effect, while increasing the suffering and prolonging dying. 45% of the respondents consider euthanasia unacceptable, 41% think that euthanasia could be performed in cases in which patient's suffering cannot be relieved. 49% of the surveyed think that euthanasia should remain strictly prohibited by the Polish law, while 31% think that Polish legal system should legalize euthanasia.

CONCLUSIONS

The nurses are aware that futile medical care for terminally ill and dying patients does not lead to successful treatment but instead it prolongs dying and suffering, at the same time resulting in extremely high financial costs. In most cases they are advocates of its discontinuing. The surveyed nurses differ in their approach towards euthanasia, some of them supporting the idea, the other--opposing it. Most of them express the opinion that euthanasia should be forbidden in the Polish law and their personal approach towards euthanasia is negative.

Integrating the 3Ds: a nursing perspective

The 3Ds (diversity, disparities, and determinants) that serve as a framework for this supplement are concepts that are key foundations of nursing education, practice, and research. Despite this fact, however, the nursing profession has faced challenges recognizing the full potential of these concepts. While their importance is documented and acknowledged, they are not clearly evident or easily recognized within the nursing profession. In fact, there are many barriers to the integration of these concepts. We identify and address two barriers to addressing health disparities and increasing diversity: disconnects and discrimination. Furthermore, we discuss three factors-dissemination, durability, and data-that may facilitate nursing's efforts to integrate the 3Ds into the profession. Five pivotal models that address these barriers and facilitators are presented as exemplars that have the potential to guide efforts to address diversity, disparities, and social determinants of health and act as catalysts for change within the nursing profession.

Pain-related work interference is a key factor in a worker/workplace model of work absence duration due to musculoskeletal conditions in Canadian nurses

OBJECTIVE

To examine the role of pain experiences in relation to work absence, within the context of other worker health factors and workplace factors among Canadian nurses with work-related musculoskeletal (MSK) injury.

METHODS

Structural equation modeling was used on a sample of 941 employed, female, direct care nurses with at least one day of work absence due to a work-related MSK injury, from the cross-sectional 2005 National Survey of the Work and Health of Nurses.

RESULTS

The final model suggests that pain severity and pain-related work interference mediate the impact of the following worker health and workplace factors on work absence duration: depression, back problems, age, unionization, workplace physical demands and low job control. The model accounted for 14 % of the variance in work absence duration and 46.6 % of the variance in pain-related work interference.

CONCLUSIONS

Our findings support a key role for pain severity and pain-related work interference in mediating the effects of workplace factors and worker health factors on work absence duration. Future interventions should explore reducing pain-related work interference through addressing workplace issues, such as providing modified work, reducing physical demands, and increasing job control.

Vertical and lateral workplace bullying in nursing: development of the hospital aggressive behaviour scale

Healthcare staff is one of the professional groups that suffers the highest exposure to sources of occupational stress such as hostility from coworkers and superiors. In order to contribute to the assessment of bullying behaviors in the healthcare sector and to obtain a brief and manageable instrument for the assessment of this psychosocial risk, we developed the Hospital Aggressive Behaviour Scale-version Co-workers-Superiors (HABS-CS). By means of thorough qualitative analysis, an initial pool of 166 items was obtained, which were reviewed according to precise criteria until concluding with a total of 57 items, which were administered to a sample of 1,484 healthcare professionals from 11 public hospitals. The analyses concluded with the selection of 17 items distributed in two subscales. The internal 5-factor structure is the result of exploratory and confirmatory factor analysis conducted in two samples. Both the resulting questionnaire and the factors identified present adequate psychometric properties: high-internal consistency (Cronbach's α of .86) and adequate criterion validity, analyzed by means of significant correlations between the HABS-CS and job satisfaction, burnout components, and psychological well-being. This instrument may be of great utility for the assessment and prevention of psychosocial risks.

Reliability and validity of the Chinese version of DESIGN-R, an assessment instrument for pressure ulcers 

Lack of a valid and reliable assessment instrument may have contributed to a lack of wound healing research in China. The DESIGN-R tool scores the severity of pressure ulcers (PUs) and monitors healing using the observable state assessment; it was developed by the Scientific Education Committee of the Japanese Society of Pressure Ulcers (JSPU) and tested for reliability and validity. A Chinese version of DESIGN-R was developed based on Brislin's model of translationand tested for validity and reliability. Using a purposive sampling method, 44 practicing registered nurses (RNs) and 11 physicians (MDs) were recruited from 52 departments of Nanfang Hospital, Guangdong, China. Based on their experience, they were classified as general medical staff (gMS) or experienced medical staff (eMS). All used the Chinese version of DESIGN-R to assess eight photographs of PUs and descriptors. In addition, eight eMS also used the Bates- Jensen Wound Assessment Tool (BWAT) to assess the same wounds. Inter-rater reliability was high (total ICC score = 0.960). ICC inflammation/infection scores were 0.530 and 0.759 for gMS and eMS, respectively; granulation ICC scores were 0.532 and 0.794 in gMS and eMS, respectively. The correlation coefficients between the BWAT and DESIGN-R tool were >0.80 for all eight raters. The results suggest the Chinese version of DESIGN-R is valid and reliable and may be a useful scoring tool for RNs and MDs to monitor PU status in daily clinical practice. Additional research is warranted, and clinical instruments for inflammation/infection and granulation assessment must be developed for gMS.

Nursing workload as a risk factor for healthcare associated infections in ICU: a prospective study

INTRODUCTION

Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS).

METHODS

This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not.

RESULTS

195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient's clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI.

CONCLUSIONS

Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

Do elderly intensive care unit patients receive less intensive care treatment and have higher mortality?

BACKGROUND

The number of elderly (≥ 80 years) will increase markedly in Norway over the next 20 years, increasing the demand for health-care services, including intensive care. The aims of this study were to see if intensive care unit (ICU) resource use and survival are different for elderly ICU patients than for younger adult ICU patients.

MATERIALS AND METHODS

A retrospective cohort study comparing ICU patients between 50 and 79.9 years (Group I) with patients over 80 years (Group II) registered in the Norwegian Intensive Care Registry from 2006 to 2009. A subgroup analysis of 5-year age groups was performed.

RESULTS

A total of 27,921 patients were analysed. The ICU/hospital mortalities were 14.3%/21.4% (Group I) and 19.8%/32.4% (Group II). Overall mortality increased with increasing age, and hospital mortality rate increased more than ICU mortality. The observed difference in admission categories could not explain the significant difference in median length of stay (LOS), 2.3 days (Group I) vs. 2.0 days (Group II). The elderly received less mechanical ventilatory support (40.6% vs. 56.1%) and had shorter median ventilatory support time, 0.8 days vs. 1.9 days. Median LOS dropped from around 80 years on, ventilator support time from around 65-70 years.

CONCLUSION

Octogenarians had shorter ICU stays, had higher overall mortality, had a shift of dying at the ward rather than in the ICU, and received less and shorter mechanical ventilatory support.

[Scoring systems in intensive care medicine : principles, models, application and limits]

Scoring systems are used in all diagnostic areas of medicine. Several parameters are evaluated and rated with points according to their value in order to simplify a complex clinical situation with a score. The application ranges from the classification of disease severity through determining the number of staff for the intensive care unit (ICU) to the evaluation of new therapies under study conditions. Since the introduction of scoring systems in the 1980's a variety of different score models has been developed. The scoring systems that are employed in intensive care and are discussed in this article can be categorized into prognostic scores, expenses scores and disease-specific scores. Since the introduction of compulsory recording of two scoring systems for accounting in the German diagnosis-related groups (DRG) system, these tools have gained more importance for all intensive care physicians. Problems remain in the valid calculation of scores and interpretation of the results.

Effectiveness of a computer based medication calculation education and testing programme for nurses

The aim of the study was to evaluate the effect of an on-line, medication calculation education and testing programme. The outcome measures were medication calculation proficiency and self efficacy. This quasi-experimental study involved the administration of questionnaires before and after nurses completed annual medication calculation testing. The study was conducted in two hospitals in south-east Queensland, Australia, which provide a variety of clinical services including obstetrics, paediatrics, ambulatory, mental health, acute and critical care and community services. Participants were registered nurses (RNs) and enrolled nurses with a medication endorsement (EN(Med)) working as clinicians (n=107). Data pertaining to success rate, number of test attempts, self-efficacy, medication calculation error rates and nurses' satisfaction with the programme were collected. Medication calculation scores at first test attempt showed improvement following one year of access to the programme. Two of the self-efficacy subscales improved over time and nurses reported satisfaction with the online programme. Results of this study may facilitate the continuation and expansion of medication calculation and administration education to improve nursing knowledge, inform practise and directly improve patient safety.

Towards a national report card in nursing: a knowledge synthesis

This paper is an abridged version of a knowledge synthesis undertaken to inform the proceedings of a collaborative forum of nurse leaders convened under the auspices of Health Canada, the Academy of Canadian Executive Nurses, the Canadian Nurses Association and Canada Health Infoway for the purpose of discussing the development of a nursing report card for Canada. The synthesis summarized the state of the science in the measurement of nursing-sensitive outcomes and the utilization of nursing report cards - information that informed forum participants' dialogue and planning. This condensed version of the synthesis focuses on initiatives related to outcomes and performance monitoring in nursing, including specific indicators and reporting systems and the development, implementation and utilization of nursing report cards.

Exposure to anesthetic gases and congenital anomalies in offspring of female registered nurses

BACKGROUND

Studies of offspring of mothers exposed to anesthetic gases have shown associations with congenital anomalies reported by the mothers, but rarely in studies with objectively ascertained outcomes. We conducted a retrospective cohort study to examine associations between registry-ascertained congenital anomalies in offspring and anesthetic gas exposure of mothers employed as nurses.

METHODS

A cohort of registered nurses in British Columbia, Canada, was linked to records of births and congenital anomalies from 1990 to 2000. Exposures were assessed via a survey of anesthetic gas use in all hospitals in the province and records of nurses' jobs, departments, and hospitals.

RESULTS

Departments most frequently reporting anesthetic gas use were operating rooms, post-anesthetic recovery rooms, and maternity units. In the cohort of 15,317 live-borne children of 9,433 mothers, 1,079 had congenital anomalies. Anomalies were associated with ever and probable maternal exposure to halogenated gases (ORs: 1.49, 95% CI: 1.04-2.13; and 2.61, 95% CI: 1.31-5.18, respectively) and to nitrous oxide (ORs: 1.42, 95% CI: 1.05-1.94; and 1.82, 95% CI: 1.11-2.99). Anomalies most frequently associated with exposure were those of the heart (OR, halogenated gases: 2.31, 95% CI: 1.07-4.97) and integument (OR, halogenated gases: 3.56, 95% CI: 1.53-8.32; OR, nitrous oxide: 3.02, 95% CI: 1.37-6.64). Gases most frequently associated with anomalies were halothane (predominantly used early in the study period), isoflurane, and sevoflurane (predominantly used later in the period).

CONCLUSIONS

In this study, where both exposures and outcomes were assessed objectively, certain congenital anomalies were associated with estimated anesthetic gas exposure.

Assessment of nurses' nutritional knowledge regarding therapeutic diet regimens

Metabolic diseases and cardiovascular disease (CVD), the incidence of which is currently increasing in Korea, can be managed well with dietary education and modification. However, it has yet to be established whether nurses have sufficient knowledge to impart appropriate nutritional counseling to patients with these diseases. Our study involved 506 nurses working at Asan Medical Center, Samsung Medical Center, and Seoul National University Hospital between March and May, 2006. The questionnaire was comprised of 42 diet-related questions pertaining to diabetes, obesity, and CVD. Nurses' correct-response rate for overall nutritional knowledge was worse than reported in Western countries (58.4%), and particularly so with regard to obesity and CVD. Although many nurses were aware of the therapeutic aspects of nutrients in relation to CVD, most of them had limited knowledge about low-cholesterol diets and sources of water-soluble fiber, fatty acids and the specific food items that prevent CVD. Our results suggest that there is an urgent need to update the contents of nutrition education for nurses to reflect the current changes in the Korean diet and the increasing incidence of metabolic diseases and CVD.

[The intensity of nurses' night shift in medical wards: an observational study on patients' calls]

INTRODUCTION

It is recognised that the night shift is a difficult one but only scarce data are available on what happens during the night.

AIM

The aim of this paper is to describe the reasons of patients' calls during the nights and the number of problems that require the intervention of the doctor on night duty.

METHODS

Data were collected by a non participant observer, in 4 general medical wards during a convenience sample of 12 nights. For each call, a form was completed reporting hour, patients characteristics and reasons for call.

RESULTS

During the nights 483 calls were observed; on average 40.2 for each night and 4 for each of the 115 patients who made a call. On average each nurse did answer 18 calls. The 40.4% (205/483) occurred between 21.00 and 23.59 hours; 18.6% had more than one reason (on average 1.2 reasons for each call). The doctor on duty was called for the 3.1% of calls.

DISCUSSION

The night duty can be very intensive. Situations nurses have to deal with and workload need to be explored to increase patients (and nurses) safety.

[Burnout syndrome epidemiology]

The burnout syndrome constitutes a process which bears high prevalence and important consequences among sanitary professionals, particularly among nurses. Therefore, the authors have proposed to study the three dimensions of this syndrome, namely emotional tiredness, depersonalization and lack of a sense of achievement plus the function certain personal, labor, and institutional factors have in development of this process. The authors carried out a transversal study based on a random sample from among all the nursing staff at a Madrid hospital. Two methods to gather information were employed: one questionnaire gathered sociodemographic data, labor and institutional variables while the Maslach Burnout Inventory (MBI), in its verified Spanish version, studied the three burnout syndrome dimensions. The authors made a multiple logistical regression analysis, using as dependent variables the three syndrome scales and adjusting parameters for all the other variables. Clear risk factors were shown; these included unfavorable opinions professionals hold regarding institutional variables; the scale for emotional tiredness warrants special note.

[The implementation of NEMS and NAS systems to assess the nursing staffing levels in a polyvalent intensive care unit]

NEMS and NAS scoring systems allow to calculate the number of nurses needed in an intensive care unit. Aim of the study is the assessment of nursing workload in a polyvalent intensive care unit, the evaluation of easiness of routine use of the systems and the assessment of the number of nurses needed.

METHOD

The NEMS and NAS scores of 752 patients admitted respectively from may 2004 and July 2006 and of 250 patients admitted from August 2006 to July 2007 were analysed and adjusted to the number of inpatients.

RESULT

Mean NEMS score were 32.05 (+/- 2.11) and mean NAS scores 76.17 (+/- 14.66) and minutes of care needed per day 1009 according to NEMS and 1096 according to NAS. Medical patients have an higher workload compared to surgical (NAS Score 84.2 +/- 16.4 vs 79.0 +/- 12.4, p = 0.0047). The workload is influenced by the main illness (extracorporeal circulation: 102.26 +/- 5.70, shock. 88.00 +/- 1 7.48, cardio-circulatory arrest out of the ward: 81.95 +/- 15.46, ARDS 86.62 +/- 14.10) and by the day of admission, being higher at admission.

CONCLUSIONS

The routine assessment of patients' workload allows to measure the gap between nurses needed and available, to monitor patients with higher workload and to quantify the need of nursing care according to patients case-mix.

Propuesta de una nueva escala de valoración de cargas de trabajo y tiempos de enfermería (VACTE©)

The scale Nine Equivalents of nursing Manpower use Score (NEMS) for the evaluation of the nursing care loads is the most well known and applied worldwide. Nevertheless, we have found a series of limitations: it does not reflect the "proper nursing activity" but only the cares related to the medical intervention. Furthermore, it is directly related to severity while integral attention to the patient implies an infinity of cares, which are not necessarily related to the severity. In addition, we understand that the planned personnel ratios may be unsuitable, with the consequent repercussions for the patient, nurses and the sanitary institution. The primary targets were: elaboration of a representative scale of all the cares and tasks made by the nurses (VACTE) in our unit, to determine if it is more precise and objective than NEMS for the measurement of the service loads and to calculate the operative ratio patient-nurse based on the new proposed scale. We made a descriptive and retrospective study on 91 patients admitted to the Intermediate Care Unit of the Fundación Hospital de Jove during the first three months of 2004. Previously we created scale VACTE, making real measurements of the time inverted in the execution of each one of the cares in 50 patients. Later, a comparison was made between the APACHE II, NEMS and VACTE scales, taking as reference the scores obtained in the same ones during the first 24 hours of the stay. The statistical analysis was made by SPSS 11.0, assuming a confidence level of 95% (p < 0.05): lineal analysis of simple regression to compare the different scales; the force of its correlation with Spearman's coefficient and we compared the independent dichotomize variables with the Mann-Whitney test. The main results determined after the study were the following: regarding the scale to evaluate seriousness applied to the patients, an average APACHE II score of 12.1 +/- 5.9 was obtained. The average value with the NEMS was 19.5 +/- 5.7 and the average one with VACTE was 365 +/- 91.2. Significant differences were found between APACHE II and the NEMS (p = 0.008) and VACTE (p < 0.001) scales. This relationship presented more force with VACTE (r = 0.43; p < 0.001) than with NEMS (r = 0.23; p = 0.002). The operative patient-nurse ratio calculated with VACTE was 2.01. Scale VACTE is representative of nursing activity and seems to be more effective than NEMS to determine service loads. The ratio planned in the unit duplicated the calculated operative ratio.

Issues and challenges in nursing and nursing education in Japan

In this editorial we discuss the challenges and issues in nursing and nurse education in Japan. These include a rapid growth in the number of universities offering nursing programs without sufficient time for preparation of faculty; issues in the traditional ways of teaching in classrooms; the appearance of nursing shortages in a country with the highest rate of longevity in the world; and the position of nursing faculty in a society that is largely male dominated.