Association Between Perceived Stress and Burnout Among Neonatal Intensive Care Nurses.

Productivity in Audiology and Speech-Language Pathology

This study investigated self-perceived work-related stress, along with salivary IgA (s-IgA), cortisol and 3-methoxy-4-hydroxyphenyl glycol (MHPG) in 38 neonatal intensive care unit (NICU) nurses and 26 general ward (GW) nurses. To adjust for sociodemographic characteristics, the two groups of nurses were strictly matched for age, gender (feminine), average work experience and marital status (unmarried). General fatigue and anxiety were significantly higher, and depressive mood tended to be higher, in NICU nurses compared to GW nurses, based on Cumulative Fatigue Symptoms Index scores (p < 0.05, p < 0.05, p = 0.079, respectively). s-IgA concentrations were also inversely correlated with self-perceived work-related stress and were significantly lower in NICU nurses than in GW nurses (p < 0.01). There tended to be a positive association between high cortisol concentrations and the CFSI subscale of depressive mood in both NICU and GW nurses (p = 0.053). Cortisol and MHPG levels were not different between NICU and GW nurses. These work-related stress markers, both self-perceived (CFSI) and biological (s-IgAand cortisol concentrations), highlight the importance of creating and sustaining healthy work environments for NICU and GW nurses.

Moral distress is common in neonatal intensive care unit (NICU) nurses. The purpose of this study was to evaluate the relationships between NICU nurses' moral foundations, moral emotions, and moral distress. This is an observational cross-sectional self-report questionnaire study. One hundred and forty-two (24%) of 585 Level 3-4 NICU nurses completed pen-and-paper self-report measures of moral foundations (harm, fairness, ingroup, authority, and purity) (Moral Foundations Questionnaire-20), proneness to self-conscious moral emotions (guilt and shame) (modified Personal Feelings Questionnaire-2), and moral distress (futile care, compromised care, and untruthful care) (modified Revised Moral Distress Scale). Participation was voluntary and anonymous. The ethics committees of the participating hospitals approved the study protocol (HREC Reference: LNR/18/SCHN/316). Non-parametric statistical analyses showed medium to large correlations between moral foundations and moral emotions. Moral foundations and moral emotions had trivial to small correlations with moral distress. Using a liberal p-value of <.10 for statistical significance because of the small sample size, harm (rs = 0.22) and fairness (rs = 0.16) predicted futile care, ingroup predicted compromised care (rs = 0.19) and untruthful care (rs = 0.15), and purity predicted untruthful care (rs = 0.15). Guilt-proneness predicted futile care (rs = 0.15). Shame-proneness did not predict moral distress. The correlations between moral foundations and moral emotions were significant. Moral foundations and guilt-proneness predicted one or more dimensions of moral distress. The smaller than expected effect sizes may have been owing to how moral foundations, moral emotions, and moral distress were conceptualized and measured, or to moral disengagement, including NICU nurses' possible reluctance to countenance aversive but morally warranted feelings of guilt and especially shame. Understanding the nature of these relationships may complement the efforts of NICU administrators, educators, counsellors, and nurses themselves to mitigate moral distress.

COVID-19 pandemic has affected numerous conditions in nurses’ jobs, which led to stress. Stress in neonatal intensive care unit (NICU) nurses is different from other units due to neonates’ fragility. This study aims to identify the perceived effect of the COVID-19 pandemic in NICU nurses’ stress levels and its related factors. This cross-sectional study took place in Hasan Sadikin General Hospital Bandung, Indonesia, in October – December 2020, involving 23 NICU nurses. Subjects filled in the online questionnaires for three different time frames: before the pandemic, at the onset of the pandemic, and in the new normal era. Data were analyzed using Friedman test, post hoc Wilcoxon test, and Bonferroni correction. There was significant difference in nurses’ stress before the pandemic, at the onset of the pandemic, and in the new normal era. The stress increased at the onset of the pandemic and then decreased in the new normal era. The COVID-19 pandemic increased stress level and affected workloads, work-safety, interpersonal relationships, family problems, and economic problems. With these findings, we recommend the hospital management do a regular stress screening on NICU nurses and refer to the psychiatric department if nurses experience stress.

Objective: To investigate and compare nurses' perceived care-related distress and experiences in end-of-life situations in neonatal and pediatric intensive care units.Study design: Single-center, cross-sectional survey. Administration of an anonymous self-report questionnaire survey to nurses of two tertiary neonatal intensive care units (NICUs), and two tertiary pediatric intensive care units (PICUs) in Berlin, Germany.Results: Seventy-three (73/227, response rate 32.2%) nurses completed surveys. Both, NICU (32/49; 65.3%) and PICU (24/24; 100.0%) nurses, reported “staffing shortages” to be the most frequent source of distress in end-of-life situations. However, when asked for the most distressing factor, the most common response by NICU nurses (17/49) was “lack of clearly defined and agreed upon therapeutic goals”, while for PICU nurses (12/24) it was “insufficient time and staffing”. No significant differences were found in reported distress-related symptoms in NICU and PICU nurses. The interventions rated by NICU nurses as most helpful for coping were: “discussion time before the patient's death” (89.6%), “team support” (87.5%), and “discussion time after the patient's death” (87.5%). PICU nurses identified “compassion” (98.8%), “team support”, “personal/private life (family, friends, hobbies)”, and “discussion time after the patient's death” (all 87.5%) as most helpful.Conclusions: Distress-related symptoms as a result of end-of-life care were commonly reported by NICU and PICU nurses. The most frequent and distressing factors in end-of-life situations might be reduced by improving institutional/organizational factors. Addressing the consequences of redirection of care, however, seems to be a more relevant issue for the relief of distress associated with end-of-life situations in NICU, as compared to PICU nurses.

Psychological resilience (PR) is a trait that supports individuals as they attempt to overcome the negative factors and stressors experienced in life. Neonatal intensive care unit (NICU) nurses encounter considerable stress while providing care for medically vulnerable infants and because of this, are at risk for emotional burnout (EB). Literature suggests that PR may protect against burnout but investigation of PR and its relationship with EB in NICU nurses is limited.The ResMed PR questionnaire and the Emotional Burnout scale (EBS) were distributed to both day and night-shift neonatal nurses with over 6 months of experience working at a large academic NICU in order to investigate the relationship between these two concepts.In total 92 of 124 NICU nurses returned the survey, resulting in a response rate of 74%. The mean years of NICU nursing experience was 9.30. The average total ResMed score was 68.65 with domain scores of 21.78 for job-related gratification, 28.69 for protective practices, and 18.2 for protective attitudes. Regression analysis demonstrated a negative relationship between PR and EB, indicating that higher PR was associated with lower EB and suggesting a protective effect of PR against EB.This study provides insight into levels of PR and burnout amongst NICU nurses within a large academic NICU. These findings allow for the development of programs and strategies by healthcare leaders and institutions to maximize neonatal nursing health and well-being. · This study found a negative relationship between PR subscales and EB.. · This indicates that higher PR is associated with lower burnout.. · In this study, 40% of nurses tested positive for EB.. · Interventions targeted at improving nursing PR may be effective in managing EB..

Objective To construct a neonatal intensive care unit (NICU) nurses′ humanistic care ability evaluation index system based on knowledge, attitude, belief, practice model, thus to provide quantitative basis for the NICU nurses′ ability of humanistic care evaluation. Methods Through semi-structured interviews summed up the nursing care behavior item pool based on the knowledge, attitude, belief, practice model, used Delphi method to construct the NICU nurses′ humanistic care ability index system. Results The recovery rate of the two rounds were 87.5% (28/32) and 100.0% (32/32) respectively. The humanistic care ability included knowledge, belief, caring behavior and caring sense,11 secondary indicators and 30 level 3 indicators. The variation coefficient was 0.094-0.286. Conclusions This study scientificly and reliablly establish NICU nurses′ humanistic ability index system, which can be used to evaluate and to study the status of NICU nurses′ humanistic care ability, and to strengthen the humanity quality education, to reduce the dispute of nurses and patients has important significance. Key words: Knowledge, attitude, belief, practice model; Humanistic nursing; Transfer chain

The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. A descriptive, correlational design was used to study job satisfaction among NICU nurses. Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU nurses proves to be a limitation for generalization. Additional research is needed to further evaluate nursing role, educational level, and job satisfaction in the NICU.

Dimensions of the Burnout Measure: Relationships with shame- and guilt-proneness in neonatal intensive care unit nurses

Background: Moral distress in neonatal intensive care unit (NICU) nurses predicts burnout, the hospital ethical climate, and considering leaving the position. However, the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate remain unexamined in these nurses. Objectives: The aim of this study was to examine the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate in NICU nurses. Methods: This is an observational, multicentre, self-report questionnaire study of NICU nurses currently providing direct newborn care on 6 Level 3–4 NICUs in New South Wales, Australia. Results: Of the estimated 585 eligible nurses, 136 (23%) participated in the study. Twenty-one percent of the nurses were considering leaving. After controlling for the other predictor variables, moral distress did not predict considering leaving (p = 0.651). Burnout (odds ratio [OR] 4.25, p < 0.001) and the hospital ethical climate (OR = 0.29, p = 0.020) were significant predictors of considering leaving. The direct effect of moral distress on considering leaving was not significant, but the indirect effects mediated by burnout (B = 0.32, 95% confidence interval [CI] [0.147–0.611]) and the hospital ethical climate (B = 0.19, 95% CI [0.085–0.382]) were significant. Conclusions: The support of NICU nurses considering leaving should include preventing and resolving moral distress, managing burnout, and enriching the ethical climate of the hospital. This support may reduce psychological distress in NICU nurses and maintain or enhance the standard of care for sick newborns.

Secondary traumatic stress is an occupational hazard for healthcare providers who care for patients who have been traumatized. This type of stress has been reported in various specialties of nursing, but no study to date had specifically focused on neonatal intensive care unit (NICU) nurses. (1) To determine the prevalence and severity of secondary traumatic stress in NICU nurses and (2) to explore those quantitative findings in more depth through nurses' qualitative descriptions of their traumatic experiences caring for critically ill infants in the NICU. Members of NANN were sent e-mails with a link to the electronic survey. In this mixed-methods study, a convergent parallel design was used. Neonatal nurses completed the Secondary Traumatic Stress Scale (STSS) and then described their traumatic experiences caring for critically ill infants in the NICU. SPSS version 24 and content analysis were used to analyze the quantitative and qualitative data, respectively. In this sample of 175 NICU nurses, 49% of the nurses' scores on the STSS indicated moderate to severe secondary traumatic stress. Analysis of the qualitative data revealed 5 themes that described NICU nurses' traumatic experiences caring for critically ill infants. NICU nurses need to know the signs of secondary traumatic stress that they may experience caring for their critically ill infants. Avenues for dealing with the stress should be provided. Future research with a higher response rate to increase the external validity of the findings to the population of neonatal nurses is needed.

The phenomenon of moral distress is prevalent in the literature, but little is known about the experiences of nurses working in the neonatal intensive care unit (NICU). In addition, a paucity of literature exists exploring the relationship between moral distress and intent to leave a position in NICU nurses. To explore the phenomenon of moral distress in NICU nurses using the Measure of Moral Distress for Health Care Professionals (MMD-HP) survey. A cross-sectional, descriptive, correlational study was conducted nationally via an electronic survey distributed to NICU nurses who are members of National Association of Neonatal Nurses (NANN). Participants were asked to electronically complete the MMD-HP survey between March 27 and April 8, 2020. A total of 75 NICU nurses completed the survey, and 65 surveys were included for data analysis. Five situations from the survey had a composite MMD-HP score of more than 400. Results indicated that 41.5% of the NICU nurses surveyed considered leaving a clinical position due to moral distress, and 23.1% of the nurses surveyed left a position due to moral distress. for Practice: NICU nurses experiencing high MMD-HP scores are more likely to leave a position. Further research is needed to develop strategies useful in mitigating moral distress in and prevent attrition of NICU nurses. Many NICU nurses experiencing high levels of moral distress have left positions or are considering leaving a clinical position. Longitudinal interventional studies are vital to understand, prevent, and address the root causes of moral distress experienced by NICU nurses.

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. Strategies are needed for reducing stress in NICU nurses who work night shift.

To explore the collaboration challenges faced by neonatal intensive care unit (NICU) nurses and public health nurses when preparing premature infants for transition home and to explore the culture of cooperation between the two professional groups. Qualitative individual interviews were undertaken with two NICU nurses and two public health nurses. A qualitative content analysis was used to analyse the data. Three main themes were identified: different expectations and lack of communication between NICU nurses and public health nurses; responsibilities and interactions between the two professional groups were not clearly defined; and the public health nurses' competence was not recognised by the NICU nurses and parents. There is a need of clear guidelines about the discharge process from the NICU. This issue must be given further attention.

Although end-of-life care (EOLC) has been well-studied, the experience of neonatal intensive care unit (NICU) nurses in China, where little EOLC training is provided, requires further investigation. To explore the lived experience of EOLC delivery among NICU nurses, to provide evidence to enhance nurses' EOLC skills and improve their overall quality. This qualitative study adopted a phenomenological approach. A total of 11 NICU nurses participated in semistructured in-depth interviews between June and July 2022 at the First Affiliated Hospital of University of Science and Technology of China (USTC). Colaizzi's 7-step method was used to analyze the data. Five main themes were identified: (a) multiple emotions are experienced during EOLC delivery; (b) EOLC delivery is stressful from various sources for nurses; (c) expressing empathy and compassion is important; (d) ethical and clinical decision-making are key components of EOLC delivery; and (e) there are challenges in improving neonatal EOLC understanding and delivery. The experience of EOLC among Chinese NICU nurses is multidimensional and intensive. Institutions or units must establish and implement related protocols and guidelines to address differences between clinical practice and ideal protocols for neonatal EOLC. Educational programs that consider nurses' personal and interpersonal factors, including local culture, must be developed. Neonatal nurses in Western countries encountering Chinese-born parents who have lost their infants can gain an understanding of parents' perceptions from this study. Future research should focus on developing and testing interventions to train and support NICU nurses working with end-of-life neonates.