Hospital-based Nurses Research Articles

Teamwork, psychological detachment from work during nonwork time, and burnout experienced by hospital-based nurses.

To assess the relationships in nursing teamwork, psychological detachment from work during nonwork time, and burnout, and the mediating effect of psychological detachment on the relationship between nursing teamwork and burnout. Nurse burnout has serious implications for nurses' health and performance and the overall functioning of their organizations. Evidence on the relationships between nursing teamwork, psychological detachment, and nurse burnout is limited. This study adds to the international body of knowledge by examining the interplay between nursing teamwork, psychological detachment, and burnout in nurses, a topic of global relevance. This cross-sectional study used survey data collected in May 2021 from 1115 Korean hospital nurses. The measurements included the Nursing Teamwork Survey, a subscale of the Recovery Experience Questionnaire, and the Copenhagen Burnout Inventory. We performed mediation analysis using PROCESS Macro based on 5000 bootstrapped samples to estimate the indirect effect of nursing teamwork. Nurses in units with stronger teamwork were more likely to report being psychologically detached from work during nonwork time. Nurses who distanced themselves from work-related thoughts during nonwork time reported lower personal, work-related, and patient-related burnout. Nursing teamwork had significant indirect effects on each burnout outcome through psychological detachment. By providing empirical evidence on the associations between nursing teamwork, psychological detachment, and burnout, this study enriches the international discourse on nurse burnout and the benefits of psychological detachment. Enhanced nursing teamwork can facilitate nurses' mental distance from work during nonwork time, thereby reducing burnout. Organizational efforts to manage nurse burnout can include increasing nursing teamwork among nurses and improving nurses' psychological detachment during nonwork hours. Interventions should include improving nursing teamwork and developing a supportive and collaborative unit culture.

Pediatric nurses' fatigue descriptions in occupational injury reports: A descriptive qualitative study1.

Despite the high risks associated with occupational fatigue in healthcare, few organizations require nurses to screen and report fatigue symptoms. As a result, little is known about if and how nurses would report fatigue while on the job. To determine if hospital-based pediatric nurses reported fatigue as part of an active injury reporting method. This secondary analysis of qualitative data used a descriptive design with content analysis. Data from the parent study were collected at a U.S. pediatric hospital where nurses verbally reported on-shift injuries or near misses and pre- and post-shift health status via a digital voice recorder. Researchers used content analysis to independently code data for nurses' references to fatigue. Codes were then analyzed for patterns and themes. Approximately 30% (n = 104) of participants reported fatigue-related content. Emergent themes were Work Stressors, Individual Risk Factors, Fatigue Descriptors, Adverse Outcomes from Fatigue, Fatigue Buffers, Descriptors for Buffered Fatigue, and Favorable Outcomes from Buffered Fatigue. Fatigue descriptions align with prior literature, demonstrating the accuracy of the voice recorder data collection method. In addition, nurses expressed uncertainty about the appropriateness of reporting fatigue symptoms. Findings from this study support pediatric nurses will report fatigue, when provided an opportunity. Additional efforts are needed to better understand effective ways to improve fatigue reporting among nurses, including harnessing current technology for real-time reporting and how to change the culture around fatigue reporting.

"Moral spaces": A feasibility study to build nurses' ethical confidence and competence.

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses' ethical knowledge and confidence to respond to ethical challenges in practice. Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest "always agree" (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses' ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method.

Nurses’ contribution to antimicrobial stewardship: business as usual?

BackgroundAntimicrobial Stewardship (AMS), the set of actions to ensure appropriate antimicrobial use, is increasingly considered a multidisciplinary endeavour. However, it is unclear how Dutch hospital-based nurses envision their contribution to AMS.ObjectiveTo explore the views and visions of Dutch bedside nurses on their role regarding appropriate antimicrobial use.MethodsA qualitative study using semi-structured interviews was conducted. Fourteen bedside nurses in nine different Dutch hospitals participated. Data were analysed using a thematic content analysis.ResultsNurses considered their role regarding appropriate use of antibiotics as an integral part of their daily nursing practice. They envisioned their future role as an expansion of their current practice, improving or intensifying this contribution. Prompting review of antimicrobial treatment by nurses was seen as regular practice. Ward rounds were considered the best moment to exert their nursing role, by showing leadership in communicating about different aspects of AMS. Patient advocacy (“striving for the best possible care for their patient”) appears to be a driver of the nursing contribution. Nurses perceived a shared responsibility with prescribers on certain aspects of the antimicrobial treatment and wished for a clarification of this role. Education and cognitive reminders such as antibiotic checklist to be used in ward rounds, can support the uptake of the nurses’ role.ConclusionNurses envision their future role in AMS as an enhanced, elaborated and empowered version of their current daily practice. Education, formal acknowledgment and increased awareness of the nursing role, may advance the contributing role nurses already have.

Assessing perceptions of nursing knowledge, attitudes, and practices in diabetes management within Chinese healthcare settings.

Effective management of diabetes mellitus (DM) involves comprehensive knowledge, attitudes, and practices (KAP) by nurses, which is essential for optimal patient care and aiding patients in their self-management of the condition. This survey evaluates nurses' self-assessed knowledge, attitudes, and practices (KAP) related to diabetes management, focusing on their perceptions of personnel expertise and care approaches. Using a stratified sampling method, the survey was disseminated across various online platforms from January 2023 to February 2024 within China, including WeChat and Sina Weibo. We employed binary logistic regression and Chi-square tests to explore the statistical correlates of KAP related to DM. A total of 4,011 nurses participated, revealing significant perceived knowledge deficiencies in specialized DM management areas, with only 34% (n = 1,360) proficient in current pharmacological treatments. Attitudinal assessments showed that 54% (n = 2,155) recognized the importance of cultural competence in dietary counseling. Practices were strong in routine glucose monitoring (96%, n = 3,851) but weaker in psychological support (68%, n = 2,736). Regression analysis indicated significant effects of experience on KAP, where nurses with 1-5 years of experience were more likely to show better knowledge (OR = 1.09; p = 0.08), and those with advanced degrees demonstrated higher competence (OR = 1.52; p = 0.028). Marital status influenced attitudes, with single nurses more likely to exhibit positive attitudes (OR = 0.49; p < 0.001), and work environment impacted knowledge, with hospital-based nurses more knowledgeable (OR = 1.15; p = 0.14). Additionally, gender differences emerged, with male nurses showing greater knowledge (OR = 1.65; p = 0.03) and better practices in diabetes care (OR = 1.47; p = 0.04). The study underscores the critical need for targeted educational programs and policy interventions to enhance nursing competencies in DM management. While the study provides valuable insights into nurses' perceptions of their competencies, future research should incorporate objective knowledge assessments to ensure a comprehensive understanding of their actual capabilities. Interestingly, the data also suggests a substantial opportunity to leverage technology and inter-professional collaboration to further enhance DM management efficacy among nurses, fostering an integrated care approach.

Psychometrics of the Revised Nursing Stress Scale.

Occupational stress is one of the most impactful issues that nurses face, and it is critical to have instruments that can accurately measure occupational stress. However, existing widely used stress measures do not adequately reflect occupational stress in current practice. The aim of this study was to evaluate the reliability and validity of a revised occupational stress measure, the Revised Nursing Stress Scale. Reliability and validity were evaluated using confirmatory factor analysis, internal consistency reliability, convergent validity, and divergent validity. Confirmatory factor analysis demonstrated acceptable fit. All nine subscales had acceptable internal consistency reliability (αs ≥ 0.73 and ω ≥ 0.80). Convergent validity (r = 0.530, p < 0.01) and divergent validity (r = <0.30, 95% confidence intervals ranging from [-0.39 to -0.14] to [-0.32 to -0.06]) provided support for the scale. The Revised Nursing Stress Scale is an updated valid and reliable measure that is recommended for use when measuring occupational stress in hospital-based nurses.

Impacts of the COVID-19 pandemic on the mental health of frontline hospital-based nurses: rapid review and meta-analysis

The COVID-19 pandemic focused the world’s attention on the gross relative health risks, inequities and injustices experienced by first responders, of whom front-line, hospital-based nurses may be the most vulnerable. A series of research syntheses prior to the pandemic estimated that such front-line nurses were at approximately two-fold greater risk of experiencing mental health challenges such as increased symptoms (and diagnoses) of anxiety, depression and PTSD than were nursing administrators or otherwise similar, people in the general population. Aiming to clarify how the pandemic impacted such mental health risks, we conducted a rapid review and meta-analysis of observational studies from the worldwide published and gray research literature. Twelve longitudinal studies that covered the pandemic’s pre-vaccination phase were included. The overall pooled increased relative risk of mental health challenges among frontline, hospital-based nurses from pre-pandemic to the pre-vaccination phase of the COVID-19 pandemic was 2.62 (95% CI 2.10, 3.27). But sensitivity and moderator analyses accounting for research design limitations better estimated two-fold increased risks (relative risks ranged from 1.69 to 2.00). Already at elevated risk of experiencing symptoms of anxiety, depression and PTSD and so, such increased symptoms and diagnoses among front-line, hospital-based nurses probably doubled during the early, pre-vaccination phase of the pandemic, perhaps quadrupling among women. Implications for nursing practice, health care policy, future pandemic preparedness as well as future research are discussed.

Associations between negative patient safety climate and infection prevention practices

The relationships among positive perceptions of safety climate and better healthcare worker behaviors have been increasingly documented in the literature. The potential influence of negative perceptions is underexplored and has not been examined in relationship to infection prevention practices. We begin to address this gap using data collected as part of a multi-site, cross-sectional study. This brief report describes associations identified between negative perceptions of patient safety climate and standard precaution adherence of hospital-based nurses.

The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review.

To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing. Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible. We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed. Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

Massage therapy for hospital-based nurses: A proof-of-concept study

Massage therapy for hospital-based nurses: A proof-of-concept study

Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis.

The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery. The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave. This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice. The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave. While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system.

Healthy Work Environment Standards in Tele-Critical Care Nursing.

The COVID-19 pandemic exacerbated staffing challenges in intensive care units, with increased burnout and moral distress cited as major problems. A healthy work environment is critical to nurses' success and wellbeing. During the pandemic, a survey by the American Association of Critical-Care Nurses revealed decreased composite scores in each of the 6 critical elements of a healthy work environment. Hospital units that improved even 1 critical element reported higher job satisfaction. The use of telehealth tools by expert nurses expanded care delivery during the pandemic by improving response to acutely and critically ill patients while supporting hospital-based nurses. All of the critical elements of a healthy work environment are relevant to the tele-critical care nurse's role and challenges. This article describes how tele-critical care nurses were affected by the pandemic and how healthy work environment strategies promoted successful nurse and patient outcomes.

Ethnic inequalities during clinical placement: A qualitative study of student nurses' experiences within the London National Health Service.

To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups. A qualitative thematic analysis with an inductive approach. Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement. Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as "ward culture") providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS. These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity. Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.

A rapid review of evaluated interventions to inform the development of a resource to support the resilience of care home nurses

BackgoundNurses working in care homes face significant challenges that are unique to that context. The importance of effective resilience building interventions as a strategy to enable recovery and growth in these times of uncertainty have been advocated. The aim of this rapid review was to inform the development of a resource to support the resilience of care home nurses. We explored existing empirical evidence as to the efficacy of resilience building interventions. undertaken with nurses.MethodsWe undertook a rapid review using quantitative studies published in peer reviewed journals that reported resilience scores using a valid and reliable scale before and after an intervention aimed at supporting nurse resilience. The databases; Cumulative Index to Nursing and Allied Health Literature, Medline and PsychInfo. and the Cochrane Library were searched. The searches were restricted to studies published between January 2011 and October 2021 in the English language. Only studies that reported using a validated tool to measure resilience before and after the interventions were included.ResultsFifteen studies were included in this rapid review with over half of the studies taking place in the USA. No studies reported on an intervention to support resilience with care home nurses. The interventions focused primarily on hospital-based nurses in general and specialist contexts. The interventions varied in duration content and mode of delivery, with interventions incorporating mindfulness techniques, cognitive reframing and holistic approaches to building and sustaining resilience. Thirteen of the fifteen studies selected demonstrated an increase in resilience scores as measured by validated and reliable scales. Those studies incorporating ‘on the job,’ easily accessible practices that promote self-awareness and increase sense of control reported significant differences in pre and post intervention resilience scores.ConclusionNurses continue to face significant challenges, their capacity to face these challenges can be nurtured through interventions focused on strengthening individual resources. The content, duration, and mode of delivery of interventions to support resilience should be tailored through co-design processes to ensure they are both meaningful and responsive to differing contexts and populations.

Quality of life and its health and occupational determinants among hospital-based nurses during the COVID-19 pandemic.

Nurses worldwide were exposed to increased levels of occupational stress during the COVID-19 pandemic which could have hindered their level of health-related quality of life (HRQoL). This project investigated HRQoL level in nurses during the COVID-19 pandemic and its health and occupational predictors. A cross-sectional design was adopted and targeted full-time nurses in Jordan. Study collected data included demographics, 12-item Short Form health survey (SF-12) to measure HRQoL, Nordic Musculoskeletal Questionnaire (NMQ), nurses' evaluation of work conditions during COVID-19, and Depression Anxiety Stress Scale (DASS21). Data was analyzed descriptively to summarize main outcome measures and using multiple linear regression model to identify factors significantly associated with HRQoL. In total 245 nurses successfully completed the survey, 39.6% were males with a mean age of 35±6 years. Participant SF-12 scores were 65.94±17.85 for physical component and 50.09±19.36 mental component. The statistical model significantly explained 53.2% of variance in HRQoL (r2 = 0.534, F = 57.849, p < 0.001). Better sleep quality self-evaluation was significantly associated with higher HRQoL levels, while increased levels of depression, musculoskeletal pain, and financial burden on family were significantly associated with worse HRQoL level. Jordanian nurses' HRQoL level was relatively low during COVID-19. Sleep quality, mental health status, musculoskeletal health status, and financial status were identified as factors possibly influenced HRQoL among nurses during the COVID-19 pandemic. Nurses' quality of life along with their mental and physical health should be considered by healthcare administrators in the remaining period of COVID-19 and in future similar emergencies.

Homage to Dr. Murray Enkin and the complexity of evidence-based medicine.

Homage to Dr. Murray Enkin and the complexity of evidence-based medicine.

More and better clinical trials in health care: focusing on people, not just systems and processes.

More and better clinical trials in health care: focusing on people, not just systems and processes.

Collaborative visits by hospital specialist nurses with homecare nurses: A nationwide, cross-sectional, web-based survey

Objective: Hospital-based specialist nurses (clinical nurse specialists and certified nurses) are increasingly conducting patient home visits along with homecare nurses due to the increasing necessity of home care for persons with multiple medical needs. However, not much is known about such visits. Thus, this study examines collaborative visits by specialist nurses. Methods: A web-based questionnaire survey was sent to specialist nurses in Japan specializing in (1) wound care, (2) cancer palliative care, and (3) chronic disease care. Multiple logistic regression analyses were performed to identify the factors involved in collaborative visits, focusing not only on the individual but also on hospital/community characteristics. Results: Data from 1,027 specialist nurses were analyzed. Among them, 45.6%, 21.4%, and 18.3% of wound care, cancer palliative care, and chronic disease nurses, respectively, conducted collaborative visits. For nurses specializing in wound and cancer palliative care, holding managerial positions was associated with providing collaborative visits. Wound care nurses from hospitals in municipalities with fewer hospital beds per capita tended to conduct collaborative visits, whereas cancer palliative nurses in communities with a higher aging rate provided more collaborative visits. For chronic disease nurses, more working hours as specialists, lower participation rates in community-based multidisciplinary gatherings, and working in hospitals with open community consultation services promoted collaborative visits. Conclusions: Hospital and community factors are associated with collaborative visits, suggesting a need for hospital-wide and policy-supported efforts to further increase collaborative visits.

Occupational role and COVID-19 among foreign-born healthcare workers in Sweden: a registry-based study.

Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. We linked occupational data (2019) of 783 950 employed foreign-born workers (20-65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72-1.85; hospitalization: HR 1.79; 95% CI 1.52-2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10-1.35; hospitalization: HR 0.98; 95% CI 0.59-1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs.

COVID-19 Vaccination Attitude and Behavior among Nurses at a West Texas Regional Hospital.

Vaccinations against COVID-19 infection have become a contentious issue in the United States. Multiple segments of society, including healthcare workers, have expressed concerns regarding the need for vaccination and the safety of current vaccines. Many hospital-based nurses have helped care for patients with severe COVID-19 infections. An anonymous online survey was sent to the nursing staff at University Medical Center in Lubbock, TX, USA, through a hospital-based email system to determine vaccination status and attitudes towards the COVID-19 vaccine and other routine vaccines. Multivariable regression analysis was used to determine factors associated with vaccination. A total of 251 nurses responded to this survey; 211 nurses (83.7%) had received the vaccine. Almost all nurses (242, 96%) had received all childhood vaccinations, and 231 (91.7%) had received an influenza vaccination in the prior year. A minority of nurses (75, 29.8%) supported mandatory vaccination for healthcare workers. The reasons for declining vaccination included the possibility that diet and alternative medications provided better protection against COVID-19. This survey demonstrates that over 80% of nurses working in a hospital managing very sick patients with COVID-19 infection had been vaccinated. However, nurses who did not take the annual influenza vaccine and did not consider other protective measures useful (such as mask-wearing) were significantly less likely to vaccinate. Nurses can provide an important resource for conversations with the public and patients about vaccine initiatives.