Inpatient Nursing Staff Research Articles

Exploring the communication access and participation of a young adult with autism spectrum disorder with limited speech and inpatient nursing staff

This study aimed to describe the nature of interactions between health care professionals and a young adult with autism spectrum disorder with limited speech during an inpatient stay. An observational study was conducted to describe the interactions between a young adult on the autism spectrum and 14 of his inpatient health care providers. Naturalistic video-recordings were taken, and behavioral coding was completed to measure the frequency and type of communication turns taken. The providers took 93% of conversational turns. Most provider turns (76%) were non-obligatory in nature and did not invite the young adult to engage in turn-taking. The young adult only had access to his communication system during one of the 27 interactions (4%); however, when he had access to his system, he demonstrated higher levels of turn-taking. Health care providers should offer patients with limited speech more communicative turns, provide adequate wait time, and ensure communication systems are available during all inpatient interactions.

Analysis of needs for nurses with the workload indicator staffing needs (WISN) approach to inpatient services in the Konawe islands regional public hospital, southeast Sulawesi Province, Indonesia 2024

Background: Nurses are health human resources who have a strategic role and make a major contribution to health services to patients in hospitals. The number of health workers on duty in a hospital greatly influences services. The number of inpatient nurses at Konawe Hospital is 13 people compared to the total population, which is still in the low category with a BOR above 80%, which shows that nurses have a high workload. Objectives: This research aims to determine the analysis of nursing staff needs using the Workload Indicator Staffing Needs (WISN) approach in inpatient services at the Regional General Hospital of Konawe Islands Regency in 2023. Method: The research carried out was a qualitative descriptive study using the work sampling method. The sample for this research was all 13 inpatient nursing staff at the Konawe Islands Regional Hospital. Results: Based on the research results, it is known that the calculation of the need for nursing staff based on workload obtained 16.89 number of nursing staff with a WISN ratio of 0.7. The working days available for the HR category are multiplied by the nurses' working time so the total working time available is 1996.8. The ratio of nurses to the number of beds is 13:25 with the number of patients in 2022 being 683 patients. The workload consists of 16 types of activities, the largest of which is changing IV fluids and installing identification bracelets, namely 57048 times, while the smallest workload activities are wound care, changing dressings, nurses going around patient observation rooms, cleaning beds, taking/moving patients to another place, and received patients from other rooms, namely 11410 times. Conclusion: The current amount of power is smaller than the amount of power needed to run the existing workload. There needs to be an additional 3 people from the existing 13 people to achieve a balanced situation. Therefore, it is necessary to manage nursing staff optimally to achieve quality nursing services, considering the workload of nurses as a reference in determining the need for nursing staff.

A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours.

Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. The aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings. Four electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted. We identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath. Nursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours. Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.

Inpatient pediatric nursing staff experiences treating psychiatric patients: A mixed methods study.

A gap in the literature exists attempting to understand the impact that the influx of pediatric psychiatric patients has had on inpatient general medicine pediatric nursing staff. A mixed-method research study was conducted among full- and part-time pediatric nurses and nursing assistants working on general pediatric units. Quantitative data was collected via an anonymous survey using the Professional Quality of Life Scale version 5 and Support Appraisal for Work Stressors scale. Surveys were followed by semistructured interviews. Of the 158 staff eligible, 47 (29.7%) participated in the quantitative portion. [Correction added on 29 September 2023, after the first online publication: In the preceding sentence, the participation rate was revised from 23.5% to 29.7% in this version.] Significant differences were found between roles, with nurses experiencing lower levels of compassion satisfaction and higher levels of burnout. Role differences were seen in supervisor support and nonwork support, with nurses reporting less support from both. Supervisor support showed a significant correlational relationship with compassion satisfaction and burnout. Nonwork support showed similar correlations with compassion satisfaction and burnout. Themes that emerged from the interviews were Barriers to Care, Emotional Impact, and "Help Me Help You." Nurses may be at greater risk for compassion fatigue due to perceived inadequate support from leadership, unclear role expectations, and lack of resources.

Knowledge, Attitudes, and Practices (KAP) of inpatient nursing staff regarding bowel preparation before colonoscopy: A cross-sectional study

Knowledge, Attitudes, and Practices (KAP) of inpatient nursing staff regarding bowel preparation before colonoscopy: A cross-sectional study

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform.

Nurses perform several functions that are integral for antimicrobial stewardship (AMS). However, nurses are underrepresented in research and underutilized in implementation of AMS interventions. The objective of this pilot study was to assess the effect of asynchronous microlearning on inpatient nursing staff knowledge, attitudes, and practices (KAP) regarding AMS principles. A team of pharmacists, physicians, and nurses developed 9 case-based, multiple-choice questions with accompanying educational explanations on associated AMS principles. One case was delivered to participants daily via an institutional web-based application (QuizTime). A KAP survey with 20 questions on a 5-point Likert scale was administered before and after the intervention. Survey results were compared using a Wilcoxon signed-rank test. Participants' mean survey score after the intervention demonstrated statistically significant improvement for 18 (90%) of 20 items compared to before the intervention. Participants' confidence improved in key AMS activities: (1) differentiating between colonization and infection (mean difference, 0.63; P < .001), (2) identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (mean difference, 0.94; P < .001), (3) recognizing opportunities for intravenous to oral therapy conversion (mean difference, 1.07; P < .001), and (4) assessing for antibiotic-associated adverse effects (mean difference, 0.54; P < .001). Nursing education provided through an asynchronous, microlearning format via a mobile platform resulted in statistically significant improvement in most KAP topics. Nurses are integral members of a multidisciplinary AMS team, and novel education methods can help equip them with the necessary AMS tools. This pilot study forms the basis for expanded AMS educational efforts in all healthcare professionals.

Sustainability of evidence-based practices in the management of infants with bronchiolitis in hospital settings - a PREDICT study protocol

BackgroundUnderstanding how and why de-implementation of low-value practices is sustained remains unclear. The Paediatric Research in Emergency Departments International CollaboraTive (PREDICT) Bronchiolitis Knowledge Translation (KT) Study was a cluster randomised controlled trial conducted in 26 Australian and New Zealand hospitals (May-November 2017). Results showed targeted, theory-informed interventions (clinical leads, stakeholder meetings, train-the-trainer workshop, targeted educational package, audit/feedback) were effective at reducing use of five low-value practices for bronchiolitis (salbutamol, glucocorticoids, antibiotics, adrenaline and chest x-ray) by 14.1% in acute care settings. The primary aim of this study is to determine the sustainability (continued receipt of benefits) of these outcomes at intervention hospitals two-years after the removal of study supports. Secondary aims are to determine sustainability at one-year after removal of study support at intervention hospitals; improvements one-and-two years at control hospitals; and explore factors that influence sustainability at intervention hospitals and contribute to improvements at control hospitals.MethodsA mixed-methods study design. The quantitative component is a retrospective medical record audit of bronchiolitis management within 24 hours of emergency department (ED) presentations at 26 Australian (n = 20) and New Zealand (n = 6) hospitals, which participated in the PREDICT Bronchiolitis KT Study. Data for a total of 1800 infants from intervention and control sites (up to 150 per site) will be collected to determine if improvements (i.e., no use of all five low-value practices) were sustained two- years (2019) post-trial (primary outcome; composite score); and a further 1800 infants from intervention and control sites will be collected to determine sustained improvements one- year (2018) post-trial (secondary outcome). An a priori definition of sustainability will be used. The qualitative component will consist of semi-structured interviews with three to five key emergency department and paediatric inpatient medical and nursing staff per site (total n = 78-130). Factors that may have contributed to sustaining outcomes and/or interventions will be explored and mapped to an established sustainability framework.DiscussionThis study will improve our understanding of the sustainability of evidence-based bronchiolitis management in infants. Results will also advance implementation science research by informing future de-implementation strategies to reduce low-value practices and sustain practice change in paediatric acute care.Trial registrationAustralian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.

End of Life Care on a Neuropsychiatric Inpatient Ward for Patients with Huntington's Disease: An Overview of Issues and a Project to Optimise Care

AimsMill Lodge is a 14-bed inpatient neuropsychiatric ward in Leicestershire, UK. The service primarily functions for patients with Huntington's Disease (HD), a disorder that significantly reduces life expectancy. End of Life (EoL) care is necessitated in the inpatient setting. This project therefore aims to optimise EoL care in our specialist HD unit. Specific objectives are to: establish the levels of staff confidence in dealing with EoL care; identify specific areas of EoL care that staff felt could be improved; and to introduce a series of initiatives to optimise EoL care for our patients using a QI framework.MethodsWe commenced involvement with the local QI team to develop the project. The first stage of intervention included the planning and delivery of a stakeholder event on EoL care specific to HD with the assistance of regional palliative care colleagues.As well as our inpatient nursing and medical staff and the palliative care teams, local GPs, district nursing colleagues, speech and language therapists and psychologists attended. The session comprised an educational overview for all colleagues of HD itself and palliation was discussed at length.The meeting also comprised an open forum where we were able to identify barriers and facilitators to optimal care from all aspects of the assembled MDT.ResultsTo date our interactions have revealed that staff confidence in dealing with the different aspects of EoL care was low. This included issues with care-planning; medications; communication with patients and staff; and when to refer for specialist help.Other processes identified as difficult included paperwork that was not consistent across teams; district nursing colleagues having to liaise with multiple medical team members to ensure continuity of care; and the doses of EoL medications required in this patient group to mitigate involuntary movements that were previously controlled with multiple high-dose oral medications.ConclusionStaff without specialist knowledge require support. The efforts made to improve collaboration with external colleagues broke down barriers that were preventing optimal care and allowed all parties to express their opinions and feelings. This allowed us to transparently appraise our current processes and provide guidance on this difficult area.The journey of optimisation continues, with further practical educational interventions planned, such as syringe-driver training, and efforts to improve shared documentation and enhanced communication and collaborative working between different disciplines.Optimal, collaborative EoL care from a confident staff-group is possible and a most important part of care for this unique patient group.

Documentation of Driving Status and of Fitness to Drive Following Admission of Patients to Clock View Hospital - How Are We Doing?

AimsDeveloping a mental illness and being commenced on psychotropic medication are factors that may interfere with the ability of an individual to drive safely as both can impact information processing, psychomotor actions and social interpretation. The Driver and Vehicle Licensing Agency (DVLA) suggests that certain medical conditions require driving licence holders to notify them for further assessment of their ability to drive. DVLA notifiable mental disorders include psychosis, schizophrenia, bipolar disorder, dementia and personality disorders. The doctor's legal duty is to assess the patient for any relevant diagnosis, inform the patient of their duty to report their medical condition to the DVLA and for the doctor to comply with the legal duty to inform the DVLA of any patient who won't or can't notify the DVLA of their medical condition. The authors conducted a quality improvement project to evaluate and improve the number of fitness to drive assessments completed for patients admitted to the five wards (three general adult, one older adult and the Psychiatric Intensive Care Unit) at Clock View Hospital.MethodsThe electronic (RiO) record for each inpatient on the five wards was scrutinised for: whether the patient's driving status was established on admission; whether the patient was notified of the DVLA rules if they did drive; whether the patient agreed to fulfil their duty of notification and, in instances where they were not, whether the medical professional had taken appropriate steps to address this.Results74 patients on the five wards were included in the sample. Only nine of the 74 patients had driving status documented on admission. Three of these nine patients were noted to be driving or learning to drive and were not notified of the DVLA rules. Four of the nine patients were no longer driving and so discussion about DVLA guidance was unnecessary. The remaining two patients were confirmed to be driving and informed of the DVLA regulations. Both patients agreed to comply and therefore no further action was indicated.ConclusionA review of current practice indicates a deficit in incorporating driving status and fitness to drive assessment into the clerking proforma following admission to Clock View Hospital. The second half of this cycle will implement change and raise awareness amongst inpatient medical and nursing staff of the need to consider this important issue prior to discharge. A re-assessment of the effectiveness of these changes will be carried out in the future.

Developing a Responsive Transferable Model for Delivering Large-Scale Simulation Education to Inpatient Nursing Staff.

Implementing large-scale nursing continuing development programs for bedside staff can be operationally challenging. The aim of this project was to establish a sustainable simulation education program that is incorporated into staff nurses' work schedules and provides provisions to accommodate patient assignment coverage. This article describes the planning, implementation, and evaluation of a simulation program that was successfully delivered to 89% of nurses employed on four inpatient units at an academic medical center.

SPN 2021 Poster Abstract Awards

SPN 2021 Poster Abstract Awards

If At First You Don't Succeed...Collaborate, Communicate and Educate to Improve Inpatient Readiness for Surgery

Background Information Implementation of a first case on time start initiative, identified a lack of inpatient readiness for surgery. Inpatient readiness was not impacted by education prepared by the perioperative educator and distributed by the inpatient educators. A different approach to deliver this information was needed to facilitate practice change. Objectives of Project The specific objectives for the qproject include: • Expand chart audit data to include more data specific to inpatient readiness • Utilize data to obtain permission to educate inpatient staff during skills week • Facilitate small group sessions between perioperative and inpatient nursing staff with a focus on collaboration, communication and education • Collect post-intervention data to evaluate change Process of Implementation Chart audits were redesigned for more specific data collection. The data supported the need for a different intervention which allowed the perianesthesia nurses the ability to present the information via small group discussions with the inpatient nurses. The same data collection tool was utilized to evaluate change. The small group discussions included the following information: - Negative effects of delays/cancellations on the patient experience - Reasons for delays/cancellations that inpatient nurses can prevent - Importance of communication between pre-operative staff and inpatient staff - Hands on practice to complete the pre-op checklist - Poster presentation and pocket card provided to each nurse Statement of Successful Practice Small group facilitated collaboration, communication and education with a perioperative nurse facilitator was successful in creating practice change. Implications for Advancing the Practice of Perianesthesia Nursing The small group sessions allowed for dialogue between inpatient nursing staff and perioperative nurses that facilitated change in patient readiness for surgery. Change was not achieved using traditional power point education disseminated by the nurse educators. Communication, collaboration and education in the small group setting was successful in achieving change and should be considered in future education endeavors. Implementation of a first case on time start initiative, identified a lack of inpatient readiness for surgery. Inpatient readiness was not impacted by education prepared by the perioperative educator and distributed by the inpatient educators. A different approach to deliver this information was needed to facilitate practice change. The specific objectives for the qproject include: • Expand chart audit data to include more data specific to inpatient readiness • Utilize data to obtain permission to educate inpatient staff during skills week • Facilitate small group sessions between perioperative and inpatient nursing staff with a focus on collaboration, communication and education • Collect post-intervention data to evaluate change Chart audits were redesigned for more specific data collection. The data supported the need for a different intervention which allowed the perianesthesia nurses the ability to present the information via small group discussions with the inpatient nurses. The same data collection tool was utilized to evaluate change. The small group discussions included the following information: - Negative effects of delays/cancellations on the patient experience - Reasons for delays/cancellations that inpatient nurses can prevent - Importance of communication between pre-operative staff and inpatient staff - Hands on practice to complete the pre-op checklist - Poster presentation and pocket card provided to each nurse Small group facilitated collaboration, communication and education with a perioperative nurse facilitator was successful in creating practice change. The small group sessions allowed for dialogue between inpatient nursing staff and perioperative nurses that facilitated change in patient readiness for surgery. Change was not achieved using traditional power point education disseminated by the nurse educators. Communication, collaboration and education in the small group setting was successful in achieving change and should be considered in future education endeavors.

Enhanced Recovery After Surgery (ERAS) protocols: the impact of enhanced patient perioperative education on patient satisfaction and outcomes in gynecologic oncology practice

<h3>Objectives:</h3> Enhanced Recovery After Surgery (ERAS) protocols have been developed for several surgical fields based off the available evidence to improve patient surgical outcomes with shortened recovery to return of baseline function. The ERAS® Society 2019 preoperative guidelines for gynecologic oncology give a "strong" recommendation for written and verbal preoperative patient education with "moderate" data to support this; however, the recommendation remains vague as to how this should be implemented. We hypothesized patient satisfaction related to their disease state, treatment plan, and hospital course would be improved after implementation of a standardized written preoperative education protocol in addition to traditional oral education for patients undergoing laparotomy with the gynecology oncology faculty at the Medical College of Wisconsin. Secondarily, we hypothesized that enhanced patient education preoperatively could positivelyimpact patient length of stay, emergency department admissions, nursing calls, and readmission rates following surgery. <h3>Methods:</h3> Based on the ERAS Society recommendations, our practice initiated a pilot program to improve our perioperative patient education. In collaboration with our clinic nurses, providers and inpatient nursing staff we revised all of our patient perioperative instructions which address the surgical procedure, expectations prior to surgery, expectations during hospital admission and post- operative instructions including activity limitations, pain management, bowel management and issues of concern during recovery from surgery. We obtained Institutional Review Board (IRB) approval. We compared two groups of patients undergoing laparotomy. The Standard Group received the standard patient education: the current oral and written education that had been utilized in the clinic. The Enhanced Group received the enhanced patient education material after all providers and staff had undergone education regarding the changed process. The enhanced patient education process provided consistent written instructions in addition to the oral instructions communicated by the team. In addition, at the time of discharge standardized post-operative instructions were printed and provided to the patient. During July 2019-Dec 2019, 15 patients who underwent standard preoperative instructions were included in the pilot initiative and comprised the Standard Group. During Jan 2020 - June 2020, 17 patients were included in the pilot as the Enhanced Group. All patients included in the pilot completed the EORTC QLQ-INFO 25 validated survey at the time of discharge or at their post-operative visit. <h3>Results:</h3> Patient satisfaction scores, as quantified by items 31-55 of the EORTC QLQ-INFO 25 survey, showed improvement in patient satisfaction with the possible causes of their disease after protocol implementation (p=0.03). There was also a reduction in the number of patient nursing calls following surgery (p=0.035). There was no difference between groups regarding length of stay, emergency department visits or readmission rates. <h3>Conclusions:</h3> Consistent printed and oral perioperative patient education is an effective measure that can positively impact patient satisfaction as well as staff satisfaction (personal communication). Additional ERAS measures may need to be implemented to impact perioperative patient emergency room visits, length of stay and readmission rates.

A Critical Pathway for Mass Casualty Incident Preparedness.

Rates of mass casualty incidents (MCIs) have been on the rise in the United States, highlighting the need for health care systems to have an emergency response plan. Trauma centers are fundamental during MCIs and serve a crucial leadership role in preparedness for them. The purpose of this study was to describe the design and implementation of simulated MCI drills at an American College of Surgeons verified Level I trauma center in the Midwest. A quasi-experimental time-series design was utilized to determine MCI simulation effects on staff performance using an emergency department checklist to measure emergency department throughput time. A multidisciplinary MCI design team developed a checklist for the emergency department, which identified tasks required to complete it. The 16-item checklist, Critical Pathway Management methodology, was used to identify the critical pathway for patient throughput during a surge. Two in situ MCI simulation drills were conducted in the emergency department (October and December 2019), and Critical Pathway Management identified the primary patient throughput rate limiters as notification and inpatient nursing staff presentation. Emergency department throughput decreased from a mean of 15 to 11 min (reduction of 26.7%) between the two time periods after focusing on rate-limiting tasks. This quality improvement project demonstrated that the use of institution-specific checklists and Critical Pathway Management to identify critical pathways and potential rate limiters led to patient throughput improvements.

Evaluating adult forensic staff knowledge of olanzapine long-acting injection post injection syndrome: a service improvement project

AimsPost injection syndrome (PIS) is a serious complication that can occur after Olanzapine Long Acting Injection (LAI). It can occur without any derangement in physical observations. It is important that patients are monitored appropriately following administration of Olanzapine LAI to ensure that symptoms of PIS are appropriately identified and managed. This project aimed to evaluate the current level of knowledge about PIS in two staff groups within an Adult Forensic Service – in-patient nursing staff and junior doctors and advanced practitioners (APs) providing medical cover to inpatient wards.MethodElectronic surveys evaluating knowledge about the symptoms of PIS, monitoring requirements and management of possible PIS were circulated to inpatient nursing staff, junior doctors and APs working within an Adult Forensic Service in the North West of England.Result1) Nursing staff knowledge – 26 nursing staff completed the survey. 4.5% of nurses correctly identified all symptoms of PIS and 72.7% believed that tachycardia or hypotension occur in PIS. 22.7% of nurses identified the correct management plan if a patient feels unwell following Olanzapine LAI. 40.9% would only request a medical review if physical observations were abnormal. 2) Junior doctor and AP knowledge – 6 doctors and 6 advanced practitioners completed the survey. 17% of doctors and APs correctly identified all symptoms of PIS. 50% believed hypotension or tachycardia were symptoms of PIS. 25% of doctors and APs identified correct management of PIS and 16.7% believed that the patient should be managed on the psychiatric ward unless physical observations became abnormal.ConclusionLevels of knowledge about the symptoms and management of PIS are low within this Adult Forensic Service. Knowledge of PIS and management of suspected PIS needs to be improved in nursing staff, junior doctors and advanced practitioners to ensure correct identification and safe management. In response to these findings, a care plan for monitoring of patients after Olanzapine LAI was developed. This included a structured monitoring proforma for completion post depot administration and instructions for managing suspected PIS. This care plan is kept in the front of the drug chart of all patients prescribed Olanzapine LAI. One-page educational summaries on PIS were written and circulated to nursing staff, junior doctors and APs. Information on Olanzapine LAI use and PIS were included in junior doctor induction materials and on-call handbook, to improve trainee awareness and knowledge.

Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting.

Evidence-based practice (EBP) is essential for clinical decision-making, improving care, reducing costs and achieving optimal patient outcomes. The Evidence-based Practice Mentorship Program (EBPMP) is a flexible, self-directed programme whereby participants carry out EBP projects guided by expert mentors. To evaluate EBPMP effectiveness and participant experience. To evaluate effectiveness, as measured by changes in EBP value, knowledge and implementation, participants completed pre- and post-EBPMP Quick-EBP-Value, Implementation and Knowledge (VIK) surveys. To understand participants' experiences individual and group interviews were conducted at the end of the programme and analysed using qualitative content analysis. Most participants were over 50 years old, Caucasian, inpatient staff nurses, baccalaureate prepared, with over 11 years' experience. Statistically significant improvements were observed in the post Quick-EBP-VIK knowledge and implementation domains. Individual and group participant interviews revealed four categories of importance to the experience: 1. perceived benefits of EBP, 2. time as a barrier to EBP, 3. desire for more cohort interaction and 4. positive mentee-mentor experience. EBPMP can improve participants' knowledge and implementation of EBP in an environment that values EBP; however, opportunities exist to implement programme modifications that address barriers identified by participants including project time and increased participant interactions.

Psychometric properties of Copenhagen Burnout Inventory among nurses.

Worldwide, nurses have been reporting high levels of burnout. Given the high prevalence of nurse burnout, measurements of burnout need to be carefully considered for their validity and reliability. Our research team used a relatively new instrument to measure burnout among nurses: the Copenhagen Burnout Inventory (CBI). This 19-item instrument measures burnout in three dimensions: Personal, Work-related, and Client-related Burnout. However, the psychometric properties of the CBI have not been examined in nurses. Thus, the purpose of this study was to determine the psychometric properties of the CBI in a state-wide survey of inpatient staff nurses. A total of 928 registered nurses working in Alabama-area hospitals (N = 42 hospitals) participated in this study. Confirmatory factor analysis resulted in an adequate fit to the data and supported construct validity. As evidence of convergent validity, the CBI was moderately to highly correlated with measures of the overall work environment, job satisfaction, and intent to leave, in the anticipated directions. The Cronbach's alphas for Personal Burnout, Work-related Burnout, and Client-related Burnout were 0.91, 0.89, and 0.92, respectively, demonstrating excellent internal consistency reliability for the subscales. Based on our data, the CBI demonstrates adequate validity and reliability for measuring burnout among frontline nurses. As nurses provide care to the most vulnerable patients in healthcare systems, their psychological well-being is important due to the impact on quality of care on patient outcomes. The availability of the CBI on its website allows nurses, nurse managers, and researchers to evaluate burnout in a variety of nursing populations with no licensing costs.

99 - Development and Modification of a Critical Care/Blood and Marrow Transplant Residency Program for New Inpatient Nursing Staff: Preliminary Findings and Lessons Learned

99 - Development and Modification of a Critical Care/Blood and Marrow Transplant Residency Program for New Inpatient Nursing Staff: Preliminary Findings and Lessons Learned

A framework for studying risk factors for lower extremity musculoskeletal discomfort in nurses

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index

How does workplace bullying influence nurses' abilities to provide patient care? A nurse perspective.

To explore how workplace bullying influences nurses' abilities to provide patient care. Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. Qualitative descriptive study. Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.