Is medical training solely to blame? Generational influences on the mental health of our medical trainees

INTRODUCTION

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

METHODS

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

RESULTS

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

DISCUSSION

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

The relationship between challenge-hindrance stressors and innovative behavior among medical postgraduates in China: the mediation role of academic engagement and the moderating effect of relaxation

This study investigated the relationship between challenge-hindrance stressors and innovative behavior of medical postgraduates in China, examining the mediating role of academic engagement and the moderating effect of relaxation. Drawing from a sample of 437 medical postgraduates from three Chinese universities, our findings revealed that challenge stressors positively correlated with innovative behavior, while the direct relationship between hindrance stressors and innovative behavior was not statistically significant. Furthermore, academic engagement mediated the relationship between two types of stressors and innovative behavior. Challenge stressors enhanced academic engagement, which in turn fostered innovative behavior. Conversely, hindrance stressors were found to diminish academic engagement, which in turn indirectly limited innovative behavior. Additionally, relaxation was identified as a moderating factor that helped mitigate the negative effects of hindrance stressors on academic engagement and indirectly on innovative behavior. These results suggested that academic engagement as a mechanism played a pivotal role in determining how different stressors influenced innovative behavior, underscoring the need for stress management, particularly through relaxation techniques, to maintain high levels of academic engagement and innovative behavior. This study offers practical insights for medical education policymakers and educators in China, emphasizing the importance of balancing stressors and incorporating relaxation practices to enhance the innovative capabilities of medical postgraduates in demanding academic environments.

Under pressure - Nursing staff's perspectives on working hours and recovery during the COVID-19 pandemic: A qualitative study

Background

The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions.

Objectives

The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being.

Design

A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences.

Methods

Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study.

Results

The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes.

Conclusion

The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

Vigour as a marker of positive mental health among social media respondents

BACKGROUND

Quantitative research on vigour as a therapeutically responsive marker of positive mental health, has become possible by virtue of the validation of the Vigour Assessment Scale (VAS). Considering that its validation and therapeutic responsiveness were examined in an avolitional schizophrenia population, using the VAS outside these constraints requires that its psychometric properties be investigated in a more general non-clinical population.

METHOD

Social media respondents (n = 787) were recruited on social media through snowball sampling and data were obtained for statistical analyses through an online questionnaire comprising the VAS and measures of work-place vigour, active involvement in personal growth, behavioural activation, procrastination, and fatigue.

RESULTS

Convergent validity was confirmed in moderate to strong positive correlations between the VAS and measures approximate to vigour including physical strength (r = 0.805), cognitive liveliness (r = 0.676), planfulness (r = 0.61), and intentional behaviour (r = 0.595). Discriminant validity was evident in negative correlations with procrastination (r = -0.593) and fatigue (r = -0.786). The VAS showed good internal consistency (Cronbach α = 0.951), split-half reliability (r = 0.892), test-retest reliability (r = 0.861), and a low standard error of measurement of 3.73 within a theoretical range of 82 points. Exploratory factor analysis yielded a clear two-factor structure.

LIMITATIONS

Results are limited to willing participants who responded through social media.

CONCLUSIONS

Vigour may now be measured clinically as an indication of positive mental health and well-being. It may also be further investigated for its relations to other parameters of health, personality, and the efficacy of professional and self-enhancing interventions that aim for the cultivation of vigour.

What is known about cardiovascular diseases among seafarers: A systematic scoping review and quality assessment

BACKGROUND

Seafarers are at an increased risk of developing cardiovascular diseases (CVDs), potentially due to a stressful working environment and behavioral risk factors. To develop better prevention strategies, it is important to elucidate the extent of this risk. Therefore, we conducted a systematic literature review on CVD in seafarers.

METHOD

We conducted systematic searches in five databases. All studies investigating CVDs among occupational seafarers, published in articles or conference papers, were eligible for inclusion. The identified records were screened and reviewed by two independent researchers, who also evaluated the methodological quality of the included studies.

RESULTS

Three thousand nine hundred and seventeen records qualified for screening, and 55 were eligible for inclusion. Most of the studies were observational, including cohort, frequency, incidence or prevalence studies, and review of case records. Around half were assessed at risk of biased findings. Participants in the studies were primarily from North America or the European continent and work onboard transportation vessels. Many studies investigated CVDs as a cause of death, focusing on conditions such as CVD, ischemic heart disease, and myocardial infarction. Frequency of CVD conditions varied but indicate that seafarers face a greater risk compared to the reference populations or control groups. Environmental factors were mainly investigated as risk factors.

CONCLUSION

Our results indicate a higher risk of CVDs among seafarers compared to reference or control groups. However, due to the variable quality of the evidence, well-designed studies are needed to establish the causes of cardiovascular mortality and morbidity in seafarers and to investigate behavioral aspects of cardiovascular risk.

Effects of adding early cooperation and a work-place dialogue meeting to primary care management for sick-listed patients with stress-related disorders: CO-WORK-CARE-Stress - a pragmatic cluster randomised controlled trial

OBJECTIVES

To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact.

DESIGN

Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level.

SETTING

PCCs in Region Västra Götaland, Sweden, with care manager organisation.

PARTICIPANTS

Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (n = 142 intervention, n = 116 control PCCs).

INTERVENTION

Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs.

MAIN OUTCOME MEASURES

12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months.

RESULTS

There were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 - 138.8); control, mean = 99.1 days (95% CI 73.9 - 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%.

CONCLUSION

Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017.

Parents' work demands on next day's cortisol awakening response - the moderating role of family-to-work conflict

BACKGROUND

Constant availability, overtime and feeling overwhelmed by work can impact employees' wellbeing and their biological stress responses. Especially working parents often struggle to balance the demands of their work and family life and were found to be distracted from their work due to family responsibilities. The Family-to-Work Conflict (FWC) indicates the extent to which participating in work is made difficult by family demands. Recent studies have found associations between FWC and biological outcomes such as the Cortisol Awakening Response (CAR), a measure of an individual's Hypothalamic-Pituitary-Adrenal (HPA)-axis activity. This diary study investigates the effect of parental work demands on next day's cortisol response as well as the moderating role of FWC and the mediating role of fatigue.

METHODS

Over the course of five consecutive days (from Monday to Friday), 168 observations were made on a total of 42 parents. Participants had at least one child and worked a minimum of 20 hours per week. Salivary cortisol samples were obtained immediately, 15 and 30 minutes after awakening each day. Work demands, FWC and fatigue were assessed using standardized questionnaires. Within-person effects were examined using multilevel modeling and mediation analyses.

RESULTS

Our results indicate that there are no main effects of work demands on next day's cortisol response. The multilevel analysis revealed that FWC predicts lower wakening cortisol levels and confirmed FWC as an increasing moderator between work demands and next day's HPA-axis activity. Further, work overload was found to increase fatigue, which in turn leads to higher CAR on the following day. This indicates that fatigue mediates the relationship between work demands and CAR. Our findings add to a growing body of research demonstrating further predictors for HPA-axis activity and emphasise the importance of considering family related demands when investigating biological outcomes for working parents.

Insider versus outsider workplace mistreatment and their impact on affective ill-being in healthcare professionals: Can personal resources act as buffers?

AIMS

Workplace stress can negatively impact healthcare providers' professionalism and quality of care. One source of workplace stress is the experience of workplace mistreatment. Drawing on the Job Demands-Resources theory, this study aimed to (a) investigate the impact of mistreatment frequency experienced by healthcare workers from insider sources (i.e. co-workers, supervisors) and outsider sources (i.e. patients, visitors) on affective ill-being and (b) the potential moderating role of trait resilience and trait self-efficacy, as personal resources, in the mistreatment-ill-being relationship.

DESIGN

Lagged design.

METHODS

We collected data from 153 Irish healthcare workers between January 2018 and June 2019 via three surveys, separated by 1-week intervals. Personal resources were measured at Time 1, frequency of mistreatment from the two sources was assessed at Time 2 and affective ill-being was assessed at Time 3. We used moderated regression analyses to evaluate the association of mistreatment frequency from the two sources and affective ill-being and the moderating effect of personal resources.

RESULTS

Only insider mistreatment frequency was positively related to affective ill-being. Furthermore, the positive impact of insider mistreatment on affective ill-being was moderated by self-efficacy (but not by trait resilience). In contrast to our expectations, the relationship was stronger at high levels compared to low levels of self-efficacy.

CONCLUSION

Mistreatment from co-workers and supervisors is linked to higher levels of affective ill-being. Additionally, healthcare workers with high self-efficacy were more vulnerable to the negative consequences of co-worker and supervisor mistreatment as it impacted their affective ill-being.

IMPACT

These findings extend the literature on workplace mistreatment by integrating insider and outsider perpetrators of mistreatment and examining their differential impact on the employees' affective ill-being. It also highlights mistreatment from organizational insiders as a significant factor in the relationship between mistreatment and affective ill-being.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: The findings underscore the detrimental impact of workplace mistreatment on the well-being of healthcare professionals. The study findings of higher frequency of insider mistreatment being associated with increased affective ill-being call for action, with line managers and supervisors being critical to achieving respective changes in healthcare workers' environment. The findings have implications for policymakers interested in developing a framework to support healthcare professionals in addressing workplace mistreatment, enabling them to effectively fulfil their role as care providers.

The role of resilience in the potential benefits of cognitive-behavioural stress management therapy during pregnancy

PURPOSE

Stress during pregnancy has many negative repercussions on maternal and foetal health. It is therefore important to understand which therapies are effective in reducing stress levels and which variables influence the outcomes of these therapies. In this line, psychological resilience could play a key role. Thus, the aim of the study was to check whether pregnant women with different levels of resilience have different benefits in reducing cortisol levels, perceived stress, pregnancy worries, stress vulnerability, anxiety or depression through Cognitive Behavioural Stress Management Therapy.

METHOD

The total sample consisted of 56 pregnant women: one group of pregnant women with high levels of resilience (n = 35); and another group with low levels of resilience (n = 21). Participants' cortisol concentration levels, perceived stress, pregnancy concerns, stress vulnerability, anxiety and depressive symptoms were assessed before and after therapy. Linear mixed models were performed to compare the two groups, which showed a group x time interaction for perceived stress.

RESULTS

The low resilience group showed a reduction in their perceived stress levels with a medium effect after the intervention compared to the high resilience group, but no reduction was found in this group. No differences were found between the two groups on the other variables.

CONCLUSION

Knowing which variables have a differential effect on the results of psychological therapy would allow delimiting the groups that obtain greater benefits from the therapy. This may lead to more efficient implementation of effective intervention programmes.

A longitudinal person-centered investigation of the multidimensional nature of employees' perceptions of challenge and hindrance demands at work

BACKGROUND AND OBJECTIVES

This research relies on a combination of variable- and person-centered approaches to help improve our understanding of the dimensionality of job demands by jointly considering employees' global levels of job demands, exposure and their specific levels of exposure to challenge and hindrance demands.

DESIGN AND METHODS

We relied on a sample of 442 workers who completed a questionnaire twice over three months. Our analyses sought to identify the nature of the job demands profiles experienced by these workers, to document the stability of these profiles over time, and to assess their associations with theoretically-relevant outcomes (i.e., work engagement, job boredom, problem-solving pondering, work-related rumination, proactive health behaviors, and sleep quality and quantity). Furthermore, we examined whether these profiles and associations differed as a function of working remotely or onsite.

RESULTS

Five profiles were identified and found to be highly stable over time: Globally Exposed, Not Exposed, Not Exposed but Challenged, Exposed but Not Challenged, and Mixed. These profiles shared clear associations with all outcomes, with the most adaptive outcomes associated with the Exposed but Not Challenged profile, whereas the most detrimental ones were observed in the Mixed profile. However, none of these results differed across employees working onsite and those working remotely.

CONCLUSIONS

These findings have theoretical and practical implications regarding the effects of work characteristics on employees' functioning.

Exploring the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business: a hermeneutic phenomenological study

AIM

To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business.

DESIGN

A hermeneutic phenomenological approach.

PARTICIPANTS

Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling.

METHODS

In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed.

RESULTS

Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff.

CONCLUSIONS

Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER.

Burnout, Personal, and Occupational Factors as Predictors of Physician Assistant Faculty Intent to Leave After the COVID-19 Pandemic

INTRODUCTION

This study addressed whether burnout, personal, or occupational factors predicted physician assistant (PA) faculty intent to leave and established a new postpandemic national benchmark for PA faculty burnout and intent to leave.

METHODS

In spring 2023, a nonexperimental, cross-sectional survey was emailed to 2031 PA faculty drawn from program faculty listings and the PA Education Association member database. Descriptive statistics were used to describe the sample, and a multiple regression analysis was conducted to analyze the predictive ability of the independent variables on intent to leave.

RESULTS

The response rate was 30% (609 of 2031), with 496 responses (24.4%) included in the analysis. The sample reflected the population of PA faculty. The regression model significantly predicted intent leave ( P < .001). The adjusted R2 was 0.46, indicating the combination of independent variables predicted 46% of the variance in PA faculty intent to leave. Significant predictors included emotional exhaustion and identifying as multiracial ( P < .001), control and values ( P < .01), and depersonalization, fairness, rewards, and clinical year faculty role ( P < .05). The sample had moderate levels of burnout and experienced burnout at higher rates than in prepandemic studies. Physician assistant faculty in administrative leadership roles had the highest levels of burnout and intent to leave. Despite this, PA faculty intent to leave measures were similar to prepandemic levels.

DISCUSSION

Several of the predictive variables were related to well-being and social-emotional aspects of the workplace. These findings have implications for institutional policies and practices that support faculty well-being and workplace culture to enhance retention.

Factors Associated With Working Caregivers' Well-Being: Comparisons Between Black and White Working Caregivers in the United States

This study investigated stressors and strains, resources, and well-being among Black working caregivers (BWC) and White working caregivers (WWC) who participated in the Midlife in the United States study (Black: n  =  49, White: n  =  250). Comparisons were made between BWC and WWC for primary caregiving stressors, secondary strains, resources, and well-being, and hierarchical regression models tested associations among these factors. BWC reported less negative work-to-family spillover, more perceived control and religious/spiritual coping, and higher positive affect than WWC, complementing existing evidence of greater resilience among BWC. Secondary strains stemming from the workplace had stronger associations with well-being than primary caregiving stressors, confirming that the workplace deserves greater attention in stress research and interventions for working caregivers. Finally, perceived control, optimism, and family support were important resources for well-being for both BWC and WWC, substantiating their valuable role in interventions for working caregivers.

Intimate Partner Violence Against Women and Labor Productivity: The Mediating Role of Morbidity

This study determines that morbidity presents a mediating impact between intimate partner violence against women and labor productivity in terms of absenteeism and presenteeism. Partial least squares structural equation modeling (PLS-SEM) was used on a nationwide representative sample of 357 female owners of micro-firms in Peru. The resulting data reveals that morbidity is a mediating variable between intimate partner violence against women and absenteeism (β = 0.213; p < .001), as well as between intimate partner violence against women and presenteeism (β = 0.336; p < .001). This finding allows us to understand how such intimate partner violence against women negatively affects the workplace productivity in the context of a micro-enterprise, a key element in many economies across the world.

Evaluation of sweat-based biomarkers using wearable biosensors for monitoring stress and fatigue: a systematic review

Objectives. This systematic review aims to report the evaluation of wearable biosensors for the real-time measurement of stress and fatigue using sweat biomarkers. Methods. A thorough search of the literature was carried out in databases such as PubMed, Web of Science and IEEE. A three-step approach for selecting research articles was developed and implemented. Results. Based on a systematic search, a total of 17 articles were included in this review. Lactate, cortisol, glucose and electrolytes were identified as sweat biomarkers. Sweat-based biomarkers are frequently monitored in real time using potentiometric and amperometric biosensors. Wearable biosensors such as an epidermal patch or a sweatband have been widely validated in scientific literature. Conclusions. Sweat is an important biofluid for monitoring general health, including stress and fatigue. It is becoming increasingly common to use biosensors that can measure a wide range of sweat biomarkers to detect fatigue during high-intensity work. Even though wearable biosensors have been validated for monitoring various sweat biomarkers, such biomarkers can only be used to assess stress and fatigue indirectly. In general, this study may serve as a driving force for academics and practitioners to broaden the use of wearable biosensors for the real-time assessment of stress and fatigue.

Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout

OBJECTIVES

Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths.

METHODS

In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally "lead".

RESULTS

Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they "lead with" a specific domain. Mapped from the providers' top 10 strengths, the most common "lead with" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians.

CONCLUSION

A majority of surgical providers "lead with" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.

How Identity Impacts Bystander Responses to Workplace Mistreatment

Integrating a social identity approach with Cortina's (2008) theorizing about selective incivility as modern discrimination, we examine how identification-with an organization, with one's gender, and as a feminist-shapes bystanders' interpretations and responses to witnessed incivility (i.e., interpersonal acts of disrespect) and selective incivility (i.e., incivility motivated by targets' social group membership) toward women at work. We propose that bystanders with stronger organizational identification are less likely to perceive incivility toward female colleagues as discrimination and intervene, but female bystanders with stronger gender identification are more likely to do so. Results from two-wave field data in a cross-lagged panel design (Study 1, N = 336) showed that organizational identification negatively predicted observed selective incivility 1 year later but revealed no evidence of an effect of female bystanders' gender identification. We replicated and extended these results with a vignette experiment (Study 2, N = 410) and an experimental recall study (Study 3, N = 504). Findings revealed a "dark side" of organizational identification: strongly identified bystanders were less likely to perceive incivility as discrimination, but there were again no effects of women's gender identification. Study 3 also showed that bystander feminist identification increased intervention via perceived discrimination. These results raise doubts that female bystanders are more sensitive to recognizing other women's mistreatment as discrimination, but more strongly identified feminists (male or female) were more likely to intervene. Although strongly organizationally identified bystanders were more likely to overlook women's mistreatment, they were also more likely to intervene once discrimination was apparent.

Improving staff wellness via an after-hours healthy sustainable meals program: A general surgery residency pilot

Healthcare worker wellness is foundational to delivering quality care. Yet, healthcare facilities often lack access to healthy and sustainable food overnight and on weekends. Healthy, low-carbon meals were provided free of charge after hours to on-call General Surgery residents at the University of British Columbia and the impact on resident well-being assessed using pre- and post-intervention surveys. Financial and time stress reduced significantly with the provision of meals (P's < .01), while emotional and physical stress levels did not change. Average meal expenses decreased from $33 to $10 (P < .001). Increasing food access on call is an impactful intervention to improve resident health and well-being.

Workers' Worries, Pain, Psychosocial Factors, and Margin of Manoeuvre, in Relation to Outcomes in a Return-to-Work Program: An Exploratory Study

PURPOSE

To explore the intensity and variation of workers' worries, pain, psychosocial factors, and margin of manoeuvre before and after a return-to-work program, and identified the psychosocial factors associated with non-return to work at the end of the rehabilitation program.

METHODS

A pre-post study design was used. A convenience sample of 80 workers starting a return-to-work program and having a compensated musculoskeletal injury that caused an absence of more than three months from their regular work was recruited. Data were collected at baseline and at the end of the rehabilitation program on the nature of the worries and maintenance factors defined in Dugas' generalized anxiety and worry model, using validated questionnaires. The margin of manoeuvre was assessed by the treating occupational therapist. A series of descriptive analyses were performed, as well as Generalized Estimating Equations analyses.

RESULTS

Workers' worries were work-related or disability-related 83% of the time at baseline. These worries were essentially based on the situation then occurring at work 90% of the time. For the Generalized Estimating Equations analyses on work status, the final model was significant, explaining 54% of the variance in non-return to work (Pseudo R2 = 0.54; p = 0.0001). Workers were 8.52 times less likely to return to work when the margin of manoeuvre was insufficient, and twice as likely not to return to work in the presence of intense worry. Worries were significantly associated with insufficient margin of manoeuvre.

CONCLUSION

A strong association between workers' lack of margin of manoeuvre at work and their worries about their return to work, and poor work outcomes, supports the importance of the worker-environment interaction in rehabilitation programs.

Organizational display rules in nursing: Impacts on caring behaviors and emotional exhaustion through emotional labor

AIM

To examine the impact of display rules on nurses' caring behaviors and emotional exhaustion and the mediating role of emotional labor (surface/deep acting).

BACKGROUND

Hospitals often implement emotional display rules for nurses with the expectation of performance benefits. However, these rules may have an impact on nurses' caring behaviors and emotional exhaustion.

METHODS

This cross-sectional correlational study included a sample of 746 nurses from five hospitals and used the STROBE checklist. Relationships between display rules, emotional labor, caring behaviors, and emotional exhaustion were analyzed using structural equation modeling.

RESULTS

Display rules did not directly affect caring behaviors or emotional exhaustion. Emotional labor mediated the relationships. Display rules were associated more with surface acting. Deep acting increased caring behaviors and reduced emotional exhaustion; surface acting had the opposite effect.

CONCLUSIONS

Findings challenge the assumption that display rules effectively promote caring behaviors. Display rules lead to emotional labor and emotional exhaustion. Reducing display rules, emotional labor, and surface acting while supporting deep acting may alleviate emotional exhaustion.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse managers should review the nature and implementation of emotional display rules and explore ways to reduce emotional labor, encourage deep acting, mitigate the negative impact of surface acting, and ultimately improve nursing caring behaviors.

The Interplay Between Helping Behavior and Absenteeism in Teams: A Longitudinal Examination of Their Reciprocal Relationship in a Public Organization

This study employed a longitudinal model to investigate the reciprocal relationships between interpersonal citizenship behavior (OCB-I) and absenteeism at the team level. The research utilized four waves of data from a sample comprising over 5,000 employees in 168 teams within a large Canadian public organization. Drawing upon the focus theory of normative conduct and the collective identity perspective, our findings indicated that a positive change in OCB-I, which encompasses helping behaviors, led to a subsequent decrease in team absenteeism. In addition, emphasizing the identity perspective and allocation of time perspective, our study demonstrated that increased absenteeism within a given period was associated with a subsequent reduction in team OCB-I.

Person-centered exploration of work-related stress patterns, predictors, and their association with subhealth in midwives: A cross-sectional study

BACKGROUND

Midwives experience elevated levels of work-related stress. However, there is limited understanding of the patterns of this stress, its sociodemographic and work-related determinants, and its association with sub-health.

METHOD

This multi-center cross-sectional study, conducted in 21 hospitals in Zhuhai City, Guangdong Province, China, involved 300 midwives. Work-related stress levels in midwives were evaluated using the Chinese version of the Nursing Stress Scale, while social, physical and mental sub-health status was measured with the Sub-Health Measurement Scale. Utilizing latent profile analysis, the study aimed to categorize midwives into homogeneous profiles based on patterns of work-related stress.

RESULTS

Among the 300 midwives examined, three distinct profiles were identified: profile 1 (n=57, 19 %), characterized by low work-related stress; profile 2 (n=149, 50 %), representing the moderate work-related stress class; and profile 3 (n=94, 31 %), indicative of high work-related stress. Midwives in the high work-related stress profile tended to be younger, with lower monthly income, lower professional titles, and a higher likelihood of night shift work (all P<0.01). Significant and noteworthy trends were observed in sociodemographic characteristics (age, monthly income, and professional title) and work-related characteristics (night shift status). After controlling for confounders, the work-related stress profile demonstrated a negative association with social, physical and mental sub-health status.

CONCLUSION

This study highlights integrating stress domains and adopting a person-centered approach to examine midwives' work-related stress. Identifying predictors of profile membership and their relationship with sub-health can inform tailored interventions to reduce stress and improve midwives' well-being.

A mixed-methods stress audit with midwives in the United Kingdom

PROBLEM

UK midwives report high work-related stress, which can negatively impact their health and wellbeing, with many considering leaving the profession.

BACKGROUND

An occupational stress audit guides the implementation of stress management intervention, by identifying which stressors have the most negative impact and why, and highlighting "at risk" groups.

AIM

To conduct a concurrent mixed-methods stress audit with UK midwives in an NHS Trust.

METHODS

Seventy-one midwives (Mage= 39 years, SD = 11) completed a survey assessing stressors (e.g., relationships), stress appraisals (i.e., challenge vs. threat), coping strategies (e.g., avoidance-focused), and outcomes (i.e., mental health, performance, and intention to leave). Ten midwives (Mage = 42 years, SD = 10) participated in semi-structured interviews.

FINDINGS

Quantitative data revealed that more work-related demands, poorer peer support and relationships, and threat appraisals predicted worse mental health. Moreover, less control and more work-related demands predicted poorer performance, while less control, poorer manager support, more change-related demands, and threat appraisals predicted greater intention to leave. Qualitative data generated three themes: organisational pressures exacerbated by unexpected changes; individualised responses but largely debilitative emotions; and personal coping and power of social support.

DISCUSSION AND CONCLUSION

This study offered a comprehensive and novel insight into the stress experiences of UK midwives, highlighting targets for future stress management interventions, including key stressors (e.g., manager support), underlying mechanisms (e.g., stress appraisals), and "at-risk" groups (e.g., night shift workers). Practical recommendations are provided for stakeholders operating at multiple levels (e.g., midwife, trust, policy) to better support midwives with work-related stress.

Fading Focus: Addressing the Association Between Challenge Stressors, Role Blurring, Insomnia, Fatigue, and Workplace Cognitive Failure

The primary goal of the present study is to inspect the plausible job-related (i.e., challenge stressors and role blurring) and individual factors (i.e., fatigue and insomnia) that potentially lead to work-related cognitive failures among healthcare staff. Through the judgmental sampling technique, data was collected from healthcare personnel in Iran. The results revealed that challenge stressors in the form of time pressure, job responsibility, and work overload are significantly related to role blurring. Moreover, role blurring increases fatigue and insomnia among medical staff, and both insomnia and fatigue cause workplace cognitive failure. The results also confirm the mediation effect of role blurring in the association between challenge stressors, insomnia, and fatigue. According to the results, insomnia and fatigue similarly mediate the role blurring on workplace cognitive failure association. Theoretical implications, useful suggestions for practitioners, and prospective research avenues are debated in the study.

Effectiveness of interventions on occupational stress, health and well-being, performance, and job satisfaction for midwives: A systematic mixed methods review

BACKGROUND

Work-related stress is high in midwifery with negative implications for midwives' health and performance. This systematic review therefore examined which stress management interventions (SMIs) are most effective at reducing occupational stress and improving midwives' health and well-being, performance, and job satisfaction.

METHODS

A systematic review included studies if they were: investigating midwives or student midwives; examining an individual- or organisation-level intervention; reporting the intervention effects on at least one outcome (e.g., job performance); peer-reviewed; and published in English. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted and data were presented by SMI level (i.e., individual vs. organisation) and modality type (e.g., mindfulness, care model). Sum codes were used to compare the effects of individual- and organisation-level SMIs on outcomes.

FINDINGS

From 2605 studies identified, 30 were eligible (18 individual- and 12 organisation-level SMIs). Eight studies were deemed low quality. While individual- and organisation-level SMIs were equally effective in improving job satisfaction and performance, there was a trend for organisation-level SMIs more effectively reducing work stress and improving health and well-being. Specific individual- (i.e., mindfulness, simulation training) and organisation-level (i.e., reflective groups, midwifery care models) SMIs were most beneficial.

CONCLUSION

It is recommended that health practitioners and policy makers implement interventions that target both individual- and organisation-levels to optimally support midwives' work stress, health, well-being, and performance. Notwithstanding these findings and implications, some studies had poor methodological quality; thus, future research should better follow intervention reporting guidelines.

Perceived Social Support and Presenteeism Among Nurses: Mediation of Psychological Capital

OBJECTIVE

The aim of this study was to explore the mediating role of psychological capital in the relationship between perceived social support and presenteeism among nurses.

BACKGROUND

The concept of presenteeism explored in this study refers to the behavior of nurses who hold on to their jobs despite poor physical or mental health, manifested in poor work productivity and loss of productivity. Perceived social support and psychological capital may help reduce presenteeism. However, there is limited knowledge about the association between perceived social support, psychological capital, and presenteeism among nurses.

METHODS

Data were collected through questionnaires from 468 RNs. Data analysis used Pearson's correlation analysis, multiple linear regression, and structural equation model.

RESULTS

The results indicated that perceived social support and psychological capital were significantly negatively correlated with nurses' presenteeism. Structural equation modeling revealed that psychological capital mediated the relationship between perceived social support and presenteeism, with a partial mediating effect of -0.191, accounting for 28% of the total effect.

CONCLUSIONS

These results identified structural relationships between the 3 variables of perceived social support, psychological capital, and presenteeism and provided a theoretical reference for developing strategies to decrease nurses' presenteeism.

Feasibility and acceptability of a theory-based online tool for reducing stress-induced eating

Stress-induced eating is associated with various health risks like obesity and cardiovascular disease, exacerbated by the overconsumption of unhealthy foods. This study sought to investigate replacement coping strategies for stress-induced eating that participants can seek to implement using behaviour change techniques like implementation intentions. The study adopted a feasibility and acceptability design, with 258 participants (88.37% female) aged 17-75 years old who self-reported stress-induced eating. Participants were asked to identify cues for their stress-induced eating and evaluate the acceptability of eight potential replacement coping strategies. After selecting their preferred strategy, participants formed implementation intentions, linking the strategy with their previously identified cues. There were six themes of cues for stress-induced eating as identified by participants, including a range of external and internal stressors. Themes regarding the acceptability of the replacement coping strategies were organised based on constructs from integrated social cognition theories. Participant responses reflected cognitive and affective attitudes, and control and normative beliefs behind engagement in coping behaviour; further, automatic and volitional processes were described by participants as playing a role in whether a coping strategy was deemed as useful. Plans formulated by participants commonly detailed specific situations and strategies to utilise, though few described start times or durations of their plan. Action planning was found to significantly increase following formation of implementation intentions, and participants' descriptions supported the feasibility and acceptability of utilising implementation intentions to adopt alternative coping strategies to stress-induced eating. Future research should conduct a randomised controlled trial to assess the efficacy of the implementation intentions intervention in promoting uptake of replacement coping strategies to reduce stress-induced eating.

Measuring Situational Cognitive Performance in the Wild: A Psychometric Evaluation of Three Brief Smartphone-Based Test Procedures

Mobile devices provide new opportunities to draw conclusions about cognitive performance in everyday situations. To gain insights into cognitive performance patterns in healthy adult populations, we adapted three established cognitive tests for smartphone use: the Digit Symbol Substitution Task (DSST), Sustained Attention to Response Task (SART), and Psychomotor Vigilance Task (PVT). To increase their feasibility for ambulatory assessment, we identified the minimum measurement durations that provide reliable and valid state measures of cognitive performance. Over 2 weeks, 46 participants performed each test once per day at random times, along with self-reports (e.g., on concentration, mood, and mental demands). The validity and reliability of change are promising for the 30-second PVT and 90-second DSST and SART. The DSST and SART provide fruitful outcomes for ambulatory field studies linked to mood, stress, and mental demands. We provide digital versions of the adapted DSST and SART online for free.

Key elements to support primary healthcare nurses to thrive at work: A mixed-methods sequential explanatory study

AIM

Develop evidence-based recommendations for managers to support primary healthcare nurses to thrive at work.

DESIGN

A mixed-methods sequential explanatory design.

METHODS

National data were collected in 2020 via an e-survey based on a meta-analysis of antecedents of thriving from 213 primary healthcare nurses across New Zealand. Structural equation modelling analysis identified the key factors supporting primary healthcare nurses to thrive. This informed a second open-ended e-survey in 2022 of 19 nurses from one primary healthcare organization. The thematic analysis provided recommendations for improving management strategies to support thriving primary healthcare nurses.

RESULTS

The vitality component of thriving significantly reduced burnout and intention to leave organization and profession. In contrast, the learning component of thriving had a significant positive effect on burnout. The key factors that support thriving at work are empowering leadership and perceived organizational supports (decreases burnout and intention to leave organization and profession through enhanced vitality). Recommendations for improving thriving were made in eight key areas: communication, effective management, professional development, scope of practice, autonomy, effective orientation, reward and work-life balance.

CONCLUSIONS

Vitality is important in reducing burnout and turnover intentions. While learning was identified as increasing burnout, professional development and training for managers were identified as essential. Hence, the vitality dimension of the thriving at work construct should be studied at the dimension level, but more research is needed into the impact of learning on thriving over time. Primary healthcare nurses have identified that empowering leadership and perceived organizational support are critical factors in supporting them to thrive, and they provide specific recommendations for managers to improve these factors in the clinical setting.

NO PATIENT OR PUBLIC CONTRIBUTION

This study collected data from Registered Nurses only.

WHAT IS ALREADY KNOWN

A plethora of existing research focuses on resilience in nurses rather than thriving at work. Enabling employees to thrive at work contributes to improved well-being and sustainable organizational performance.

WHAT THIS PAPER ADDS

Empowering leadership and perceived organizational support are the key factors that support primary healthcare nurses to thrive at work. The vitality dimension of the thriving at work construct should be studied at the dimension level, and further research is needed into the impact of learning on thriving over time. Primary healthcare nurses recommend that managers focus on improving communication, management efficiency, professional development, scope of practice, autonomy, orientation, reward and work-life balance.

Development of the Hogan Personality Content Single-Items Inventory

The Hogan Personality Inventory (HPI) and Hogan Developmental Survey (HDS) are among the most widely used and extensively well-validated personality inventories for organizational applications; however, they are rarely used in basic research. We describe the Hogan Personality Content Single-Items (HPCS) inventory, an inventory designed to measure the 74 content subscales of the HPI and HDS via a single-item each. We provide evidence of the reliability and validity of the HPCS, including item-level retest reliability estimates, both self-other agreement and other-other (or observer) agreement, convergent correlations with the corresponding scales from the full HPI/HDS instruments, and analyze how similarly the HPCS and full HPI/HDS instruments relate to other variables. We discuss situations where administering the HPCS may have certain advantages and disadvantages relative to the full HPI and HDS. We also discuss how the current findings contribute to an emerging picture of best practices for the development and use of inventories consisting of single-item scales.

Personal strength use and job satisfaction in Chinese nurses: The mediating roles of basic psychological needs satisfaction and resilience

AIM

This study aimed to investigate the association of personal strength use with job satisfaction among Chinese nurses and to examine the mediating roles of basic psychological needs satisfaction and resilience in this association.

BACKGROUND

The topic of nurses' job satisfaction has been extensively studied worldwide because of its significant effects on nurse turnover, recruitment, and quality of care.

METHODS

A sample of 417 nurses completed a multi-section questionnaire that included established scales to measure personal strength use, basic psychological needs satisfaction, resilience, and job satisfaction.

RESULTS

The results revealed that personal strength use was positively linked to nurses' job satisfaction. Additionally, basic psychological needs satisfaction and resilience mediated the association of personal strength use with job satisfaction both independently and serially.

CONCLUSION

Personal strength use increases nurses' job satisfaction by satisfying their basic psychological needs and improving their resilience.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Creating a culture that supports the use of personal strengths among nurses is a promising strategy that hospital managers could consider to enhance nurses' job satisfaction. Furthermore, implementing programs and interventions to improve nurses' basic psychological needs satisfaction and resilience could further boost their job satisfaction.

Short Mindfulness Meditations During Breaks and After Work in Everyday Nursing Care: A Simple Strategy for Promoting Daily Recovery, Mood, and Attention?

BACKGROUND

Nurses experience high job demands, which makes recovery particularly necessary to maintain well-being and performance. However, these demands also make recovery challenging. Short mindfulness meditations could potentially help alleviate this paradox.

METHODS

Two ecological momentary intervention studies were conducted among geriatric nurses (Study 1: break study) and hospital nurses (Study 2: after-work study) to investigate whether short audio-guided mindfulness meditations are beneficial for recovery during breaks and psychological detachment after work. Furthermore, break recovery and after-work detachment were examined as mediators of the associations between mindfulness meditations and after-break/after-sleep mood and attention after respective recovery periods. Multilevel path models were based on a sample of 38 nurses and 208 after-break surveys in the break study and 26 nurses and 192 after-sleep surveys in the after-work study.

RESULTS

Compared to breaks spent as usual, breaks that incorporated short mindfulness meditations were associated with higher break recovery, which mediated the positive associations between mindful breaks and after-break calmness, valence, and energetic arousal. Only with certain constraints did mindfulness meditations predict a lower rate of attention failures. In the after-work study, short mindfulness meditations were positively related to psychological detachment, which mediated the positive associations between the intervention and after-sleep valence and calmness.

CONCLUSION/APPLICATION TO PRACTICE

Both pilot studies showed that short mindfulness meditations aid in recovery among nurses. However, to fully utilize the advantages of recovery-promoting breaks, structural changes are necessary to ensure that breaks of an appropriate duration are consistently implemented.

The relationship between perceived stress and emotional eating in bus drivers: the effect of shift work

This study discusses the relationship between perceived stress and emotional eating based on shiftwork in city bus drivers. It was conducted with 1403 male city bus drivers working in Istanbul. Questions about the drivers' physical activity and dietary habits, the Healthy Diet Index (HDI), Emotional Appetite Questionnaire and Perceived Stress Scale-10 data were collected and evaluated in two groups: shift and non-shift employees. It was found that the shift workers (SWs) have lower perceived stress, physical activity, HDI and positive emotional appetite averages. In addition, for SWs, a positive correlation was found between negative emotional appetite scores and physical activity and HDI scores. In conclusion, the drivers working in shifts were found to be slightly overweight and had lower physical activity levels, had lower HDI scores, and their nutritional status was more negatively impacted than their counterparts.

Psychological well-being and job performance of nurses and midwives amidst COVID-19 in Ghana; a multi-group analysis

The purpose of this study was to examine the effect of psychological well-being on job performance among nurses and midwives in rural and urban hospitals in Ghana amidst COVID-19. The study adopted a purely quantitative approach, using the explanatory research design. Data were collected from 262 nurses and midwives in two selected hospitals in the Central Region of Ghana. The Structural Equation Modelling was used to analyze the data collected. The results revealed that the levels of psychological well-being and job performance were high in both hospitals amidst the pandemic. Further, it was observed that although psychological well- being had significant influence on job performance among the nurses and midwives in both rural and urban communities, the effect was more significant in the urban settlements. Given these findings, the study recommended that in order to effectively improve the job performance of nurses and midwives, management must adopt policies such as, flexible work arrangements, leave policy, and counselling services to support their psychological well-being.

How to Reduce the Influence of COVID-19 Epidemic on Employees' Anxiety of Continuous Work in China? Empirical Analysis Based on Industrial Enterprises

The COVID-19 epidemic not only impacted China's economy but also induced periodic anxiety among employees, especially during its peak. Even as governmental controls relaxed, enterprises seemed unaffected externally. However, beneath the surface, the lingering effects on employee mental health persisted. Many faced dual stressors concerning their job and personal well-being due to the epidemic, heightening work-related anxieties. This research, a year after China resumed work, delves into the psychological stress influencing this sustained anxiety. A survey of 516 employees helped test the hypothesis using a multiple regression model. Findings indicated heightened continuous work anxiety due to the epidemic, particularly in hard-hit areas. However, individual resilience, organizational, and social support were found to mitigate these effects. The study underscores the sustained psychological aftermath of the epidemic on employees, urging health authorities to address it.

Could breaks reduce general practitioner burnout and improve safety? A daily diary study

BACKGROUND

Rates of burnout are currently at record high levels, and GPs experience higher burnout than many other specialties. Organisational interventions may reduce burnout, but few studies have investigated these in primary care.

AIM

The current study investigated whether breaks, both with and without social interactions, were associated with burnout and patient safety perceptions in GPs.

DESIGN

A within-subjects, interval contingent, quantitative daily diary design.

SETTING

UK GP practices.

METHOD

Participants completed questionnaires at baseline measuring demographic variables, burnout and patient safety perceptions. They then completed a questionnaire in the evening each day for a week which captured whether they had taken a break that day, whether it involved a positive social interaction, burnout (comprising subscales of disengagement and exhaustion), positive and negative affect and patient safety perceptions. The data were analysed using hierarchical linear modelling to assess same-day and next-day associations.

RESULTS

We included 241 responses from 58 GPs for analysis. Taking at least one break (involving any or no social interactions) was associated with lower disengagement that day and lower exhaustion the next day. Taking at least one break involving a positive interaction was associated with 1) lower disengagement, exhaustion, overall burnout and negative affect on the same day, as well as higher positive affect and improved perceptions of patient safety, and 2) lower exhaustion and improved patient safety perceptions on the next day.

CONCLUSION

Organizing daily team or practice breaks where staff can socialise may help to reduce burnout and improve perceptions of patient safety.

What would have made work in the COVID-19 ICU less demanding? A qualitative study from 13 Swedish COVID-19 ICUs

BACKGROUND

The COVID-19 pandemic stretched Swedish intensive care unit (ICU) resources to an extent never experienced before, but even before the pandemic staffing was difficult and the number of staffed ICU beds was low. Studies have revealed high levels of COVID-19 ICU staff burn-out and fatigue, and as similar situations with high demands are likely to occur in the future a better understanding of resources that improve staff resilience is important. Using the job-demand resource theory as a framework, we explored ICU professionals' views on demands and resources when working in COVID-19 ICUs with the aim to highlight factors that increased the job resources.

METHODS

Data were collected via a web survey distributed to COVID-19 ICU professionals, including both regular and temporary roles, working in 13 COVID-19 ICU wards in Stockholm and Sörmland counties during the spring 2021. A total of 251 written responses to the question "What would have made work in the COVID-19 ICU less demanding?" were analyzed using thematic analysis. One year later a member-checking focus group interview was conducted to validate and further explore staff experiences.

RESULTS

The main themes were work strategy, fairness and support, continuity, accessible leadership, introduction/information, and crisis preparedness. The analysis of the focus group conducted confirmed the main results and the extreme demands on ICU staff during the initial stages of the pandemic.

CONCLUSION

To increase staff health and performance in a long-term crisis our results suggest; maintaining workplace leadership, scheduling work in advance and, when possible, schedule for recovery.

The chain mediating role of negative emotions at work and meaning in life between interpersonal conflict at work and depressive symptoms among nurses: a multicenter cross-sectional study

BACKGROUND

Depressive symptoms among nurses have been a significant public health concern. Although many studies have demonstrated the potential relationship between interpersonal conflict at work and depressive symptoms, the mechanisms underlying this relationship among nurses remain unclear. Based on the theoretical and empirical research, this study aimed to investigate the multiple mediating effects of negative emotion at work and meaning in life on the relationship between interpersonal conflict at work and depressive symptoms among nurses.

METHODS

An online multicenter cross-sectional study was conducted in 15 hospitals from different geographical areas of Hunan Province, China, from December 2021 to February 2022. A total of 1754 nurses completed validated self-reported questionnaires, including their sociodemographic information, interpersonal conflict at work, negative emotions at work, meaning in life, and depressive symptoms. Descriptive statistics analysis, Spearman's correlation analysis, multiple linear regression analysis, and chain mediation analysis were performed using IBM SPSS software (version 29) and Mplus software (version 8).

RESULTS

There were significant correlations between interpersonal conflict at work, negative emotions at work, meaning in life, and depressive symptoms (r = -0.206 ~ 0.518, all p < 0.01). Interpersonal conflict at work had a statistically significantly direct effect on depressive symptoms (β = 0.061; 95% confidence interval, CI: 0.011 ~ 0.126, p = 0.039). Analysis of mediating effects revealed that interpersonal conflict at work also influenced depressive symptoms through two statistically significantly indirect pathways: (a) the mediating effect of negative emotions at work (β = 0.167; 95% CI: 0.138 ~ 0.195, p < 0.001) and (b) the chain mediating effect between negative emotions at work and meaning in life (β = 0.008; 95% CI: 0.003 ~ 0.013, p = 0.005).

CONCLUSION

Interpersonal conflict at work has a direct positive effect on depressive symptoms among nurses. Meanwhile, interpersonal conflict at work can influence depressive symptoms among nurses through the mediating effect of negative emotions at work and the chain mediating effect between negative emotions at work and meaning in life.

Predictors of post-exercise affect: A self-determination theory approach considering physical, social, and psychological factors

BACKGROUND

Studies have shown increases in affect after acute exercise. However, the specific aspects of an exercise experience that predict or contribute to post-exercise affect remain relatively unknown. This study aimed to determine which physical (i.e., duration and intensity), contextual (i.e., social context and time of day), and psychological factors (i.e., motivation and need satisfaction) predicted post-exercise affect.

METHODS

In 2021, 296 gym users self-reported affect before and immediately after exercising at a gym facility. Participants also reported situational motivation towards exercise, need satisfaction (i.e., autonomy, competence, and relatedness), who they exercised with (social interaction), and the duration and perceived intensity of their exercise session. We first conducted a paired samples t-test to identify whether affect significantly increased from before to after exercise, and then a hierarchical regression model to determine which factors predicted post-exercise affect.

RESULTS

Affect significantly increased from before to after exercise (t[291] = 8.116, p < .001). Autonomous motivation (β = .23, p = <.001), autonomy satisfaction (β = .15, p = <.05), and relatedness satisfaction (β = .19, p = <.01) significantly predicted post-exercise affect, whereas duration, perceived intensity, social interaction, and time of day did not.

CONCLUSIONS

People should be encouraged to engage in activities that satisfy their need for autonomy and relatedness during leisure-time (i.e., not during the workday). SO WHAT?: This approach to physical activity promotion may lead to better affective outcomes and increased adherence compared to focusing on how long, how intense, or with whom people exercise.

Relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran: a cross-sectional survey

OBJECTIVE

To examine the relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran.

DESIGN

Descriptive, cross-sectional survey and correlational analysis.

SETTING

Two hospitals associated with Tabriz University of Medical Sciences, Iran, from August to September 2022.

PARTICIPANTS

92 bedside nurses in orthopaedic wards, each with >1 year of clinical experience.

OUTCOME MEASURES

Burnout was assessed using the Copenhagen Burnout Inventory, and occupational fatigue exhaustion/recovery was measured with the Occupational Fatigue Exhaustion/Recovery Scale. Pearson's correlation, independent t-test, one-way analysis of variance and multivariable linear regression analyses determined statistical significance.

RESULTS

The mean burnout score was 63.65 (±15.88) out of 100 and the recovery rate was 35.43 (±15.60) out of 100. There were significant correlations between total burnout and each of the exhaustion recovery dimensions: chronic fatigue (r=0.70), acute fatigue (r=0.65) and intershift recovery (r=0.56). Nurses exceeding 44 weekly work hours reported higher burnout (66.52±14.77, p=0.005) than those working fewer hours (56.25±16.12, p=0.005). Rotational shift status was associated with increased burnout (64.97±15.32) compared with fixed shifts (55.54±17.42, p=0.04). Chronic fatigue (B=0.39, 95% CI 0.21, 0.57; t=4.29, p<0.001) and intershift recovery (B=-0.241, 95% CI -0.46, -0.02; t=-2.16, p=0.035) were significant predictors of burnout.

CONCLUSIONS

Burnout is a critical concern among orthopaedic nurses and is significantly linked to occupational fatigue/recovery. Addressing chronic fatigue and enhancing intershift energy recovery could mitigate burnout risk. Therefore, optimising work conditions and schedules and developing tailored recovery protocols are vital to safeguarding orthopaedic nurses' well-being.

Childhood Family Stress and Women's Health: Parasympathetic Activity as a Risk and Resiliency Factor

Childhood family stress (CFS) exacerbates risk for physical health problems across the lifespan. Health risks associated with CFS are particularly relevant for women who tend to endorse more CFS than men. Importantly, some evidence suggests that individuals may vary in their susceptibility to CFS. Parasympathetic activity, which helps to regulate automatic bodily activity (e.g., breathing, digestion), has been proposed to represent a marker of plasticity to environmental exposure. However, no research to date has tested whether parasympathetic activity may modulate the impact of early adversity on health. We examined whether parasympathetic activity would moderate the link between CFS and health complaints in a sample of 68 undergraduate women (Mean age = 19.44). Participants self-reported CFS and health complaints. Parasympathetic activity was indexed using high-frequency heart rate variability (HF-HRV) and was evaluated by measuring changes in HF-HRV in response to and following a laboratory-based stress induction. Multiple regression analyses indicated that CFS was significantly associated with more health complaints. Further, HF-HRV in response to stress and during recovery relative to baseline significantly moderated relationship between CFS and health complaints. Specifically, more CFS was significantly associated with more health complaints among women who showed mean or greater decreases in HF-HRV in response to stress. Additionally, lower levels of CFS were associated with fewer health complaints among women who showed mean or greater HF-HRV during recovery relative to baseline. Findings highlight the importance of parasympathetic activity in modulating stress-health links.

An Empirical Examination of the Relationship Between Emotion Regulation and Emotional Labor

The expression of contextually appropriate emotions in the workplace is critical to fostering effective interpersonal interactions. What constitutes an appropriate emotional expression is determined by the display rules an employee perceives. Within the emotional labor framework, the management of emotional expression at work (i.e., ensuring alignment with display rules) occurs through the engagement in two primary strategies by employees. These are known as surface acting and deep acting. Despite theoretical efforts to synthesize these strategies with the broader emotion regulation framework and its strategies of expressive suppression and cognitive reappraisal, no empirical examination of their relationship exists. The present study aimed to investigate this empirical relationship to provide clarity on the extent to which these constructs (i.e., strategies) are unique across frameworks. A second aim was to assess whether method bias could explain any overlap between these constructs. A total of 800 participants (Mage = 22.4 years, 78.8% female) who worked across a range of service industries completed measures of emotion regulation and emotional labor under two conditions designed to manipulate the presence of method bias (i.e., varying the order of item administration). Participants also completed the DASS-21, a measure of affective symptom severity. Using multigroup analysis, the results indicated that analogous latent constructs (cognitive reappraisal and deep acting; expressive suppression and surface acting) yielded significant, small-to-moderate correlations, and that correlation coefficients were invariant regardless of how items were administered. The pattern of correlations with affective symptoms also differed across constructs. Together, the limited correlations between the analogous strategies, and the differential associations with affective symptoms, suggest a relative independence between these constructs. Findings carry theoretical and practical implications across research and clinical settings.

Implementing workplace health promotion in nursing - A process evaluation in different care settings

OBJECTIVE

Workplace health promotion (WHP) in Germany is receiving increasing support from health insurance funds. Nevertheless, there is hardly any knowledge on the process of how health outcomes are achieved, especially in nursing. The aim of the study was to find out how and what can be implemented in different care settings and to examine the reactions and interactions of the participants under routine conditions.

METHODS

Guided by a logic model, a holistic WHP approach was implemented in four acute care hospitals, seven inpatient care facilities and four outpatient care services from April 2021 to October 2022. Data on realized WHP interventions, participant assessment and topics of work design was collected and analyzed descriptively.

RESULTS

The realized WHP interventions were adapted depending on the content and context. Mainly short relaxation interventions were delivered or those with an event character were received by participants. The highest participation rate of planned participants was achieved in team building training. Participants predominantly assessed WHP interventions as useful, the quality as (very) good and were generally (very) satisfied with the intervention components. For work design topics, intentions for the design of work organization were mainly documented in action plans.

CONCLUSION

Cooperation with practitioners in research should be continued as a contribution to quality development. This could provide suggestions as to which content adjustments lead to greater acceptance by the target group in a specific context.

TRIAL REGISTRATION

The project was registered in the German Clinical Trial Register (DRKS00024961, 2021/04/09).

The mediating effect of resilience between work fatigue and psychological distress among healthcare workers in Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia

OBJECTIVES

To test the hypothesis that resilience has a mediating effect on the association between work fatigue and psychological distress.

METHODS

A cross-sectional survey was conducted online in eight countries in 2021: Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia. A total of 1094 healthcare professionals specialized in medicine, pharmacy, and nurse practitioners that were exposed to/worked with COVID-19 patients were included (age: 33.89 ± 10.79 years; 59.6% females).

RESULTS

After adjusting for potential confounders (i.e., country, gender, primary work in emergency department, primary work in infectious disease, primary work in intensive care unit, working in a COVID-19 ward, and working voluntary hours), the results of the mediation analysis showed that resilience fully mediated the association between physical work fatigue and psychological distress and partially mediated the associations between mental and emotional work fatigue and psychological distress. Higher work fatigue was significantly associated with less resilience; higher resilience was significantly associated with less psychological distress. Finally, higher mental and emotional, but not physical, work fatigue, were directly and significantly associated with more psychological distress.

CONCLUSION

Identifying resilience as an important mediator in the path from fatigue to distress helps elucidate underlying mechanisms and pathways leading to the mental health-alteration process among healthcare workers during COVID-19. New strategies targeting resilience may be developed to further improve mental health outcomes among healthcare workers.

Mapping and Characterizing Instruments for Assessing Family Nurses' Workload: Scoping Review

BACKGROUND

The importance of knowing the workload of family nurses lies essentially in the possibility of improving health outcomes, care processes and the nurse's professional life. There is a lack of studies that fully describe the nursing workload in primary care, particularly, in the context of family health nursing, and the ideal metrics to be used remain unknown, making it impossible to characterize and therefore provide the necessary insight to acknowledge the different contributions of several aspects that embody the global workload of family nurses. The objective of this scoping review was to map the known evidence and characterize the instruments used to assess the workload of family nurses.

METHODS

Scoping review, according to the Joanna Briggs Institute, proposed a methodology for scoping reviews, consisting of three research stages: (1) an initial research in Medline and CINHAL; (2) an extended search, using keywords and search terms, in the following databases: JBI, CINAHL Complete, MEDLINE, Cochrane and Scopus; and (3) a search of the reference lists of the selected articles. No time limit was defined.

RESULTS

Fourteen studies referring to ten assessment instruments were included. Nine of them analyze workload as a dimension of a broader instrument, and two studies refer to an instrument that focuses exclusively on workload.

CONCLUSIONS

The diversity of professional competencies and contexts, the conceptual complexity of workload and the absence of a theoretical framework make it difficult to identify consensual instruments to assess the workload of family nurses. This study was prospectively registered with the Open Science Framework® on 6 September 2023, with the registration number: 3k6vr.

Examining the mental health services among people with mental disorders: a literature review

BACKGROUND

Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use.

METHODS

PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria.

RESULTS

Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use.

CONCLUSION

This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.

Towards an assessment of psychosocial work factors in a multi-level mental health intervention in the workplace: results from the MENTUPP pilot-study

BACKGROUND

Mental health in the workplace is a growing concern for enterprises and policy makers. MENTUPP is a multi-level mental health intervention implemented in small and medium size enterprises from three work sectors in nine countries. This pilot study aimed to evaluate the feasibility, delivery, and instruments for the MENTUPP intervention to inform the planning of a clustered randomized controlled trial.

METHODS

We administered items from the Copenhagen Psychosocial Questionnaire and the Danish Work Environment Cohort Study measuring psychosocial workplace factors. The questionnaire was answered by 382 participants at baseline, of which 98 participants also answered after six months at follow-up. We calculated mean scores of 19 psychosocial factors at baseline and conducted repeated measures ANOVAs to assess differences in eight psychosocial factors at follow-up. We also examined whether outcomes differed between work sectors and job positions at follow-up.

RESULTS

The construction sector and workers with no or a lower leadership role reported more negative working environment factors at baseline. We observed a statistically significant decline in social support from colleagues and social community at work, and a marginally significant decline in justice at work. For the rest of the constructs, we did not observe statistically significant changes.

CONCLUSIONS

We found significant differences in psychosocial work environment factors among work sectors and job positions at baseline. Contrary to our hypotheses, three psychosocial work environment factors decreased at follow-up. Possible explanations are the utilization of specific psychosocial factors as resources to cope with psychosocial stressors, high participant expectations that were not met by the intervention, insufficient time for structural changes, or the intervention prompting critical evaluations of the work environment. These findings will inform the design and implementation of the forthcoming clustered randomized controlled trial, where they will also be further investigated to validate their significance.

A rank ordering and analysis of four cognitive-behavioral stress-management competencies suggests that proactive stress management is especially valuable

The main objective of this study was to determine the relative value of four cognitive-behavioral competencies that have been shown in empirical studies to be associated with effective stress management. Based on a review of relevant psychological literature, we named the competencies as follows: Manages or Reduces Sources of Stress, Manages Thoughts, Plans and Prevents, and Practices Relaxation Techniques. We measured their relative value by examining data obtained from a diverse convenience sample of 18,895 English-speaking participants in 125 countries (65.0% from the U.S. and Canada) who completed a new inventory of stress-management competencies. We assessed their relative value by employing a concurrent study design, which also allowed us to assess the validity of the new instrument. Regression analyses were used to rank order the four competencies according to how well they predicted desirable outcomes. Both regression and factor analyses pointed to the importance of proactive stress-management practices over reactive methods, but we note that the correlational design of our study has no implications for the possible causal effects of these methods. Questionnaire scores were strongly associated with self-reported happiness and also significantly associated with personal success, professional success, and general level of stress. Data were collected between 2007 and 2022, but we found no effect for time. The study supports the value of stress-management training, and it also suggests that moderate levels of stress may not be as beneficial as previously thought.

Psychosocial Stressors at Work and Atrial Fibrillation Incidence: An 18-Year Prospective Study

BACKGROUND

Psychosocial stressors at work, defined by the job strain and effort-reward imbalance at work (ERI) models, were shown to increase coronary heart disease risk. No previous study has examined the adverse effect of psychosocial stressors at work from both models on atrial fibrillation (AF) incidence. The objective of this study was to examine the separate and combined effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in a prospective cohort study.

METHODS AND RESULTS

A total of 5926 white-collar workers (3021 women and 2905 men) free of cardiovascular disease at baseline were followed for an average of 18 years. Job strain (high psychological demands combined with low decision latitude) and ERI were assessed using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression models, controlling for socioeconomic characteristics and lifestyle-related and clinical risk factors. A total of 186 AF incident events were identified over 18 years. Workers exposed to job strain (HR, 1.83 [95% CI, 1.14-2.92]) and ERI (HR, 1.44 [95% CI, 1.05-1.98]) had a higher risk of AF in fully adjusted models. Combined exposure to job strain and ERI was associated with a 2-fold AF risk increase (HR, 1.97 [95% CI, 1.26-3.07]).

CONCLUSIONS

Psychosocial stressors at work from the job strain and ERI models are associated with an increased risk of AF, separately and in combination. Workplace prevention strategies targeting these psychosocial stressors at work may be effective to reduce the burden associated with AF.

The Effects of Burnout, Team Support, and Perceived Leader Effectiveness on Career Intentions Among JAG Corps Personnel

INTRODUCTION

Destructive interpersonal relationships at work may result in negative feelings among employees that hinder personal and organizational productivity, which may also result in high levels of job disengagement and subsequent career turnover intentions. Leaders play a key role in creating work environments conducive to optimizing employee performance, organizational culture, and workplace well-being. Social support, which may include support from one's supervisor, colleagues, and loved ones, has been shown to reduce strains and perceived stressors at work. In the Army, the Judge Advocate General's Corps (JAGC) personnel have a unique position as lawyers and legal staff and have been shown to have high rates of burnout. To promote soldier health, well-being, and career longevity, it is important to understand the impact interpersonal relationships have on career intentions. The current study assesses the relationship between perceived leadership effectiveness and career intentions as moderated by burnout measured by job disengagement and team care activities in JAGC personnel.

MATERIALS AND METHODS

The Walter Reed Army Institute of Research conducted a survey to understand factors affecting the well-being of the JAGC's soldier and civilian personnel as requested by the JAGC. JAGC personnel were administered several questionnaires covering a range of work and mental health topics. Job disengagement, career intentions, team care activities, and general leadership were assessed. A total of 831 JAGC personnel completed the survey, the majority (92%) of which were soldiers. Among soldiers, first lieutenants and captains (∼49%) were the majority. The sample largely consisted of men (∼63%), White individuals (∼76%), married individuals, (70%), and individuals with graduate degrees (∼81%).

RESULTS

One in four participants (∼29%) experienced high levels of disengagement, with their work. Over two-thirds of participants agreed that their immediate supervisor is an effective leader. When asked about career intentions, the majority of JAGC participants (54%) indicated that they would probably or definitely stay in the JAGC until retirement. Ordinal logistic regressions were conducted to assess the relationship between perceived leader effectiveness and career intentions, assessing the main effects of job disengagement and team care activities, and the interactions between those variables. No interaction effects were found to be significant, but main effects for perceived leader effectiveness were significant.

CONCLUSIONS

JAGC personnel reported higher levels of job disengagement for those with career intentions that were undecided or definitely leaving the JAGC after their current obligation. Those who were engaged in more team care activities had lower levels of disengagement. While the majority of the JAGC participants indicated career intentions to stay in the JAGC until retirement, increasing perceived effectiveness of leaders could help increase attrition and career intentions to stay in the JAGC beyond one's current obligation.