Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurses' aides: a cross-sectional study

The Effect of Foot Reflexology on Stress, Fatigue, and Low Back Pain in Intensive Care Unit Nurses: A Randomized Controlled Trial

OBJECTIVES

This study, which uses a randomized controlled design, aimed to determine the effect of foot reflexology on stress, fatigue, and low back pain (LBP) in intensive care unit (ICU) nurses.

METHODS

The study was conducted with intensive care unit nurses at two hospitals in a city between September 2022 and April 2023. The study sample consisted of 42 nurses, 21 of whom had low back pain for at least 3 months and 21 of whom were controls. In the study, foot reflexology was applied to the intervention group for 20 minutes (10 minutes on each foot) once a week for 4 weeks. There was no intervention applied to the control group. Data were collected using the Personal Information Form, the Perceived Stress Scale (PSS), the Fatigue Severity Scale (FSS), and the Visual Analog Scale (VAS).

FINDINGS

Based on the change in the mean scores of the scale in the intervention and control groups over time, a statistically significant decrease was found between the pre-test (before foot reflexology) and post-test mean scores of the LBP-VAS (from 6.33 to 2.24, respectively) and the Fatigue Severity Scale (from 4.81 to 3.60, respectively) in the intervention group. Although there was no statistically significant difference between the perceived stress scale pre-test and post-test scores, it was found that there was a decrease in favor of the intervention group.

CONCLUSION

Foot reflexology appears to offer promise as an effective method for ICU nurses to reduce lower back pain and fatigue.

Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives

OBJECTIVE

The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress.

METHODOLOGY

A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024.

RESULTS

The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit.

CONCLUSION

Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses' stress merits further investigation in future research studies.

Identifying individual and organizational predictors of accidental exposure to blood (AEB) among hospital healthcare workers: A longitudinal study

BACKGROUND

Accidental exposure to blood (AEB) poses a risk of bloodborne infections for healthcare workers (HCWs) during hospital activities. In this study, we identified individual behavioral and organizational predictors of AEB among HCWs.

METHODS

The study was a prospective, 1-year follow-up cohort study conducted in university hospitals in Paris, France. Data were collected from the Stress at Work and Infectious Risk in Patients and Caregivers (STRIPPS) study. Eligible participants included nurses, nursing assistants, midwives, and physicians from 32 randomly selected wards in 4 hospitals. AEB occurrences were reported at baseline, 4 months, 8 months, and 12 months, and descriptive statistical and multilevel risk-factor analyses were performed.

RESULTS

The study included 730 HCWs from 32 wards, predominantly nurses (52.6%), nursing assistants (41.1%), physicians (4.8%), and midwives (1.5%). The incidence rate of AEB remained stable across the 4 visits. The multilevel longitudinal analysis identified several significant predictors of AEB occurrence. Individual-level predictors included younger age, occupation as nurses or midwives, irregular work schedule, rotating shifts, and lack of support from supervisors. The use of external nurses was the most significant ward-level predictor associated with AEB occurrence.

CONCLUSIONS

AEBs among HCWs are strongly associated with organizational predictors, highlighting the importance of complementing infection control policies with improved staff management and targeted training. This approach can help reduce AEB occurrences and enhance workplace safety for HCWs.

[The impact of the coronavirus pandemic on the mental health of critical care workers]

INTRODUCTION

The coronavirus pandemic has focused attention on the importance of critical care and highlighted the shortage of critical care specialists. Due to increasing workloads and high mortality rates, healthcare professionals were exposed to higher levels of physical and psychological stress during the pandemic than before.

OBJECTIVE

Our study investigated the effects of the coronavirus outbreak on the emotional, mental and moral stress of intensive care professionals.

METHOD

Our workgroup performed paper-based surveys among caregivers in the Department of Anaesthesiology and Intensive Therapy at Semmelweis University. The first survey was conducted at the start of the pandemic in 2020, the second survey was conducted after the third wave in 2021. We applied validated questionnaires (Professional Quality of Life, Demoralization Scale, Perceived Stress Scale, Impact of Event Scale, and Posttraumatic Growth Inventory), collected demographic data and information on lifestyle, recreation, dietary habits, and accepting psychological support.

RESULTS

The number and demographic characteristics of the participants in the two studies are different, reflecting the changes in the workforce during the pandemic. Our results revealed no differences between the working and socio-demographic groups before the outbreak, however, one year later, nurses scored significantly higher on all negative psychological scales compared to other groups. Only a minority of the respondents had sought psychological support (9.5-12.7%), although more than a third of respondents reported the need for psychological support. Employees in new work positions showed significantly increased posttraumatic growth (2.91 ± 0.82 vs. 2.20 ± 1.06, p = 0.016).

DISCUSSION

These findings demonstrate that nurses are the most strained workgroup during an uncertain and stressful period. The available mental support alone is not enough to help caregivers.

CONCLUSION

Further steps are needed to improve the mental health of critical care workers. Orv Hetil. 2023; 164(42): 1646-1655.

Cytokine associated with severity of depressive symptoms in female nurses in Korea

Background

Depression has been associated with the risk of developing physical illnesses and diseases. Inflammatory hypotheses of immunoactive and dysregulated cytokine production have been proposed to describe this association; however, data pertaining to the high prevalence of depression among nurses are limited.

Objective

This study aimed to use a comprehensive immune-profiling approach to determine whether an abnormal profile of circulating cytokines could be identified in nurses with self-reported depression and whether this profile is associated with the severity of depression.

Methods

We investigated a cohort of 157 female nurses in Korea. The self-report Patient Health Questionnaire was used to measure the depression levels of nurses. In addition, peripheral blood samples were collected and used to measure the cytokine profile using the Luminex multiplexing system. Generalized gamma regression analyses were conducted to evaluate the association between cytokine and depressive symptoms.

Results

Regarding severity of depressive symptoms, 28.0% of nurses had moderately severe depression while 9.6% had severe depression. Moderately-severe depressive symptoms in nurses were associated with elevated levels of interleukin-6 (B = 0.460, p = 0.003), interleukin-8 (B = 0.273, p = 0.001), and interleukin-18 (B = 0.236, p = 0.023), whereas interferon-gamma levels (B = -0.585, p = 0.003) showed the opposite profile. Participants with severe depressive symptoms presented decreased interferon-gamma levels (B = -1.254, p < 0.001).

Conclusion

This study demonstrated that proinflammatory cytokines were associated with depression among nurses. This calls for early detection and intervention, considering the mechanisms linking depression to physical illness and disease.

Effects of nurses' schedule characteristics on fatigue: An integrative review

An integrative review of 21 studies found mixed results on the associations of work schedule and nurse fatigue. Suggestions for nurse leaders include monitoring fatigue in shift workers, ensuring supportive work design, promoting a healthy lifestyle, and implementing scheduling interventions.

Psychobiotic supplementation of HK-PS23 improves anxiety in highly stressed clinical nurses: a double-blind randomized placebo-controlled study

Nurses often experience adverse health effects associated with increasing levels of work-related stress. Stress may induce systemic effects through the HPA axis, glucocorticoid responses, and inflammatory cascades. Psychobiotics may help alleviate stress through associations of the microbiota, anti-inflammation factors, and the gut-brain axis. We aimed to investigate whether interventions with a psychobiotic, heat-killed (HK)-PS23 cells, may help improve perceived stress, anxiety, and related biological markers among highly stressed clinical nurses. This double-blind, randomized, placebo-controlled study included seventy clinical nurses from a medical center in Northern Taiwan who scored 27 or higher on the 10-item version of the Perceived Stress Scale (PSS), and participants were randomized into either taking HK-PS23 or a placebo for 8 weeks. Baseline and endpoint results of the PSS, Job Stress Scale, State and Trait Anxiety Index (STAI), emotional questionnaires, gastrointestinal severity questionnaires, Trails Marking Tests, blood biological markers, and sleep data were analyzed. While both groups demonstrated improvements in most measures over time, only the blood cortisol measure demonstrated significant group differences after the 8-week trial. Further analyses of the subgroup with higher anxiety (nurses with STAI ≥ 103) revealed that anxiety states had improved significantly in the HK-PS23 group but not in the placebo group. In summary, this placebo-controlled trial found significant reduction in the level of blood cortisol after 8 weeks of HK-PS23 use. The distinctive anxiolytic effects of HK-PS23 may be beneficial in improving perceived anxiety and stress hormone levels in female nurses under pressure. Clinical trial registration: https://clinicaltrials.gov/, identifier: NCT04452253-sub-project 1.

Validity and Reliability of Cultural Mix Coping Inventory for Stressful Situations among Healthcare Professionals in Ghana Amidst COVID-19

The Cultural Mix Coping Inventory for Stressful Situations is one of the recent coping measures developed to overcome the weaknesses of existing coping scales. Since its development and validation, the inventory has been used by previous studies to measure coping among teachers and students in stressful situations. Health professionals are workers who typically encounter stressful situations due to their work demands. In this study, we assessed the validity and reliability of cultural mix inventory for stressful situations among healthcare professionals in Ghana. The research was guided by three major objectives: (1) to assess the factor structure of the cultural mix coping inventory, (2) to evaluate the construct validity and reliability of the cultural mix coping inventory based on internal structure and (3) to test for evidence of criterion validity based on the external structure of the measure. Approximately 312 health workers were purposefully sampled to participate in the study. The study confirmed the original four-factor solution of the coping inventory with evidence of the construct validity based on the internal structure. Validity evidence based on the external structure of the measure was found to be sufficient. Given the COVID-19 pandemic and coupled with the stressful nature in the line of duty of healthcare professionals, this inventory provides a useful and sound measure of coping options among this cohort.

Multilevel approach to individual and organisational predictors of stress and fatigue among healthcare workers of a university hospital: a longitudinal study

OBJECTIVE

Healthcare workers (HCWs) are at high risk of experiencing stress and fatigue due to the demands of their work within hospitals. Improving their physical and mental health and, in turn, the quality and safety of care requires considering factors at both individual and organisational/ward levels. Using a multicentre prospective cohort, this study aims to identify the individual and organisational predictors of stress and fatigue of HCWs in several wards from university hospitals.

METHODS

Our cohort consists of 695 HCWs from 32 hospital wards drawn at random within four volunteer hospital centres in Paris-area. Three-level longitudinal analyses, accounting for repeated measures (level 1) across participants (level 2) nested within wards (level 3) and adjusted for relevant fixed and time-varying confounders, were performed.

RESULTS

At baseline, the sample was composed by 384 registered nurses, 300 auxiliary nurses and 11 midwives. According to the three-level longitudinal models, some predictors were found in common for both stress and fatigue (low social support from supervisors, work overcommitment, sickness presenteeism and number of beds per ward). However, specific predictors for high level of stress (negative life events, low social support from colleagues and breaks frequently cancelled due to work overload) and fatigue (longer commuting duration, frequent use of interim staff in the ward) were also found.

CONCLUSION

Our results may help identify at-risk HCWs and wards, where interventions to reduce stress and fatigue should be focused. These interventions could include manager training to favour better staff support and overall safety culture of HCWs.

Experiences, Perceptions, and Coping Patterns of Emergency Department Nurses with Occupational Stressors in Saudi Arabian Hospitals: Mixed-Method Study

Extended working hours, a complicated workplace environment, and engagement in numerous physical and psychological stressors have been associated with the stressful nature of the nursing profession. Only a few studies have provided some insight into workplace stress and coping strategies adopted by nurses in Saudi Arabia and neighboring countries. Therefore, this study utilized a mixed-method design to explore the numerous factors that lead to stress among emergency nurses, their experience and perception of stress, and the coping mechanisms they find useful. A survey containing four domains and 86 items was adapted, pilot tested, and validated. The quantitative phase recruited 296 nurses who returned completed questionnaires, and then 21 nurses were interviewed for the qualitative phase. In total, 89.5% (n = 265) of the participants were female, 51% (n = 151) were aged 20–29 years, 83% (n = 246) were non-Saudi nationals, 49% (n = 145) were married, and 82% (n = 245) had a bachelor’s degree. The most common causes of occupational stress were work overload, personnel shortages, and inadequate pay. The qualitative phase data revealed five primary themes, including increased workload, rising living costs despite equal compensation, and staff shortages as main stressors. In addition, the study found that praying and spending quality time with friends are the primary coping techniques among nurses. The study results contribute to a better understanding of nurses’ working conditions in the emergency department. Additionally, they may contribute to the development of policies and practice reforms to improve Saudi nurses’ well-being, health, and overall work experience.

Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature

Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.

The relationship between occupational stress, mental health and work ability of coal chemical workers in Xinjiang

OBJECTIVE

To understand the current working ability of coal chemical workers in Xinjiang, and analyze the impact of occupational stress, mental disorders, and their interaction on work ability. To provide a scientific basis for improving the working ability and quality of life of coal chemical workers.

METHODS

In this study, a stratified random sampling method was used to conduct a questionnaire survey of 1,400 workers in six coal mining enterprises from June to December 2019. The Effort-Reward Imbalance Questionnaire (ERI), the Symptoms Checklist 90 (SCL-90), and the Work Ability Index Scale (WAI) were used to evaluate the level of occupational stress, mental disorders, and the ability to work as coal chemical workers.

RESULTS

The results showed that WAI scores had statistically significant differences between gender, age, length of service, shift, education, marital status, and monthly income (P < 0.05). The ability to work and its dimensions were inversely correlated with occupational stress, and mental disorders (P < 0.001). Occupational stress and mental disorders are risk factors affecting the ability to work. Workers with high occupational stress^* mental disorders (OR = 10.666, 95% CI: 6.443-17.658) are 10.666 times more likely to be at risk for developing poor work ability than low occupational stress^* no mental disorders. Structural equation models show that occupational stress and mental health conditions had a direct impact on work ability, and mental health conditions were the mediators of the relationship between occupational stress and work ability.

CONCLUSION

Occupational stress, mental disorders, and their interaction are risk factors affecting the ability of coal chemical workers to work. Occupational stress can indirectly affect the ability to work through mental health conditions.

[Intensive care nurse in 2021, from expertise to recognition]

The profession of intensive care nurse has been in constant evolution since the 1960s. The technical nature of medical equipment and the care of increasingly complex patients require a high level of qualification. The current health crisis has highlighted the difficulties of this profession and the lack of recognition of these carers. They are demanding a specialisation with a diploma course aimed at improving the quality of patient care.

Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments - a cross-sectional study

Background

Rationing of nursing care is a relatively new concept. It refers to an error of omission and has a direct influence on the quality of nursing care and treatment outcomes. Nurses who experience chronic fatigue often fail to perform their duties properly, which may lead, for instance, to medical errors attributed to impaired judgment. Therefore, it is necessary to identify factors which give rise to fatigue, leading to rationing of nursing care, and develop strategies to eliminate them. The primary objective of the study was to assess the impact of fatigue on nursing care rationing in paediatric haematology and oncology departments. The secondary objective of this study was to identify the factors, which may influence the nursing care rationing.

Methods

The study was conducted among 95 nurses (aged between 23 and 58 years) workinginthe Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation of the University Teaching Hospital in Wroclaw. Participation in the study was voluntary and anonymous. Our own sociodemographic questionnaire, the Basel Extent of Rationing of Nursing Carequestionnaire and the modified fatigue impact scale (MFIS) were used in the study.

Results

The level of fatigue among the nurses participating in the study, as measured by the MFIS, was high, namely 28.97 ± 16.78. It was found that the fatigue of the nurses influenced most often the psycho-social dimension of QoL (1.78 ± 1.05), and least often - cognitive (1.24 ± 0.78). A correlation analysis showed that all aspects of fatigue had a statistically significant positive impact on care rationing (p < 0.05), i.e. the greater the fatigue, the higher the level of care rationing. A regression analysis showed that a 12-h shift pattern was an independent predictor of the level of care rationing (r = 0.771, p < 0.05).

Conclusions

Nurses working in paediatric haematology departments report a high level of fatigue. Work pattern is an independent determinant of nursing carerationing. A high level of nursing care rationing was found for nurses working 12-h shifts.

Trial registration

The study was approved by the Bioethics Committee of the Wroclaw Medical University, Poland (February 8th 2019, No. 205/2019).

Acute and chronic fatigue in nurses providing direct patient care and in non-direct care roles: A cross-sectional analysis

Nurses are at risk for work-related fatigue, which can impact their health, well-being, and job readiness. The purpose of this study was to examine the levels, types, and factors associated with fatigue in registered nurses (RNs) in direct patient care (DCRNs) and in non-direct patient care (non-DCRNs) roles. A cross-sectional survey was administered to 313 RNs. Measures included: Multidimensional Fatigue Symptom Inventory, Occupational Fatigue Exhaustion Recovery, Brief COPE, PROMIS® Global Sleep Disturbance, and Job Content Questionnaire. Acute fatigue levels in RNs were similar to those in diseased populations, and nearly 50% reported moderate/high levels of chronic fatigue. DCRNs reported higher levels of acute and chronic fatigue than non-DCRNs, but the differences were small and disappeared when accounting for other factors associated with fatigue including sleep disturbance, job strain, workplace support, maladaptive coping, and especially intershift recovery, which accounted for 20%-41% of fatigue variability. This study suggests that it may not be only nurses providing direct patient care who are at risk for acute and chronic fatigue. Intershift recovery may be particularly important in alleviating acute and chronic fatigue in nurses.

Predictors of stress and associated factors among healthcare workers in Western Ghana

Healthcare professionals are the most vulnerable to stress among all occupational groups due to the nature of their work environment. The aim of this study is to determine the level of stress and associated factors among healthcare workers in Western Ghana. The study employed a cross-sectional design with self-administered questionnaires. The results show that 69.5% of the respondents were stressed. Prevalence of stress was higher among female respondents than males. We found that 40.4 % of respondents intend to change work as a result of stress faced at their work places. Respondents aged 56≥ were more (3.16) likely to be stressed than those in the other age groups. We found a significant association between age, marital status, workload and educational background and stress levels among the respondents. The management of these healthcare institutions and their stakeholders must adopt strategies to help health workers cope with the stress they encounter.

Determinants of healthcare worker turnover in intensive care units: A micro-macro multilevel analysis

BACKGROUND

High turnover among healthcare workers is an increasingly common phenomenon in hospitals worldwide, especially in intensive care units (ICUs). In addition to the serious financial consequences, this is a major concern for patient care (disrupted continuity of care, decreased quality and safety of care, increased rates of medication errors, …).

OBJECTIVE

The goal of this article was to understand how the ICU-level nurse turnover rate may be explained from multiple covariates at individual and ICU-level, using data from 526 French registered and auxiliary nurses (RANs).

METHODS

A cross-sectional study was conducted in ICUs of Paris-area hospitals in 2013. First, we developed a small extension of a multi-level modeling method proposed in 2007 by Croon and van Veldhoven and validated its properties using a comprehensive simulation study. Second, we applied this approach to explain RAN turnover in French ICUs.

RESULTS

Based on the simulation study, the approach we proposed allows to estimate the regression coefficients with a relative bias below 7% for group-level factors and below 12% for individual-level factors. In our data, the mean observed RAN turnover rate was 0.19 per year (SD = 0.09). Based on our results, social support from colleagues and supervisors as well as long durations of experience in the profession were negatively associated with turnover. Conversely, number of children and impossibility to skip a break due to workload were significantly associated with higher rates of turnover. At ICU-level, number of beds, presence of intermediate care beds (continuous care unit) in the ICU and staff-to-patient ratio emerged as significant predictors.

CONCLUSIONS

The findings of this research may help decision makers within hospitals by highlighting major determinants of turnover among RANs. In addition, the new approach proposed here could prove useful to researchers faced with similar micro-macro data.

Shift Work and Occupational Stress in Hospital Nurses in Sofia

Prevalence of shift work and occupational stress is one of the highest in nursing compared to other sectors. For years Bulgaria is facing nurses’ shortage, which contributes to their long working hours. The aim of the study was to follow the working time arrangements, stressors and health symptoms in hospital nurses in Sofia.

Methods: The study is cross-sectional and comprised 1292 female nurses of average age 50.0 ± 10.2 years from 19 hospitals in Sofia. The anonymous questionnaire was filled, including demographic information, working hours and shift system, with special attention to night work and long working hours, stress and health symptoms. Statistical analysis was carried using SPSS.

Results: The shift work, night work, including 5 and more night shifts per month and the extended shifts were common among the studied nurses with the greatest deal of the emergency and intensive care unit nurses, followed by department nurses. The high rates of overtime and second job contributed to long working hours of 51-60 hours per week in 16.9 % of the nurses and > 61 hours in 11.1 %. About 90 % of the nurses felt under strain and experienced emotional dissonance while working with patients. Work-related stress, night work and long working hours were related to self-rated emotional and physical exhaustion and poor health.

Discussion: The work-related stress, night work and the long working hours raise health concerns for occupational health of hospital nurses. Urgent preventive measures are needed to control stress and reduce working hours and night work.

The physical and mental health of the medical staff in Wuhan Huoshenshan Hospital during COVID-19 epidemic: A Structural Equation Modeling approach

Introduction

Early in the epidemic of coronavirus disease 2019, the Chinese government recruited a proportion of healthcare workers to support the designated hospital (Huoshenshan Hospital) in Wuhan, China. The majority of front-line medical staff suffered from adverse effects, but their real health status during COVID-19 epidemic was still unknown. The aim of the study was to explore the latent relationship of the physical and mental health of front-line medical staff during this special period.

Methods

A total of 115 military medical staff were recruited between February 17th and February 29th, 2020 and asked to complete questionnaires assessing socio-demographic and clinical characteristics, self-reported sleep status, fatigue, resilience and anxiety.

Results

55 medical staff worked within Intensive Care and 60 worked in Non-intensive Care, the two groups were significantly different in reported general fatigue, physical fatigue and tenacity (P<0.05). Gender, duration working in Wuhan, current perceived stress level and health status were associated with significant differences in fatigue scores (P<0.05), the current perceived health status (P<0.05) and impacted on the resilience and anxiety of participants. The structural equation modeling analysis revealed resilience was negatively associated with fatigue (β=-0.52, P<0.01) and anxiety (β=-0.24, P<0.01), and fatigue had a direct association with the physical burden (β=0.65, P<0.01); Fatigue mediated the relationship between resilience and anxiety (β=-0.305, P=0.039) as well as resilience and physical burden (β=-0.276, P=0.02).

Conclusion

During an explosive pandemic situation, motivating the effect of protective resilience and taking tailored interventions against fatigue are promising ways to protect the physical and mental health of the front-line medical staff.

Factors associated with workplace fatigue among midwives in southern China: A multi-centre cross-sectional study

AIMS

To identify the level of workplace fatigue among midwives and factors influencing their fatigue.

BACKGROUND

Midwives who play an important role in medical care are prone to experience workplace fatigue, which negatively affects their well-being and work quality.

METHODS

A multi-centre cross-sectional study was conducted among 666 Chinese midwives from 38 hospitals in March 2019. Data were collected by four questionnaires of self-designed demographic questions, the Pittsburgh Sleep Quality Index, the Social Support Self-Rating Scale and the 14-item Fatigue Scale. Descriptive statistics, univariate analysis and multiple linear regression were used to analyse the data.

RESULTS

Midwives had moderate levels of fatigue with the mean scores of physical fatigue, mental fatigue and total fatigue being 9.53, 6.25 and 15.79, respectively. Multiple linear regression results showed that sleep quality, social support, job satisfaction, occupational injuries, adverse life events, frequency of irregular meals and employment type were statistically significant factors influencing fatigue among the participants.

CONCLUSIONS

Physical and mental fatigue were generally common among midwives and were affected by personal-related and work-related factors, sleep quality and social support.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators have the opportunity to advocate for improved health policy under the two children rule to prevent workplace fatigue amongst midwives.

Investigation of the Status of Nurses Returning to Work After Recovering From COVID-19 and Influencing Factors

BACKGROUND

More than 3000 medical personnel in China had been infected with coronavirus disease-2019 (COVID-19). We report on 75 previously infected nurses who returned to work.

PURPOSE

The aim was to understand the adaptation status of nurses after recovering from COVID-19 and returning to work.

METHODS

Data were collected online via the Work Adaptation Scale and the Psychological Capital Scale, and the related influencing factors were analyzed.

RESULTS

The social integration and task mastery scores were highest, and the clear roles and cultural adaptation scores were low. The self-efficacy and hope scores were highest, but the resilience and optimism scores were not high. Psychological capital was positively correlated with work adaptation (P < .01).

CONCLUSIONS

To ensure the quality and safety of nursing care, nurse managers should adopt effective intervention measures to address the physical and mental health of returning nurses and improve their levels of psychological capital and adaptability.

Intensive care nurse staffing and nurse outcomes: A systematic review

BACKGROUND

Intensive care units (ICU) are associated with significant work stress and exert continuous physical and emotional demand upon health care providers. The health and well-being of care providers, including ICU nurses, is a matter of great concern. However, to the researcher's knowledge, there have been no reviews synthesizing the evidence about the relationship between nurse staffing and nurse outcomes in the ICU.

PURPOSE

The purpose of this systematic review was to examine nurse staffing in the ICU and synthesize literature to examine the relationship with nurse outcomes such as job satisfaction, burnout, fatigue, and intent to leave.

METHODS

This review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles published between January 2000 and September 2019 were identified via eight electronic bibliographic databases. Articles were included and reviewed if they were correlational studies examining the relationships between nurse staffing and nurse outcomes in the ICU, and were published in peer-reviewed journals written in either English or Korean. The Quality Assessment and Validity Tool for Correlation Studies was used for quality appraisal.

RESULTS

From 5086 articles, eight published between 2006 and 2019 were included in this review. Three studies found expected relationships between worse nurse staffing and adverse nurse outcomes (high burnout, fatigue state, emotional exhaustion, depersonalization, and stress). However, the relationships between nurse staffing and other adverse nurse outcomes were not significant. Perceived adequate staffing was negatively related to adverse nurse outcomes. However, a non-significant relationship also was found.

CONCLUSION

This study found limited evidence on relationships between nurse staffing and nurse outcomes in the ICU. More studies are needed to conduct to find a conclusive relationship.

RELEVANCE TO CLINICAL PRACTICE

Given high demands and workload in the ICU, nurse staffing levels should be closely monitored to prevent adverse nurse outcomes.

The Mediating Role of Fatigue Between Mental Health and Its Associated Factors: Evidence From Chinese Healthcare Workers During the COVID-19 Pandemic

The aim of this study was to explore the mediating role of fatigue between mental health and its associated factors, including workload, social support, and occupational protection, among healthcare workers during the COVID-19 pandemic in China. A national cross-sectional survey was performed to collect data from healthcare workers who have attended to patients with COVID-19. Structural equation modeling (SEM) was conducted to test the mediating effect of fatigue. The results indicated that fatigue was a significant mediator of mental health. The proportion of indirect effect with regards to the total effect of workload on mental health was 54.2%, significantly greater than other factors such as social support (19.7%) and occupational protection (23.4%). The findings confirmed that workload, social support, and occupational protection both had indirect and direct effects on mental health status through fatigue. To some extent, potential interventions designed to alleviate fatigue would reduce mental health problems among healthcare workers during the COVID-19 pandemic.

Serial Multiple Mediation of Professional Identity, and Psychological Capital in the Relationship Between Work-Related Stress and Work-Related Well-Being of ICU Nurses in China: A Cross-Sectional Questionnaire Survey

This study aimed to investigate the serial-multiple mediation effect of professional identity, psychological capital (PsyCap), work-related stress, and work-related wellbeing among intensive care unit (ICU) nurses in China. The cross-sectional survey was conducted from January 2017 to May 2017 in two Grade III A general hospitals (with more than 2000 beds) in Jining, Shandong Province, China. Cluster sampling was used to recruit participants from the two hospitals. A total of 330 ICU nurses participated in the study. The nurses’ work stress scale, Chinese nurse’s professional identity scale, the PsyCap questionnaire, and Chinese work-related wellbeing scale were used to collect the data. Descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analysis, linear regression analysis, and structural equation modeling were used to analyze the data (P < 0.05 was considered statistically significant). The average score for the work-related wellbeing of ICU nurses was 85.91 ± 13.94. Work-related stress, professional identity, and PsyCap correlated significantly with work-related wellbeing. The major predictors of work-related wellbeing were PsyCap, work-related stress, professional identity, and monthly salary. The serial-multiple mediation effects of professional identity and PsyCap in the relationship between work-related stress and work-related wellbeing were statistically significant. Positive professional identity and PsyCap were sequentially associated with decreased work-related stress, which in turn was related to increased work-related wellbeing among ICU nurses. Therefore, this study aims to explore the impact of ICU nurses’ work-related stress on work-related wellbeing, as well as the mediating effect of professional identity and PsyCap. It is hoped that hospital care managers will pay attention to the mental health of ICU nurses, increase their professional identity, and reduce work-related stress to improve the quality of the ICU nursing service and stabilize nursing work.

Cognitive Behavioral Therapy for Occupational Stress among the Intensive Care Unit Nurses

Background and Aims:

Nurses working in the intensive care units (ICU) are faced with numerous stressors that can pose a serious threat to their self-efficacy and affect the quality of care. The aim of this study was to evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) on the ICU nurses’ occupational stress.

Methods:

This interventional study was conducted in a hospital in southeast of Iran. The participants included 120 nurses, who were randomly assigned into the control (n = 60) and intervention (n = 60) groups. In the pre-test, the occupational stress was assessed using Osipow questionnaire. Later, the intervention group attended the CBT course conducted in six 90 minute sessions. One month after the intervention, the post-test data were collected from both groups.

Results:

The means of occupational stress and its dimensions were not significant before the intervention between the intervention and control groups (P = 0.47). The means of occupational stress and its dimensions were moderately high at pretest for all nurses. In the post-test, the stress level and all its dimensions reduced from moderate-high to moderate-low (P < 0.001), except for the physical environment dimension that remained at the moderate-high level (P = 0.32).

Conclusion:

The findings showed that CBT was effective on the nursing stress. Therefore, CBT training is suggested in in-service training programs for nurses.

Prevalence and Influencing Factors on Fatigue of First-line Nurses Combating with COVID-19 in China: A Descriptive Cross-Sectional Study

Nurses’ work-related fatigue has been recognized as a threat to nurse health and patient safety. The aim of this study was to assess the prevalence of fatigue among first-line nurses combating with COVID-19 in Wuhan, China, and to analyze its influencing factors on fatigue. A multi-center, descriptive, cross-sectional design with a convenience sample was used. The statistical population consisted of the first-line nurses in 7 tertiary general hospitals from March 3, 2020 to March 10, 2020 in Wuhan of China. A total of 2667 samples from 2768 contacted participants completed the investgation, with a response rate of 96.35%. Social-demographic questionnaire, work-related questionnaire, Fatigue Scale-14, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Chinese Perceived Stress Scale were used to conduct online survey. The descriptive statistic of nurses’ social-demographic characteristics was conducted, and the related variables of work, anxiety, depression, perceived stress and fatigue were analyzed by t-tests, nonparametric test and Pearson’s correlation analysis. The significant factors which resulted in nurses’ fatigue were further analyzed by multiple linear regression analysis. The median score for the first-line nurses’ fatigue in Wuhan was 4 (2, 8). The median score of physical and mental fatigue of them was 3 (1, 6) and 1 (0, 3) respectively. According to the scoring criteria, 35.06% nurses (n=935) of all participants were in the fatigue status, their median score of fatigue was 10 (8, 11), and the median score of physical and mental fatigue of them was 7 (5, 8) and 3 (2, 4) respectively. Multiple linear regression analysis revealed the participants in the risk groups of anxiety, depression and perceived stress had higher scores on physical and mental fatigue and the statistically significant positive correlation was observed between the variables and nurses’ fatigue, the frequency of exercise and nurses’ fatigue had a statistically significant negative correlation, and average daily working hours had a significantly positive correlation with nurses’ fatigue, and the frequency of weekly night shift had a low positive correlation with nurses’ fatigue (P<0.01). There was a moderate level of fatigue among the first-line nurses fighting against COVID-19 pandemic in Wuhan, China. Government and health authorities need to formulate and take effective intervention strategies according to the relevant risk factors, and undertake preventive measures aimed at reducing health hazards due to increased work-related fatigue among first-line nurses, and to enhance their health status and provide a safe occupational environment worldwide. Promoting both medical and nursing safety while combating with the pandemic currently is warranted.

Trait Forgiveness Moderated the Relationship Between Work Stress and Psychological Distress Among Final-Year Nursing Students: A Pilot Study

This study was to explore the potential moderating effect of trait forgiveness and its facets on the relationship between perceived work stress and psychological distress among Chinese nursing students in clinical practice. A total of 182 Chinese nursing students who had been receiving final-year clinical training completed self-report measures of nursing work stress, trait forgiveness and psychological distress. Correlation analysis and hierarchical multiple regressions were mainly applied for data analysis. Results showed that trait forgiveness was negatively associated with psychological distress, even after controlling for the effects of perceived work stress and demographic/workplace related variables. Further analyses indicated that the ability to forgiveness of situations was particularly crucial in reducing the negative effects of perceived work stress on psychological well-being, especially when students perceived higher level of stress. These results demonstrated that alternative interventions targeting on trait forgiveness, especially those programs which can improve one’s ability to acceptance uncontrollable bad circumstances, may be beneficial for the well-being of nursing students in clinical practice.

The Mediating Role of Psychological Capital in the Relationship Between Occupational Stress and Fatigue: A Cross-Sectional Study Among 1,104 Chinese Physicians

Purpose: This study aimed to explore the association of occupational stress with fatigue and to examine the mediating role of psychological capital (PsyCap) among Chinese physicians. Materials and Methods: A cross-sectional study was conducted in Liaoning province, China, in 2018. Using a multistage stratified sampling method, a total of 1,500 physicians participated and 1,104 (73.6%) physicians responded effectively. The study used a self-administered questionnaire consisting of the 14-item Fatigue Scale (FS-14), the Effort-reward Imbalance questionnaire (ERI), the Psychological Capital Questionnaire (PCQ) and items about demographic and working characteristics. Hierarchical multiple regression analyses were performed to explore the association of occupational stress, PsyCap, and fatigue among physicians. Asymptotic and resampling strategies were used to examine the mediating effect. Results: The incidence of fatigue among Chinese physicians was 83.70%. The average level of fatigue was 7.96 ± 3.95 (mean ± SD). Occupational stress and PsyCap were significantly associated with fatigue. PsyCap significantly mediated the association of ERR (a × b = 0.106, bias-corrected and accelerated 95% confidence interval [BCa 95% CI]: 0.078, 0.138) and overcommitment (a × b = 0.068, BCa 95% CI: 0.044, 0.092) with fatigue. Two important components of PsyCap, self-efficacy and resilience, play more important roles in the mediating effect. Conclusions: The level of fatigue among Chinese physicians was high, which should be taken seriously by management. PsyCap could mediate the association between occupational stress and fatigue. The intervention strategies and measures to relieve fatigue could be focused on physicians' positive PsyCap improvement.

Occupational fatigue and work absenteeism in female assistant nurses of a high-complexity hospital, Chile

This research examined the association between occupational fatigue and work absenteeism in 110 female assistant nurses of a high-complexity hospital in Chile. A sociodemographic questionnaire and the Checklist Individual Strength (CIS) scale were used. The results showed that the predominant absenteeism range was 11-29 days. The highest means of fatigue occurred in those with seniority above 2 years, with more than 10 patients in charge and an annual contract. No significant difference was observed between the fatigue means concerning absenteeism, but a significant association was observed between physical fatigue (p = 0.040, OR = 1.054) and service seniority (p = 0.001, OR = 1.084) with work absenteeism. Finally, we can conclude that physical fatigue and seniority in the clinical service are significant risk factors for the occurrence of absenteeism.

Factors correlating with prolonged fatigue among emergency department nurses

BACKGROUND

Fatigue affects nurses negatively and leads to physical, cognitive and emotional problems that may influence nurses' quality of life. However, there is a lack of studies about prolonged fatigue and its relationship with socio-demographic characteristics and job-related psychosocial factors among nurses, especially emergency nurses, worldwide and in Jordan.

AIMS

This study aims to assess the relationship between demographic factors, physical health, psychological distress and job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among emergency department nurses in Jordan.

METHODS

A descriptive correlational study using a convenience sample was used to recruit 153 emergency nurses. Physical health Questionnaire, General Health Questionnaire, Job Content Questionnaire and Checklist Individual Strength were used.

RESULTS

The majority of emergency nurses experienced abnormally prolonged fatigue, moderate health, high psychological distress, high job demands and low job control and social support. Significant negative relationships were addressed between job control, social support and prolonged fatigue, whereas income had a negative weak relationship. Psychological distress and job demands had a positive weak relationship with prolonged fatigue. There was a significant positive weak relationship between psychological distress, job demands and prolonged fatigue. Job-related psychosocial factors (with exception of social support) and mental health were the predictors of prolonged fatigue.

CONCLUSIONS

Prolonged fatigue is a multidimensional phenomenon that can be affected by several factors such as job-related psychosocial factors and psychological health. These factors should be taken into consideration when testing and developing interventions to minimise prolonged fatigue among emergency nurses.

Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout

OBJECTIVE

To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors.

BACKGROUND

There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied.

METHODS

Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory.

RESULTS

Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02).

CONCLUSIONS

Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

AIM

To assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors.

BACKGROUND

Literature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels.

METHODS

A cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses.

RESULTS

57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (ρ = 0.03, r² = -0.28), number of family dependents (ρ = 0.03, r² = -0.27), and years of nursing experience (ρ = 0.03, r² = -0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (ρ = 0.01, r² = -0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (ρ < 0.01), age group (ρ = 0.03), shift schedule (ρ = 0.02), and nursing experience (ρ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals.

CONCLUSIONS

More than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.

Psychosocial correlates of work-related fatigue among Jordanian emergency department nurses

PURPOSE

This study purposed to assess the psychosocial correlates of work-related fatigue among Jordanian emergency department nurses.

DESIGN AND METHODS

A cross-sectional study was conducted among Jordanian emergency nurses (n = 220). Measures included Occupational Fatigue Exhaustion/Recovery Scale (OFER15) and Copenhagen Psychosocial Questionnaire version Two (COPSOQ II).

FINDINGS

The psychosocial factors correlated with all types of work-related fatigue (acute, chronic, and inter-shift [recovery]) were quantitative demands, work-family conflict, sexual harassment, threats of violence, physical violence, and bullying. Importantly, quantitative demands and sexual harassment were the main predictors of all types of work-related fatigue.

PRACTICE IMPLICATIONS

The psychosocial correlated factors should be considered when developing interventions to minimize work-related fatigue phenomenon. This would lead to a more positive working environment which will promote safe nursing care.

Negative Mental States and Their Association to the Cognitive Function of Nurses

Abstract. Nurses’ inherently stressful occupation leaves them at a higher risk of developing negative mental states (stress, anxiety, and depression). However, research examining the effect of negative mental states on these health professionals’ cognitive performance is sparse. Thus, the present study aimed to assess the link between negative mental states and cognitive performance in nurses ( n = 53). Negative mental state data was obtained using the Depression Anxiety Stress Scale, brain activity was measured using electroencephalography, and finally, cognitive performance was assessed using the Cognistat and the Mini-Mental State Examination. Significant negative correlations ( p < .05) were observed between anxiety and attention, and all three negative mental states and memory performance. Electroencephalographic changes indicated that increases in anxiety were significantly associated ( p < .05) with decreases in gamma reactivity at fronto-central sites. The current study suggests that higher levels of negative mental states are associated with domain-specific cognitive impairments, and variations in gamma reactivity; possibly reflecting less optimal cortical functioning.

Presenteeism in multiprofessional team workers in the Adult Intensive Care Unit

OBJECTIVE

To analyze the occurrence of presenteeism in multiprofessional team workers of an Adult Intensive Care Unit, relating it to sociodemographic and labor characteristics.

METHOD

It is an analytical cross-sectional qualitative study, which used a questionnaire for sociodemographic data collection, and Stanford Presenteeism Scale(SPS-6) to assess presenteeism.

RESULTS

There was predominance of women (75.9%), nursing workers (66.7%), mean age of 39.81 years, and 6 to 10 years (31.6%) of experience in the labor market. Regarding presenteeism, 48.7% presented work impairment and 31.8% presentedperformance and completion of tasks altered by this phenomenon.

CONCLUSION

Expressive numbers of general presenteeism were identified, with results indicating impairment in completing work. When connecting presenteeism to sociodemographic and labor characteristics, the variables sex, dependent children and absence from work presented values with statistical significance among the studied workers.

Effects of Co-worker and Supervisor Support on Nurses’ Energy and Motivation through Role Ambiguity and Psychological Flexibility

One of the job resources most strongly associated with nurses’ well-being and motivation is social support. However, the psychosocial mechanisms that would explain this relationship have not been sufficiently researched. Thus, the main aim of this study was analyze whether this relationship could be mediated by two variables: role ambiguity and psychological flexibility. A total of 196 nurses from various Spanish hospitals and primary health care centers participated in this cross-sectional study. A multiple mediation analysis was run using the “PROCESS” macro script in SPSS 23.0. The results showed that co-worker support was related to higher levels of vigor and vitality through role ambiguity (Estimate = .158, 95% CI [.050, .298], and Estimate = .212, 95% CI [.076, .390], respectively). The same applied to supervisor support, (Estimate = .197, 95% CI [.059, .378], and Estimate = .212, 95% CI [.076, .390], respectively). Co-worker support was also related to higher levels of vigor and vitality through psychological flexibility, (Estimate = .132, 95% CI [.048, .271], and Estimate = .216, 95% CI [.086, .394], respectively). The same applied to supervisor support (Estimate = .092, 95% CI [.024, .208], and Estimate = .157, 95% CI [.035, .333], respectively). However, in the relationships between co-worker, supervisor support and exhaustion, only psychological flexibility played a mediating role. In conclusion, social support in nursing is a job resource that is associated with high levels of energy and motivation among nurses through the mediating role of certain job demands and personal resources.

Stress coping styles among anaesthesiology and intensive care unit personnel - links to the work environment and personal characteristics: a multicentre survey study

BACKGROUND

High levels of stress among anaesthesiology and intensive care unit workers are commonly reported. Personnel in these units are prone to stress because of specific characteristics of their work. Their development of skills to cope with stress may affect their psychophysical condition and, consequently, patient safety.

OBJECTIVES

The aim of this study was to define the coping styles of anaesthesiology and intensive care unit personnel and to evaluate the connections between the work environment as well as personal characteristics and the dominant coping styles.

METHODS

Anaesthesiology and intensive care unit personnel from 15 selected Polish hospitals were surveyed using the Coping Inventory for Stressful Situations, which examines task-oriented coping, emotion-oriented coping and avoidance-oriented coping. The Perceived Stress Scale was used to assess stress levels.

RESULTS

The analysis included 425 successfully completed surveys. The examined population was divided into two groups: Group N comprised 311 nurses (73.18%) and group P comprised 114 physicians (26.82%). For 167 participants (39.29%), the dominant coping style was defined. The most common style was the task-oriented coping style; it was dominant in 96 participants (22.58% of the entire examined population). This style was significantly predominant among men. The domination of some coping styles coexisted with marital status, number of children and financial situation. The occurrence of different coping styles did not significantly differ among workers at different-sized hospitals, with different job seniority or with different living locations. Perceived stress was correlated with all coping styles.

CONCLUSIONS

Work-related stress among anaesthesiology and intensive care unit workers is an important problem. Further investigations of stress levels and the causes and effects of stress in this population are necessary.

Perceived stress and coping strategies among ICU nurses in government tertiary hospitals in Saudi Arabia: a cross-sectional study

BACKGROUND

No study has examined the stress level and coping strategies among critical care nurses in Saudi Arabia.

OBJECTIVES

Examine perceived stress and coping behaviors among nurses in intensive care units in Saudi Arabia, and the influence of cop.ing mechanisms on stress.

DESIGN

Descriptive cross-sectional.

SETTING

Two tertiary training hospitals in Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

Nurses from cardiac, surgery and pediatric intensive care units responded to an online survey. Perceived Stress Scale-10 (PSS-10) and the Brief COPE Inventory were used as primary research tools. Multivariate methods were used to analyze the data.

MAIN OUTCOME MEASURES

Stress levels, coping strategies, and associated factors.

SAMPLE SIZE

154 nurses.

RESULTS

The majority of the respondents reported a moderate level of stress in the past month (87.0%). Mean (SD) scores for nurses working in the cardiac ICU indicated significantly higher levels of stress compared to surgical ICU (18.18 [3.88] vs 6.17 [3.21], P=.025). Belief in religion was the most common coping behavior while the use of substances was the lowest (mean scores [SD] 6.70 [ 1.72] vs 2.22 [0.81]). In the multivariate analysis, behavioral disengagement (P=.016) and self-blame (P less than .001) intensified the PSS-10 score, whereas acceptance (P=.048) reduced the PSS-10 score.

CONCLUSION

The additional knowledge that behavioral disengagement and blaming aggravate stress can serve as the basis in formulating work-related stress reduction strategies among nurses caring for critical patients.

LIMITATIONS

The use of self-reports, convenience sampling, and selected demographic factors may have limited the scope and generalizability of the findings and induced social desirability bias.

CONFLICT OF INTEREST

None.

Moral distress is associated with general workplace distress in intensive care unit personnel

PURPOSE

To assess the association between moral distress and general workplace distress in intensive care unit (ICU) personnel.

MATERIALS AND METHODS

We administered the Moral Distress Scale Revised and the Job Content Questionnaire to all clinicians (870 nurses, 68 physicians, 452 other health professionals) in 13 ICUs (3 tertiary, 3 large community, 7 small community) in British Columbia, Canada. We used mixed effects regression, treating ICUs as clusters, to examine the association between the Moral Distress Score and each Job Content Questionnaire scale (decision latitude, psychological stressors, social support, psychological strain) after adjusting for age, sex, and years of experience of respondents; separate analyses were done for each profession.

RESULTS

Overall response rate was 45%. Nurses and other health professionals had higher moral distress scores than physicians, but there were no differences in general workplace distress scores among professional groups. After adjustment for demographic characteristics, higher moral distress in nurses was associated with lower decision latitude and social support, and with higher psychological stressors and psychological strain. For physicians and other professionals, these relationships were similar.

CONCLUSIONS

Moral distress is associated with general workplace distress in ICU personnel. Interventions that ameliorate either type of distress may also ameliorate the other.

Sociodemographic and organizational factors associated with musculoskeletal symptoms among intensive care unit professionals

BACKGROUND

The heavy and complex work routine in the intensive care unit (ICU) involves high workload, long working hours, high levels of tension, exposure to extreme situations and to hazards of different nature.

OBJECTIVE

To investigate the influence of sociodemographic and organizational factors on the development of musculoskeletal pain, tension and fatigue among ICU professionals.

METHODS

We interviewed 128 professionals from seven public hospitals in João Pessoa, Paraiba, Brazil.The data were analyzed using a logistic regression model, and differences between professional categories by means of the likelihood ratio, the Wald and χ2 tests, with significance level set to <0.05.

RESULTS

The risk to develop musculoskeletal symptoms differed as a function of the participants' professional category.The odds of nursing technicians to simultaneously develop musculoskeletal pain, fatigue and tension were 4.968 times higher (p=0.023) compared to physicians, nurses and physical therapists.This difference was mediated by factors such as sex, body mass index and number of ICU jobs.Nursing technicians were the most exposed group, and thus they require more attention as concerns workplace health interventions.

CONCLUSIONS

The participants had long working hours, and differed in regard to the most frequent musculoskeletal complaints as a function of the specificities inherent to the activities of each professional category.

Fatigue in Intensive Care Nurses and Related Factors

BACKGROUND

Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems.

OBJECTIVE

To determine the level of fatigue among nurses working in intensive care units and the related factors.

METHODS

This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index.

RESULTS

The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (p<0.001).

CONCLUSION

Anxiety, depression and quality of sleep were significantly affected by the intensive care nurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.

Effort-Reward Imbalance and Burnout Among ICU Nursing Staff: A Cross-Sectional Study

BACKGROUND

Occupational stress is commonly observed among staff in intensive care units (ICUs). Sociodemographic, organizational, and job-related factors may lead to burnout among ICU health workers. In addition, these factors could modify the balance between efforts done and rewards perceived by workers; consequently, this imbalance could increase levels of emotional exhaustion and depersonalization and decrease a sense of personal accomplishment.

OBJECTIVE

The purpose of this study was to analyze the relationship between effort-reward imbalance and burnout dimensions (emotional exhaustion, depersonalization, and personal accomplishment) among ICU nursing staff in a university hospital in Santiago, Chile.

METHODS

A convenience sample of 36 registered nurses and 46 nurse aides answered the Maslach Burnout Inventory and Effort-Reward Imbalance Questionnaire and provided sociodemographic and work-related data.

RESULTS

Age and effort-reward imbalance were significantly associated with emotional exhaustion in both registered nurses and nurse aides; age was negatively correlated with emotional exhaustion, whereas effort-reward imbalance was positively correlated. Age was negatively associated with depersonalization. None of the predictors were associated with personal accomplishment.

DISCUSSION

This study adds valuable information about relationships of sociodemographic factors and effort-reward imbalance and their impact on dimensions of burnout, particularly on emotional exhaustion.

Occupational risk between nursing workes in Intensive Therapy Unit

Background

The global records of occupational accidents and diseases are alarming, having serious consequences for victims and their families. Among hospital settings, the Intensive Care Unit (ICU) is considered to be the most tense, traumatic and aggressive, due to its heavy work routine and the constant risks to which the staff is exposed. Nurses are some among the professionals who are constantly exposed to various risk factors.

Objective

To analyze the occupational hazards to which ICU nursing professionals are exposed in the national and international literature. Methods: Integrative literature review conducted in databases LILACS, CINAHL, MEDLINE and SciELO from July to August 2015.

Results

Most studies were published in Brazilian journals (66.6%), however, little difference was found by comparison to international studies with the same perspective.

Discussion

The ICU setting exhibits a wide variety of risks, which are considerably minimized when nursing professionals make correct use of personal protective equipment.

Conclusion

Hospitals should develop effective educational strategies for professionals to make correct use of the equipment. In addition, workers should have accurate knowledge of the risks to which they are exposed and how they might affect their health and quality of life.