Breakaway technique training as a means of increasing confidence in managing aggression in neuroscience nursing

Factors associated with the general well-being of nurses in a tertiary Chinese hospital: A cross-sectional study

BACKGROUND

Good general well-being of nurses is associated with reduced burnout and improved patient safety. However, few studies explored the factors of nurses' general well-being.

AIM

The study aimed to assess general well-being and its predictors among hospital nurses.

METHODS

The study recruited 573 nurses working in a tertiary Chinese hospital to complete a survey of sociodemographic characteristics, DiSC^® personality profile, Self-Rating Anxiety Scale and general well-being. Multivariate linear regression was conducted to assess factors affecting nurses' general well-being.

RESULTS

Marital status and clinical rank had a positive impact on general well-being, especially when nurses were married or in the stage of assistant nursing manager. Conversely, source of stress, DiSC^® profile and SAS score had a negative effect on general well-being, especially when nurses' stress came from colleagues, nurses were characterized by steadiness and conscientiousness, and nurses had extreme anxiety.

CONCLUSION

Marital status, clinical rank, source of stress, DiSC^® profile and SAS score were main factors affecting hospital nurses' general well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

By giving careful attention to nurses' family life, career development, personality characteristics and applying appropriate interventions, nursing managers can improve general well-being of nurses and promote patient care.

The attributes of successful de-escalation and restraint teams

Inpatient violence is a widespread problem on psychiatric wards often with serious consequences, and psychiatric hospitals have set up teams to de-escalate and restrain patients with aggression (D-E&R teams) which are specially trained to respond to it in a safe manner. Successful de-escalation and restraining of patients with aggression depend not only on the methods learned in training but also on the confidence of the team. Therefore, it is of great importance to understand the factors that enhance D-E&R teams' competence in managing patients with aggression in a successful and safe manner. The aim of this hermeneutic study was to identify and understand those factors. Purposive-expert sampling was used and twelve D-E&R team members with significant experience participated in the study. The central theme found was a safe team. Ensuring the safety of the team and its members was found to be a prerequisite for successful teamwork in managing patients with aggression in a safe manner. This central theme falls into two interacting domains: the internal dynamics of the team and the team's interaction with patients. Several themes, such as mutual trust, flexibility, and knowing one's role, influence these domains and hence strengthen or weaken the confidence and safety of the team. The findings of the study will contribute to a better understanding of these factors; understanding which could be used to improve the training, supervision, and quality assessment of D-E&R teams and hence lead to more safety in psychiatric wards.

The effect of a workplace violence training program for generalist nurses in the acute hospital setting: A quasi-experimental study

BACKGROUND

Workplace violence prevalence has attracted significant attention within the international nursing literature. Little attention to non-mental health settings and a lack of evaluation rigor have been identified within review literature.

OBJECTIVES

To examine the effects of a workplace violence training program in relation to risk assessment and management practices, de-escalation skills, breakaway techniques, and confidence levels, within an acute hospital setting.

DESIGN

A quasi-experimental study of nurses using pretest-posttest measurements of educational objectives and confidence levels, with two week follow-up.

SETTING

A 440 bed metropolitan tertiary referral hospital in Sydney, Australia.

PARTICIPANTS

Nurses working in specialties identified as a 'high risk' for violence.

METHOD

A pre-post-test design was used with participants attending a one day workshop. The workshop evaluation comprised the use of two validated questionnaires: the Continuing Professional Development Reaction questionnaire, and the Confidence in Coping with Patient Aggression Instrument. Descriptive and inferential statistics were calculated. The paired t-test was used to assess the statistical significance of changes in the clinical behaviour intention and confidence scores from pre- to post-intervention. Cohen's d effect sizes were calculated to determine the extent of the significant results.

RESULTS

Seventy-eight participants completed both pre- and post-workshop evaluation questionnaires. Statistically significant increases in behaviour intention scores were found in fourteen of the fifteen constructs relating to the three broad workshop objectives, and confidence ratings, with medium to large effect sizes observed in some constructs. A significant increase in overall confidence in coping with patient aggression was also found post-test with large effect size.

CONCLUSIONS

Positive results were observed from the workplace violence training. Training needs to be complimented by a multi-faceted organisational approach which includes governance, quality and review processes.

A quantitative systematic review of the effects of training interventions on enhancing the competence of nursing staff in managing challenging patient behaviour

AIMS

This systematic quantitative review identifies and summarizes the current knowledge and effects of training interventions for managing patients' challenging behaviour.

BACKGROUND

Challenging behaviour is an acknowledged worldwide healthcare problem and its management can have a huge impact on quality of care. Evidence-based training interventions that focus on managing challenging behaviour are needed, but few tools for the systematic evaluation of these interventions are currently offered.

DESIGN

A quantitative systematic review following the 2008 Centre for Reviews and Dissemination guidelines.

DATA SOURCES

CINAHL, Scopus, PsycInfo, PubMed and Cochrane were searched using the same terms for papers published in English from 2005-2015.

REVIEW METHODS

Studies were assessed for quality and risk of bias, according to the Cochrane Effective Practice and Organisation of Care Group criteria. A narrative summary was conducted.

RESULTS

We included 17 studies and evaluated 16 training interventions. Interventions were classified into four key themes: disengagements, communication, controlling behavioural symptoms and restrictive measures. Our review showed that interventions were more likely to decrease violent incident rates and increase staff confidence than change staff attitudes or increase knowledge. The elements of competence used to manage challenging behaviour were measured unilaterally. The evidence provided by studies was largely weak.

CONCLUSION

The variety of measurements used in the studies made comparing the effectiveness of the training interventions difficult. An individual's competence to manage challenging behaviour needs to be defined and a comprehensive scale for evaluating competence is also needed. Patient safety should be included in future evaluations.

'Mental health day' sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics

AIM

To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as 'mental health days'.

BACKGROUND

The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a 'mental health day' as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence.

DESIGN

Online cross-sectional survey.

METHODS

Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of 'mental health day' reportage were determined using logistic regression.

RESULTS

Fifty-four percentage of the n = 5041 nurse and midwife respondents took 'mental health days'. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use.

CONCLUSION

Specific characteristics of nurses and midwives who report taking 'mental health day' sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.

Self-harm in nurses: prevalence and correlates

AIMS

The aim of this study was to examine the weighed prevalence of self-harm and its correlates among Hong Kong nurses.

BACKGROUND

Recent epidemiological data suggest that the weighted prevalence of past-year suicidality among Hong Kong nurses was found to be 14·9%. Deliberate self-harm was a significant correlate of suicidality. Nonetheless, there are few population-based studies exploring the prevalence of self-harm and its correlates among medical occupational groups in Asia.

DESIGN

The study uses a cross-sectional survey design.

METHOD

Data were collected in Hong Kong over a four-week period from October-November 2013. Statistical methods, including binary and multivariate logistic regression models, were used to examine the weighted prevalence of self-harm and its associated factors in nurses.

RESULTS

A total of 850 nurses participated in the study. Seventy-nine participants (9·3%) reported self-harm in the past year. Nurses aged between 25-44 were at especially high risk of self-harm. Female nurses reported self-harm more than male nurses. The most common forms of self-harm were self-cutting, striking oneself and poisoning oneself. Clinical experience, chronic illness, relationship crises with family members, a family history of self-harm, smoking, symptoms of stress and psychiatric disorder were significantly associated with nurses' self-harm. The positive correlation between psychiatric disorder and self-harm was confirmed.

CONCLUSIONS

There is a need for a raft of self-harm prevention strategies, including a continuous monitoring system in the healthcare setting detecting and managing the risks of self-harm in nurses as part of the ordinary provision for their well-being.

Lifestyle and Depression among Hong Kong Nurses

Recent longitudinal data suggest a close association between depression and lifestyle. Little work to date has estimated the prevalence of depression in the nursing workforce in China, nor considered what lifestyle factors might be correlated with it—a gap filled by the present study. The study’s web-based cross-sectional survey solicited data from qualified nurses aged between 21 and 65 registered with the Hong Kong Nursing Council. The Depression, Anxiety and Stress Scale 21 was used to measure 850 nurses for depression, anxiety and symptoms of stress; a generalized linear regression model examined associations between lifestyle factors and depression. Mean depression symptom scores show a downward linear trend for male and female participants. Gender and age, however, did not emerge as significant predictors of depression. Three lifestyles factors (sleep, entertainment and hobbies) showed a significant association with depression. Nurses should make therapeutic lifestyle changes to improve their work-life balance and safeguard their functioning at work and personal well-being.

Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study

Recent epidemiological data suggests 13.3% of Hong Kong residents suffered from Common Mental Disorders, most frequently mixed anxiety and depressive disorder. This study examines the weighted prevalence and associated risk factors of depression, anxiety and stress among Hong Kong nurses. A total of 850 nurses were invited to participate in this cross-sectional study. Participants completed the Depression, Anxiety and Stress Scale 21 and multiple logistic regression was used to determine significant relationships between variables. Chronic past-year illness and poor self-perceived mental health were significant correlates of past-week depression, anxiety and stress. It confirmed further positive correlations between depression and divorce, widowhood and separation, job dissatisfaction, disturbance with colleagues, low physical activity levels and sleep problems. Marital status; general medicine; sleep problems, and a lack of leisure significantly correlated with anxiety. Stress was significantly associated with younger age, clinical inexperience, past-year disturbance with colleagues, low physical activity, no leisure and drinking alcohol. Nurses were more depressed, anxious and stressed than the local general population, with over one-third of our respondents classified as subject to these disorders.

The mental health of nurses in acute teaching hospital settings: a cross-sectional survey

Background

Nursing is an emotionally demanding profession and deficiencies in nurses’ mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses’ health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals.

Methods

A cross sectional survey design was used.

The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected.

Results

A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month.

Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating.

Conclusion

Nurses and their managers should strive to create workplaces where working practices promote nurses’ health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration.