Nurse burnout and stress in the NICU

Communication at work: A survey to explore the relationships between healthcare providers' communication competence and professional quality of life in neonatal care

Objective

Providing medical care to preterm infants can be rewarding yet also stressful for healthcare providers in the neonatal care unit (NICU). While the impact of provider-parent communication on parent-related stress and satisfaction is widely accepted, little is known about the provider perspective. Therefore, this study explores the relationships between neonatal care providers' communicative competence and their professional quality of life and job satisfaction.

Methods

Using the NICU Communication Framework, we conducted a cross-sectional survey among N = 300 Dutch pediatricians‑neonatologists, nurses, and ancillary staff.

Results

Communication performance and providers' job satisfaction were correlated, particularly in terms of perceived quality of care, professional relationships, and personal rewards. When providers deemed communication important and perceived themselves as skilled communicators, job satisfaction increased. Experiencing sufficient time for conversations with parents was inversely correlated with provider fatigue and burn-out. Yet, providers reported insufficient opportunity for communication.

Conclusion

These results warrant reflection on the importance of communication in neonatal care, for the wellbeing of parents and providers alike.

Innovation

Focusing on the provider perspective, this study provides novel insights into the relationships between communication and outcomes of care. Our findings uniquely emphasize the power of communication to foster staff satisfaction and reduce burn-out in the NICU.

Webcam technology on neonatal wards-examining the objective and subjective workload of nurses: a combined observational and survey study

BACKGROUND

This study was conducted to estimate the additional objective and perceived workload of nurses resulting from the use of webcams. The successful implementation of webcam technology into routine care requires an analysis to prevent adverse events of increased nursing workload.

METHODS

The study took place on three neonatal wards in two University Hospitals in Germany. In the first Hospital, the study was conducted from February to July 2021; in the second one it was conducted between June and November 2021. Data were collected using a combined approach of a standardised diary questionnaire study and passive observations. The participants were accompanied in their daily work and their activities were recorded 65 nurses participated.

RESULTS

2,031 h were observed in 1,630 observation blocks. In 14.74% of the observation blocks webcam activities were detected. The extent to which the nurses had webcam-related additional workloads was rated as no additional workload in 82.16% of the daily questionnaires (n = 1,026).

CONCLUSION

The observed low workload due to the webcams is in line with the nurses' perception. The observational data revealed, on a number of different analysis levels, that a limited additional workload was generated. There was no decrease in activity performance observed and no clear indication for interruptions due to the webcam-related activities for the nurses. However, it is important to raise awareness about the individual workload levels for the successful implementation. Additional education programs can be provided for nurses.

TRIAL REGISTRATION

The Neo-CamCare study is registered at the German Clinical Trials Register.

DRKS-ID

DRKS00017755 .

"Collateral beauty." Experiences and needs of professionals caring for parents continuing pregnancy after a life-limiting prenatal diagnosis: A grounded theory study

BACKGROUND

Caring for parents continuing pregnancy after learning about a severe life-limiting condition in their unborn is challenging. Most existing studies focus on affected families, whereas research on the subjective experience of care professionals is scarce.

AIM

We aimed to (1) explore experiences and needs of involved care professionals, (2) obtain information about existing care structures, and (3) identify requirements for a structured perinatal palliative care program.

DESIGN

Grounded Theory study using theoretical sampling. Data was collected by semi-structured interviews and analyzed following the principles of grounded theory coding and situational analysis.

SETTING

A total of 18 professionals from 12 different services in Munich and surroundings participated in the study: 8 physicians, 3 midwives, 2 nurses, 1 each pregnancy counselor, grief counselor, chaplain, clinical psychologist, and undertaker.

RESULTS

Several organizations provide support for affected parents, but inter-institutional communication is scarce. Due to the lack of a dedicated perinatal palliative care program, professionals make immense and partly unpaid efforts to support concerned parents. Providers experience "collateral beauty" in their work despite all the suffering and grief. This includes the development of a humble attitude and feelings of gratitude toward life, the feeling of having a meaningful task and professional as well as personal growth. Requirements for a structured perinatal palliative care program include: fostering peer support, ensuring regular supervision, and enhancing interdisciplinary exchange.

CONCLUSIONS

Perinatal palliative care demands a high level of personal engagement but is experienced as highly rewarding by care professionals.

Opinion and Beliefs of Physicians about Integrating Families into the Care System of Preterm Hospitalized Neonates- A Qualitative Experience

OBJECTIVES

To explore the opinions and beliefs of physicians about integrating families into the care system of hospitalized preterm neonates.

METHODS

The setting was Neonatal Intensive Care Unit (NICU) of a tertiary care center in North India. Focus group discussions (FGDs) were conducted with the physicians using a pre-validated FGD topic guide. The FGDs were audio-recorded and transcribed. The meanings were drawn, and dependability was ensured. Themes and sub-themes were generated and finalized with a common consensus.

RESULTS

Five FGDs were conducted involving 28 physicians. The physicians opined that making families a part of the care system has several benefits, though they brought out some concerns. They opined that involving parents gives them confidence and satisfaction as they get empowered about neonatal care at the hospital and home after discharge. They reported difficulties in communication due to perceived inadequacy in counseling skills, language barriers and literacy levels of families, and lack of adequate time due to clinical overload. They identified nurses and public health nurses as an important bridge between physicians and families, and peer support as a useful facilitator. They suggested that role assignments to team members, training in counseling and communication, improving the comfort of parents and organizing information in easy-to-understand audio- visual content can help improve the family integration.

CONCLUSIONS

The physicians highlighted practical barriers, facilitators, and remedial measures to effectively integrate the families into the care system of preterm hospitalized neonates. There is a need to address the concerns of all stakeholders including the physicians for successful implementation of family integration.

Cultivating Self-Compassion to Protect Nurses From Burnout and Secondary Traumatic Stress

Nursing burnout, a result of prolonged occupational stress, has always been a challenge in health care, but recently the COVID-19 pandemic made this issue into a national priority. In fact, burnout among health care workers is one of the four priorities of the U.S. Surgeon General. Health care leaders and organizations are eager to implement strategies to improve nurses' well-being and, thus, enhance their mental health. Much of the literature has focused on the antecedents and consequences of nursing burnout, but there is limited information on strategies that protect perinatal nurses from burnout. Self-compassion is emerging as one strategy that has a positive correlation with nurse well-being and a negative association with burnout, depression, and anxiety. In this article, we identify and translate strategies to promote self-compassion in perinatal nurses.

Attitudes and Experiences Towards Death of Healthcare Professionals Working in Neonatal Intensive Care Units

BACKGROUND

Death is an integral part of neonatal intensive care units' (NICUs) environment and little it is known about NICU's staff death concepts.

AIM

To investigate attitudes and experiences towards death of healthcare professionals (HPs) working in NICUs.

DESIGN

Totally 131 participants from six hospitals were included in the study. Research instruments were a questionnaire designed by the authors and the scale Death Attitude Profile-Revised.

RESULTS

Gender, marital and educational status, frequent contact with end of life neonates and provision of neonatal end of life care during the research period correlated significantly with dimensions of DAP-R. Impact of NICU neonatal deaths on personal life correlated negatively with fear of death and positively with escape acceptance.

CONCLUSION

Evaluating the interrelationships among personal characteristics, attitudes and experiences towards death among NICU HPs may increase our understanding concerning working with dying neonates and provide direction for educational intervention and continuing professional support.

Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science.

The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life

BACKGROUND

Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS).

PURPOSE

To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL.

METHODS

Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit, for 3 weeks.

RESULTS

Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low (P = .003), while their low BO scores (P = .12) and moderate CS scores (P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased (P =.01). The hypothesis was partly supported.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.

Association between burnout and nurses' quality of life in neonatal intensive care units: During the COVID-19 pandemic

BACKGROUND

Neonatal intensive care unit (NICUs) nurses could suffer from job stress and burnout, which could cause increased turnover rates and decreased Quality of Life (QoL) among nurses.

PURPOSE

To determine the association between burnout and nurses' QoL in NICUs.

STUDY DESIGN

This correlational study was performed in 2020 on 140 nurses working in NICUs. The Maslach burnout and WHO Quality of Life-BREF was used to collect data.

RESULTS

There is a positive association between personal accomplishment and all dimensions of QoL (r = 0.40 to 0.56) and a negative association between emotional exhaustion, depersonalization of burnout and all dimensions of QoL (r = -0.47 to -0.79).

CONCLUSION

It is suggested that several interventions must be taken to prevent burnout and increased QoL in NICU nurses. The findings could provide scientific evidence for managers and encourage evidence-based decision-making to reduce burnout and improve the QoL of nurses especially during the Covid-19 pandemic.

Pediatric Critical Care Nursing Research Priorities in Asia: An eDelphi Study

OBJECTIVES

To identify nursing research priorities in pediatric critical care in Asia.

DESIGN

We conducted a modified three-round eDelphi survey with pediatric critical care nurses in Asia. The eDelphi technique has been extensively used within health research to achieve a common viewpoint from experts using questionnaires to gather research priorities. In round 1, participants were asked to list three to five research topics that they deemed important. These topics were thematically analyzed and categorized into a questionnaire. Participants rated the research topics in round 2 on a 6-point scale (1 = not important to 6 = extremely important). In round 3, the same questionnaire was used with addition of the calculated mean scores from round 2 for each topic. Research topics ranked among the top 10 were considered extremely important.

SETTINGS

Twenty-two PICUs in eight Asian countries.

SUBJECTS

Clinical nurses, managers, educators, and researchers.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In round 1, 146 PICU nurses across eight countries provided 520 research topics. Topics from round 1 were categorized into seven domains with 52 research topics. Prioritized research topics included early recognition of patient deterioration (mean 5.58 ± 0.61), prevention of healthcare-associated infections (mean 5.47 ± 0.70), and interventions to reduce compassion fatigue (mean 5.45 ± 0.80). The top three research domains were end-of-life care (mean 5.34 ± 0.68), professionalism (mean 5.34 ± 0.69), and management of pain, sedation, and delirium (5.32 ± 0.72).

CONCLUSIONS

This first PICU nursing research prioritization exercise within Asia identified key nursing research themes that should be prioritized and provide a framework for future collaborative studies.

The protective effect of grit on clinical nurses' occupational psychological distress: Mediating and suppressing effects of Hope

As at a high-risk group of psychological distress, nurses generally experience varying degrees of stress, anxiety, and depression. This paper identifies the positive factors that may negatively regulate the psychological pain of clinical nurses and their mechanisms of action, providing reliable references for clinical nurse support management. The effects and mechanisms of hope and the two components of grit consistency of interest and perseverance of effort) on clinical nurses' psychological distress (depression, anxiety, and stress) were observed in this study. A total of 635 Chinese clinical nurses (90.4% female) completed an anonymous questionnaire for the survey. As expected, hope, consistency of interest, and perseverance of effort were negatively correlated with the three indicators of psychological distress (r = -0.21 ~ -0.38, p < 0.01). Path analysis results showed that hope significantly mediated the negative effect of consistency of interest on psychological distress, with an effect of 12.96%. Hope also covered up the perseverance of effort on psychological distress, the effect of 110.63%. In the influence of consistency of interest and perseverance of effort on psychological distress, hope contributed a vital mediating. Based on these results, it can be concluded that grit and hope have protective effects on psychological distress in clinical nurses. Significantly increasing the level of hope or grit may effectively prevent and reduce psychological distress in clinical nurses.

Data-Driven Nurse Staffing in the Neonatal Intensive Care Unit

ABSTRACT

The challenge of nurse staffing is amplified in the acute care neonatal intensive care unit (NICU) setting, where a wide range of highly variable factors affect staffing. A comprehensive overview of infant factors (severity, intensity), nurse factors (education, experience, preferences, team dynamics), and unit factors (structure, layout, shift length, care model) influencing pre-shift NICU staffing is presented, along with how intra-shift variability of these and other factors must be accounted for to maintain effective and efficient assignments. There is opportunity to improve workload estimations and acuity measures for pre-shift staffing using technology and predictive analytics. Nurse staffing decisions affected by intra-shift factor variability can be enhanced using novel care models that decentralize decision-making. Improving NICU staffing requires a deliberate, systematic, data-driven approach, with commitment from nurses, resources from the management team, and an institutional culture prioritizing patient safety.

Ethical Considerations for Equitable Access to Genomic Sequencing for Critically Ill Neonates in the United States

Rare diseases impact all socio-economic, geographic, and racial groups indiscriminately. Newborn screening (NBS) is an exemplary international public health initiative that identifies infants with rare conditions early in life to reduce morbidity and mortality. NBS theoretically promotes equity through universal access, regardless of financial ability. There is however heterogeneity in access to newborn screening and conditions that are screened throughout the world. In the United States and some other developed countries, NBS is provided to all babies, subsidized by the local or federal government. Although NBS is an equitable test, infants admitted to neonatal intensive care units (NICUs) may not receive similar benefits to healthier infants. Newborns in the NICU may receive delayed and/or multiple newborn screens due to known limitations in interpreting the results with prematurity, total parenteral nutrition, blood transfusions, infection, and life support. Thus, genomic technologies might be needed in addition to NBS for equitable care of this vulnerable population. Whole exome (WES) and genome sequencing (WGS) have been recently studied in critically ill newborns across the world and have shown promising results in shortening diagnostic odysseys and providing clinical utility. However, in certain circumstances several barriers might limit access to these tests. Here, we discuss some of the existing barriers to genomic sequencing in NICUs in the United States, explore the ethical implications related to low access, consider ways to increase access to genomic testing, and offer some suggestions for future research in these areas.

Impact of Dying Neonates on Doctors' and Nurses' Personhood: A Systematic Scoping Review

CONTEXT

Caring for dying neonates is distressing for healthcare professionals (HCP)s. Yet, the extent of these effects is poorly understood, compromising support of HCPs. To better understand and support HCPs, a systematic scoping review (SSR) of prevailing data is proposed.

OBJECTIVES

In mapping prevailing data on the impact of caring for dying neonates on HCPs, an SSR proffers new insights on changes to their beliefs, values, coping, actions, relationships and self-concepts of personhood.

METHODS

Krishna's Systematic Evidenced Based Approach (SEBA) supports a robust, reproducible review whilst its constructivist approach and relativist lens effectively contends with diverse data sources, facilitating a holistic study.

RESULTS

A total of 9826 abstracts were reviewed and 69 articles were included. Thematic and content analysis were used simultanously. The four categories drawn from the Ring Theory of Personhood (RToP) complements the four themes identified: Emotional and Physical Difficulties, Coping Mechanisms, Conflict and Recommendations.

CONCLUSION

In highlighting significant longitudinal effects upon all aspects of their lives, this SSR in SEBA reveals a critical need for timely, appropriate and personalized support. We recommend adapting the RToP as an assessment tool to identify and evaluate the needs of these HCPs. It may also be used to structure a holistic support mechanism. Future studies are required to validate its use and appraise other aspects of support available for HCPs.

Psychosocial and psychological interventions' effectiveness among nurses in intensive care units caring for pediatric patients: A systematic review and meta-analysis

OBJECTIVE

This review aimed to evaluate the effectiveness of psychosocial and psychological interventions in nurses among intensive care units caring for pediatric patients.

METHODS

A literature search was performed in PubMed, EMBASE, CINAHL databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Study design, population characteristics, contents of the programs, measured outcomes, and results were systematically reviewed from 8 selected studies. To estimate the effect size, a meta-analysis of the studies was performed using the RevMan 5.3 program. The effect size used was the standardized mean difference.

RESULTS

Of 1,630 studies identified, 4 met the inclusion criteria, and 3 studies were used to estimate the effect size of psychosocial and psychological interventions. The primary outcome variable of these studies was stress. The effect of the intervention program on stress was also found to have no effect in individual studies, and the overall effect size was not statistically significant (standardized mean difference = -0.06; 95% confidence interval: -0.33, 0.20; Z = 0.48, p = 0.630). However, according to the individual literature included in this study, after the stress management program was applied as a group, a significant stress reduction was shown in the experimental group (p = 0.021).

CONCLUSIONS

These results show that psychosocial and psychological interventions were effective in stress management by a group approach. Therefore, it is necessary to develop psychosocial support interventions for stress management of nurses among intensive care units caring for pediatric patients more diversely.

Organizational Sensegiving in Family-Centered Care: How NICU Nurses Help Families Make Sense of the NICU Experience

As frontline caregivers, nurses play a central role in the coordination and delivery of family-centered care (FCC) in neonatal intensive care units (NICUs). Nurses see first-hand the fear, uncertainty, and anxiety parents experience due to unfamiliar and intimidating elements of neonatal care and the NICU environment. This study examines the sensegiving strategies nurses use to help families make sense of their NICU experience. In-depth, semi-structured interviews were conducted with 14 NICU nurses at a mid-size nonprofit hospital. Findings reveal nurses utilize four sensegiving strategies to influence parents' understanding of, response to, and participation in neonatal care practices: educate parents, personalize information, promote open communication, and encourage meaningful involvement. Overall, nurses rely on communication to align parents' meaning construction with FCC features and goals. Hospital administrators and nurse managers should integrate this study's findings into nurse training and professional development opportunities to teach nurses about parental sensemaking, factors that affect nurse sensegiving efforts, how to create effective sensegiving strategies, and sensegiving challenges they may face. Healthcare leaders should also provide organizational structures, resources, and continuing education programs that help nurses cope with the emotional demands of sensegiving. Moreover, nurses should talk to colleagues or supervisors and participate in self-care activities if sensegiving starts to impact their well-being or ability to provide effective FCC.

Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals: A Repeated-Measures Observational Study

BACKGROUND

Healthcare providers working in neonatal intensive care units (NICUs) are considered at high risk for psychological work-related stress.

PURPOSE

To evaluate both perceived and biological measures of work-related stress in neonatal healthcare professionals and to compare professionals working in the NICU with their colleagues working in less critical environments (ie, neonatal wards [NWs]).

METHODS

The salivary cortisol level at the beginning (CORT-B) and at the end (CORT-E) of a daily work shift was collected once a week for 6 weeks and a psychological questionnaire was submitted to NW and NICU workers of a tertiary university center.

RESULTS

No differences emerged in the overall cortisol secretion between professionals (NW 45 vs NICU 28), but the decrease in the mean cortisol values between CORT-B and CORT-E was less pronounced in NICU professionals (P < .001) who had greater psychological stress (P < .001). Lack of correlation between perceived and biological indexes was observed.

IMPLICATIONS FOR PRACTICE

NICU professionals reported greater levels of self-perceived psychological stress, especially in terms of professional self-doubt and the complexity of interactions with infants and their parents.The disconnection between psychological and biological indexes raises the issue that work-related stress might be covert to the professionals themselves. Dedicated resources should be developed to address quality of life and the work environment of NICU professionals.

IMPLICATIONS FOR RESEARCH

The absence of a correlation between perceived and biological indexes highlights the need to incorporate multidimensional physiological and biological measurements in evaluating burnout levels in neonatal healthcare providers.

Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout

OBJECTIVE

Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout.

DESIGN

RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control.

RESULTS

Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95%CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months.

CONCLUSION

WISER appears to durably improve HCW well-being.

CLINICAL TRIALS NUMBER

NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.

Comparison of Psychological and Physiological Stress in NICU Nurses: Effects of Unit Design and Shift

BACKGROUND

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied.

PURPOSE

To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift.

METHODS

Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models.

RESULTS

NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001).

IMPLICATIONS FOR PRACTICE

Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress.

IMPLICATIONS FOR RESEARCH

Strategies are needed for reducing stress in NICU nurses who work night shift.

Dimensions of the Burnout Measure: Relationships with shame- and guilt-proneness in neonatal intensive care unit nurses

BACKGROUND

Burnout in neonatal intensive care unit (NICU) nurses has been correlated with personality proneness to shame. However, the structural validities of the one-factor Burnout Measure (BM) and the two-factor Personal Feelings Questionnaire-2 (PFQ-2) used to assess burnout and shame-proneness, respectively, in these nurses were not evaluated.

OBJECTIVES

The aim of the study was (i) to perform factor analyses of the BM and the PFQ-2 and (ii) to determine the relationships of burnout dimensions retrieved by factor analysis with similarly validated dimensions of shame- and guilt-proneness in NICU nurses.

METHODS

This is a multicentre cross-sectional cohort study that involved 142 (24%) of 585 NICU nurses who were currently providing direct newborn care in six level 3-4 NICUs in New South Wales, Australia.

RESULTS

The BM was a multidimensional measure of burnout composed of three latent factors: Demoralisation, exhaustion, and loss of motive. Based on burnout dimension mean scores of 4 or more, worryingly high levels of Demoralisation, Exhaustion, and Loss of Motive were reported by 21%, 84%, and 24% of nurses, respectively. Shame and Guilt together explained 41%, 9%, and 15% of the variance in Demoralisation, Exhaustion, and Loss of Motive, respectively. Shame controlled for guilt made respective large and moderate contributions to the variance in Demoralisation (β = .62, p < .001) and Loss of Motive (β = .33, p < .001). Guilt moderated the effect of Shame on Loss of Motive (ΔR² = .031, p = .027).

CONCLUSIONS

Factor analysis of the BM showed burnout in NICU nurses was a multidimensional syndrome comprising exhaustion, Demoralisation, and loss of motive. Worryingly high levels of exhaustion, Demoralisation, and loss of motive were not uncommon. The Demoralisation dimension had a strong correlation with shame-proneness. Understanding the nature of Demoralisation and the phenomenology of shame and guilt should be psychoeducational components of the holistic management of burnout in NICU nurses.

Correlation between Ethical Intelligence, Quality of Work Life and Caring Behaviour of Paediatric Nurses

AIMS

The aim of this study is to determine correlation between paediatric nurses' "ethical intelligence" with "quality of work life" and "caring behaviour."

DESIGN

Descriptive correlational study.

METHODS

Data were collected with EIQ, QWL and CBI. Two hundred and one nurses and 201 caregivers of children hospitalized in a paediatric hospital in Tehran were randomly selected as participants. Data were analysed by SPSS. The data were collected in 2019.

RESULTS

Comparison of the subscale "ethical intelligence" with the scale "quality of work life" indicated a significant positive correlation between "honesty" with "job and carrier satisfaction" and "forgiveness" with "job and carrier satisfaction". In addition, findings showed a significant positive correlation between "honesty" and "control at work" and between "accountability" with "home-work interface." There was no significant correlation between "ethical intelligence" and "caring behaviours" and between nurses' "quality of work life" and "caring behaviours." Structural equation modelling showed a correlation between nurses' "ethical intelligence" and "quality of work life."

Burnout Syndrome in Paediatric Nurses: A Multi-Centre Study

BACKGROUND

Burnout syndrome is an increasingly prevalent problem, characterised by emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA), feelings that appear with prolonged exposure to stress-inducing situations. The syndrome alters physical well-being and endangers the quality of services provided. Among nurses working in the paediatric area, the association between burnout and the corresponding risk profile has received little research attention, despite the highly stressful nature of this work.

MATERIALS AND METHODS

The study population was composed of 95 nurses working in four hospitals in the province of Granada. Data were collected using the Maslach Burnout Inventory, the NEO Personality Inventory, and the Educational-Clinical Questionnaire: Anxiety and Depression.

RESULTS

According to the results obtained, 22.0% of the nurses working in the paediatric area present high levels of EE, 18.5% present high levels of D, and 39.6% had feelings of low PA. These burnout levels do not depend on sociodemographic or labour variables, but the three domains of the syndrome are related to the psychological factors analysed.

CONCLUSIONS

Among the nurses who participated in this study, 38.6% presented high levels of burnout, especially regarding feelings of low personal accomplishment. Personality factors play an important role in the development of this syndrome. This study shows the impact of burnout in paediatric nurses as well as the risk factors, providing information for the development of strategies to prevent it.

Burnout and its correlates among nursing staff of intensive care units at a tertiary care center

Background:

Burnout syndrome has been widely reported in nursing staff. It is more pronounced in intensive care setting (up to 80%). This survey was designed to assess the prevalence of burnout and its correlates among critical care nurses.

Methods:

Anonymous questionnaire was distributed to all ICU nursing staff of a tertiary care teaching hospital. Questionnaire had 25 questions covering – demography, job characteristics, Visual Analogue Scale for stress, co-worker support, work–life balance, question for measuring burnout, job satisfaction, turnover intention, organizational commitment, for depression screening and psychosomatic symptoms. The burnout scale score was used to dichotomize into low burnout (<3) or high burnout (> = 3) group. These two groups were compared using Chi-square test, Fischer's exact test for categorical variables and independent t-test for continuous variables. Significant variables were entered in multivariate logistic regression analysis.

Results:

Out of 150 ICU nurses, 125 (83.3%) gave completely filled questionnaires which were evaluated. 47 (37.6%) participants reported experiencing high burnout. Binary logistic regression model revealed that lack of specialized ICU training (OR = 4.28, 95% CI: 1.62 to 11.34, P = 0.003), performing extra duty in last month (OR = 5.28, 95% CI: 1.90 to 14.67, P = 0.001), High physical symptoms in last 12 months (OR = 4.73, 95% CI: 1.56 to 14.36, P = 0.006) and mid-level experience (1–5 years) were significantly associated with burnout.

Conclusions:

Burnout is significantly prevalent (37.6%) among intensive care nurses. Specialized training and limiting work hours can help in mitigating this problem. High frequency of physical symptoms could be early indicators of burnout.

Factors associated with secondary traumatic stress and burnout in neonatal care staff: A cross-sectional survey study

INTRODUCTION

High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff.

OBJECTIVE

The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support.

METHODS

A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate.

RESULTS

Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa.

CONCLUSION

Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.

COVID-19 Outbreak Can Change the Job Burnout in Health Care Professionals

Background: The outbreak of COVID-19 in China was a sudden bio-disaster, which may bring a negative impact on the job burnout of health care professionals (HCPs). Objective: We aim to find out the association factors, especially those closely related to this outbreak, of job burnout in Chinese HCPs. Method: The cross-sectional survey about HCPs' job burnout based on a network platform was conducted in high and low infection regions during the COVID-19 outbreak in China. The demographic characteristics, medical-work-related factors, risk of getting infected due to occupational exposure, and family factors were collected by the self-reported questionnaire. The Chinese version of the Maslach Burnout Inventory (CMBI) and the Trait Coping Style Questionnaire (TCSQ) were employed in this study to evaluate the job burnout and coping style, respectively. Furthermore, statistical analysis was done to find out the associated factors of job burnout. Results: We collected 880 complete questionnaires from doctors and nurses from February 9, 2020 to February 11, 2020. In this study, the positive rates of three dimensions of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and overall burnout were 9.09, 50.57, 56.59, and 73.98%, respectively. After the statistical analysis, we found that several factors can independently affect the dimensions. Working in the high infection region and negative coping styles can affect all three dimensions at once. More night shift quantity and having symptoms could increase emotional exhaustion and depersonalization, while higher work intensity and senior title could increase emotional exhaustion and reduce personal accomplishment, respectively. Conclusion: The rate of moderate and severe burnout had increased due to the outbreak. More attention should be paid to burnout in HCPs, especially those with negative coping. There were some potential ways to reduce burnout, such as reducing their workload and providing better protection from the virus.

What Keeps Neonatal Nurses Up at Night and What Gets Them Up in the Morning?

BACKGROUND

Occupational stress in neonatal nursing is a significant professional concern. Prolonged exposure to morally distressing patient care experiences and other healthcare issues may lead to worry among nurses. When worry becomes excessive, nurses and advanced practice registered nurses may lose joy that gives meaning to their work. Enhancing meaning in work may have a positive impact on nurse satisfaction, engagement, productivity, and burnout.

PURPOSE

To explore neonatal nurses' top professional satisfiers and top professional worries and concerns.

METHODS

A descriptive study was conducted in a convenience sample of neonatal nurses to identify the top professional satisfiers that get them up in the morning and the top professional worries and concerns that keep them awake at night.

RESULTS

Complete data were available for 29 neonatal nurses. The top professional satisfiers were caring for infants and families, making a difference, witnessing resilience, intellectual challenge of specialty, positive working relationships with colleagues, and educating parents and families. The top professional worries and concerns were staffing, missed care, workload, making a mistake, and failure to rescue.

IMPLICATIONS FOR PRACTICE

Healthcare and professional organizations must develop strategies to address occupational stress in today's complex healthcare environment. Identifying professional worries and concerns may help nurses navigate challenging and distressing situations. Furthermore, understanding nurses' professional satisfiers may promote personal and professional resiliency and help organizations create healthier workplace environments.

IMPLICATIONS FOR RESEARCH

Future studies are needed to test effective interventions that may promote professional satisfaction and help neonatal nurses cope with occupational stressors.

Physical environments that support the mental health of staff and families in the NICU

INTRODUCTION

The number of individuals suffering from mental and behavioral health disorders and the lack of access to treatment and appropriate facilities for these individuals are among the most pressing issues of our time. The purpose of this study is to describe the psychological challenges of staff and families in a neonatal intensive care unit (NICU), apply the outcomes of a study on mental health environments to the NICU setting, and make recommendations for the design of NICUs in support of mental health therapy and care.

MATERIALS AND METHODS

This study involved the translation of a previous study in mental and behavioral health facilities to the NICU setting. The original study involved interviews (N = 19) and online surveys (N = 134) investigating the importance and presence of particular environmental amenities intended to support mental and behavioral health settings. Data analyzed using Mann-Whitney U tests suggested that the "importance" scores of specific environmental qualities and features were significantly higher than the "effectiveness" scores. An analysis using the Dunn-Bonferroni correction revealed that some environmental qualities and features were rated as significantly more important or more effective than others. For the purposes of this paper, the variables were reexamined for applicability to NICU settings.

RESULT

Twenty of the original 26 design goals for mental health units were applicable to NICUs. These goals and how they might be implemented are summarized.

DISCUSSION

Guidelines identified as being important in therapeutic environments can be applied to NICU settings.

Acceptance of Traditional Chinese Medicine in the Neonatal Intensive Care Unit: A Launching Point

BACKGROUND

Because neonatology is a relatively new medical specialty, it is host to on-going, rapid adaptation and evolution of medical treatments and practices. This process has almost exclusively focused on Western, biomedical treatment modalities, without inclusion of potentially beneficial Traditional Chinese Medicine practices. It is unclear how receptive health-care providers in the neonatal intensive care unit (NICU) and families of NICU patients would be to the introduction of adapted Traditional Chinese Medicine treatments into the NICU environment.

OBJECTIVE

To assess the potential for engagement of patients, families, and staff in the NICU with Traditional Chinese Medicine therapies and to provide targeted education and low-risk Traditional Chinese Medicine treatments to support the health and well-being of those 3 groups.

METHODS

A feasibility pilot study including weekly walk-in Traditional Chinese Medicine sessions within the NICU for parents and staff, and neonatal patient consultations, both of which included hands-on therapies and education tailored to each participant's unique needs. Pre- and postsurveys were administered over 3 phases.

RESULTS

Walk-in sessions were attended by 83 adults and participants reported benefits, with no ill effects. There were 5 neonatal consultations with staff expressing an interest in more. Several obstacles to accessing Traditional Chinese Medicine modalities were identified in pre-surveys and were addressed with education and preemptive modifications to the therapies offered.

CONCLUSION

Acceptance of Traditional Chinese Medicine modalities in the NICU opens the door to future studies implementing integrative health services into the NICU care model.

Perceived Infant Well-Being and Self-Reported Distress in Neonatal Nurses

BACKGROUND

Infants who are admitted to a neonatal intensive care unit (NICU) may experience significant symptom burden. Parents are often distressed by these symptoms, which can affect their long-term coping and distress. There is limited research examining nurse perceptions of infant well-being (symptoms, suffering, and quality of life [QOL]) and associations with nurse distress.

OBJECTIVE

The objective of this descriptive study was to explore associations between nurse perceptions of infant well-being and self-reported distress.

METHODS

Nurses caring for infants with potentially life-threatening/life-limiting conditions were recruited from a Level IV NICU in the Midwestern United States as a part of a study on infant symptom burden. Nurses reported their perceptions of infant well-being and their own distress on a 5-point Likert scale. Surveys were administered at the bedside weekly for up to 12 weeks, depending on length of stay. Infant suffering and QOL were examined in relation to nurse distress. A cross-classified multilevel model was used to account for dependence within nurse and within patient.

RESULTS

A total of 593 surveys were collected from nurses. Using a cross-classified multilevel model with variables entered simultaneously, nurse perceptions of greater infant suffering and lower infant QOL were significantly associated with greater nurse distress.

DISCUSSION

Preliminary evidence shows that greater perceived infant suffering and lower perceived infant QOL may be associated with greater levels of self-reported distress in NICU nurses. Further work is needed to better understand factors related to symptom management in the NICU and the potential role of caregiver distress and compassion fatigue in NICU nurses.

Interventions to reduce occupational stress and burn out within neonatal intensive care units: a systematic review

Occupational stress is an emerging problem among physician and nurses, and those working in intensive care settings are particularly exposed to the risk of developing burnout. To verify what types of interventions to manage occupational stress and burn out within neonatal intensive care units (NICUs) have been introduced so far and to verify their efficacy among caregivers. PsycINFO (PsycINFO 1967-July week 3 2019), Embase (Embase 1996-2019 week 29) e Medline (Ovid MEDLINE(R) without revisions 1996-July week 2 2019) were systematically searched combining MeSH and free text terms for "burn out" AND "healthcare provider" AND "NICU". Inclusion criteria were interventions directed to healthcare providers settled in NICUs. Only English language papers were included. Six articles were included in the final analysis. All the studies reported an overall efficacy of the interventions in reducing work-related stress, both when individual focused and organisation directed. The analysis revealed low quality of the studies and high heterogeneity in terms of study design, included populations, interventions and their evaluation assessment. There is currently very limited evidence regarding the management of occupational stress and burn out within NICUs. The quality of available studies was suboptimal. The peculiarities of the NICUs should be considered when developing strategies for occupational stress management. Training self-awareness of workers regarding their reactions to the NICU environment, also from the pre-employment stage, could be an additional approach to prevent and manage stress.

You Can't Take Your Baby Home Yet: A Longitudinal Study of Psychological Symptoms in Mothers of Infants Hospitalized in the NICU

Evidence suggests that mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) experience elevated rates of psychological symptoms. However, previous studies of this population have been mainly cross-sectional and have focused on very preterm infants. Although moderate- to late-preterm infants generally thrive, the possible psychological toll on their mothers has not yet been sufficiently examined. In the current study, we used a longitudinal design to investigate whether mothers of moderate- to late-preterm infants experience elevated rates of psychological symptoms during the infant's hospitalization in the NICU and 6 months later. Results indicated that these mothers did show elevated depression, anxiety, and PTSD symptoms, and that symptom levels were similar in mothers of moderate- versus late-preterm infants. Mothers of moderate- to late-preterm infants hospitalized in the NICU appeared to experience these symptoms steadily over a 6-month period after giving birth. These findings suggest a need for greater support for these mothers while in the NICU.

Fostering Vicarious Resilience for Perinatal Palliative Care Professionals

Background: The demands on healthcare professionals caring for families grappling with a life-limiting condition in an unborn or newly born child can be overwhelming. Clinicians working in emergency/trauma, hospice, and pediatric settings are already at high risk for burnout and compassion fatigue, which can leave healthcare institutions increasingly vulnerable to poor retention, absenteeism, and waning quality of care. The provision of exemplary palliative care requires a cohesive interdisciplinary team of seasoned professionals resilient to daily challenges. In September 2019, the American College of Gynecology, in a committee opinion, published standard of care guidelines for perinatal palliative care. This has created an impetus for exceptional caregiving and a greater demand for both physician and interdisciplinary healthcare provider education, training, and ongoing support that promotes truly beneficent care for pregnant patients confronted with life-limiting fetal conditions. Methods: A scoping review of the research literature was conducted in order to distinguish the barriers and facilitators of professional resiliency in perinatal palliative care. PubMed, Medline, CINAHL, and EBSCO Psychology & Behavioral Sciences Collections were systematically reviewed. Because of the paucity of studies specific to perinatal palliative care, several interviews of nurses and physicians in that field were conducted and analyzed for content distinctly pertaining to personal practices or workplace factors that support or hinder professional resiliency. Results: The research indicated that medical professionals often cite a lack of knowledge, inexperience using effective communication skills related to perinatal palliative care and bereavement, challenges with interdisciplinary collaboration, misconceptions about the role and function of palliative care in the perinatal or neonatal settings, moral distress, and workload challenges as encumbrances to professional satisfaction. Strategic implementation of facility-wide bereavement care training, effective communication modalities, and evidenced-based practical applications are critical components for a thriving perinatal palliative care team. Authentic formal and informal debriefing, peer mentoring, adequate caseloads, robust provider self-care practices, exceptional relational efficacy, and cultural and spiritual humility can foster personal growth and even vicarious resilience for perinatal palliative care professionals. Conclusions: Support should be strategic and multifaceted. The onus to implement salient measures to cultivate resilience in the perinatal palliative caregiver should not be only upon the individuals themselves but also upon prevailing regulatory governing bodies and healthcare institutions.

Improving Staff Knowledge and Attitudes Toward Providing Psychosocial Support to NICU Parents Through an Online Education Course

BACKGROUND

Provider-parent communication is a critical determinant of how neonatal intensive care unit (NICU) parents cope, yet staff feel inadequately trained in communication techniques; many parents are not satisfied with the support they receive from hospital providers.

PURPOSE

This study evaluated whether NICU staff would demonstrate improved knowledge and attitudes about providing psychosocial support to parents after taking an online course.

METHODS

After providing demographic information, staff at 2 NICUs took a 33-item survey both before and after taking a 7-module online course "Caring for Babies and Their Families," and again at 6-month follow-up. Scores (means ± standard deviation) from all time periods were compared and effect sizes calculated for each of the course modules.

RESULTS

NICU staff participants (n = 114) included nurses (88%), social workers (7%), physicians (4%), and occupational therapists (1%). NICU staff showed significant improvement in both knowledge and attitudes in all modules after taking the course, and improvements in all module subscores remained significant at the 6-month follow-up mark. Night staff and staff with less experience had lower pretest scores on several items, which improved on posttest.

IMPLICATIONS FOR PRACTICE

This course, developed by an interprofessional group that included graduate NICU parents, was highly effective in improving staff knowledge and attitudes regarding the provision of psychosocial support to NICU parents, and in eliminating differences related to shift worked and duration of work experience in the NICU.

IMPLICATIONS FOR RESEARCH

Future research should evaluate course efficacy across NICU disciplines beyond nursing, impact on staff performance, and whether parent satisfaction with care is improved.

Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study

Background

Extremely premature infants (those born before 28 weeks’ gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child’s grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs.

Method

Sixteen open-ended interviews were conducted with 27 parents after their infant’s discharge from the NICU. Inductive content analysis was performed.

Results

Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy.

Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients’ parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU.

Conclusions

The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses’ competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant’s hospitalization.

The Experiences of Parents of Children Undergoing Surgery for Congenital Heart Defects: A Holistic Model of Care

The present article is based on a qualitative study focusing on parents of children born with congenital heart defects (CHDs) and hospitalized in the children's intensive care unit post-surgery. Our aim was to explore parents' subjective experiences as primary caregivers. Ten semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis according to the instructions of Smith and Osborn. Our analysis yielded eight categories which were grouped into four themes and two main superordinate themes: (1) dialectical tension between positive and negative experiences; and (2) fluctuations between the inner and the outer world. The two superordinate themes intersect such that parents report positive as well as negative experiences within both their inner and outer worlds. Based on our analysis, we found that the experience of having a child undergo surgery for a CHD can be regarded as a chaotic period characterized by uncertainty, confusion, and helplessness. It is therefore no surprise that many parents display negative psychological outcomes which extend beyond the period of hospitalization and may also affect their future parenting and coping. However, within this chaotic and stressful situation, parents had occasional supportive experiences which decreased their emotional distress and isolation and helped them throughout this difficult period. We thus conclude that the support offered to parents during the hospitalization period should be increased by trying to minimize their negative experiences and strengthen their inner coping abilities. These changes cannot be implemented without also addressing the needs of the medical staff in their role as caregivers. Therefore, we propose a holistic model of care which supports both parents as caregivers of children undergoing surgery for CHD and the medical staff involved in their care.

Work Engagement and Resiliency Impact the Relationship Between Nursing Stress and Burnout

Nursing is a stressful occupation, and consequently, nurses are at risk for work-related burnout. This is highly problematic, as numerous negative consequences are associated with burnout. Most notably, burnout may result in nurses leaving the profession, thereby exacerbating the nursing shortage. The purpose of the present study was to advance the understanding of burnout in the nursing profession. Specifically, three types of work engagement (i.e., vigor, dedication, and absorption) and resiliency were hypothesized to mediate the relationship between work-related stress and burnout. Nurses and nursing students were recruited through a college and a state nursing association, and participants (N = 76) completed a series of online surveys. Mediation models were assessed using multiple regression analyses and the bootstrapping method of testing indirect effects. Results indicated that vigor, dedication, absorption, and resiliency partially mediated the relationship between work-related stress and burnout, although the exact pattern of results varied depending on the specific type of burnout (Emotional Exhaustion, Depersonalization, and Reduced Personal Accomplishment). These results could be useful in helping to prevent burnout in the nursing profession and should be taken into consideration when designing employee training and support programs.

NICU Graduate Reunion: "A Celebration of Life"

BACKGROUND

Few understand the experience of having an infant in the neonatal intensive care unit (NICU). This article provides a discussion about the importance of an annual reunion for former NICU infants, their families, and neonatal staff.

PURPOSE

The purpose of this article is to explain the impact of the NICU reunion on families and neonatal healthcare providers and describe the experience of organizing this reunion over the past 20 years.

METHODS

This is a description of how a NICU reunion was organized at a regional neonatal center. Graphic-designed invitations were e-mailed to NICU graduates, who previously agreed to being contacted, 2 months prior to the reunion date. Social media were utilized to publicize the event on the hospital's Web site.

RESULTS

At the reunion, parents and families introduced their NICU graduate to the neonatal staff who cared for them while hospitalized. Sometimes staff found it difficult to recognize the NICU graduates, who were toddlers or older. Parents were relaxed, expressing their appreciation for care received.

IMPLICATIONS FOR PRACTICE

The impact of seeing an infant, born at 24 weeks, now walking, talking, and running cultivates pride in the NICU healthcare team. The reunion adds a positive dimension to the work of NICU caregivers. Parents look forward to attending the reunion to reconnect with NICU staff and other NICU parents.

IMPLICATIONS FOR RESEARCH

Directions for future study include a comparison of staff and families who attend the NICU reunion and those who do not, by using a survey or online evaluation tool, to improve future reunions.

CheckMates, Helping Nurses Plan Ahead in the Neonatal Intensive Care Unit

Workflow in a neonatal intensive care unit (NICU) is relatively unpredictable, which makes it difficult to plan activities. Simple tasks, such as checking device statuses may be forgotten, resulting in disturbing alarms. In this paper, we will present CheckMates, ambient lighting displays, which visualize device statuses to provide nurses with more overview. We performed expert reviews to obtain insights into the different potentials of CheckMates. Additionally, we performed a simulation study to gather user experiences regarding the functioning of CheckMates and their capacity to improve planning in an NICU environment. The results showed a variety of potential benefits for increasing nurses’ overview of device statuses and their opportunities for workflow planning. Furthermore, CheckMates did not appear to be distracting.

The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital

This qualitative study explored the experiences of social workers, nurses, and physicians providing end-of-life care to children in a pediatric acute-care hospital setting. Findings demonstrated that participants experienced both professional and personal impacts of their work and employed various coping strategies under each of these domains. The acute-care setting was found to create unique challenges in providing end-of-life care. Implications for policy and practice include promotion of both individual and institutional-level coping strategies and supports that meet the various needs of staff. Implications for future research include a nuanced examination of differences in experiences among nurses, social workers, and physicians.

Assessing Compassion Fatigue Risk Among Nurses in a Large Urban Trauma Center

OBJECTIVE

This study evaluated the prevalence and severity of compassion fatigue (CF) risk among nurses employed in a large southwestern hospital system.

BACKGROUND

Compassion fatigue is defined as multifaceted exhaustion stemming from untreated distress that leads to physical and emotional problems. Low morale, increased medication errors, and higher turnover can result.

METHODS

A descriptive design was used to identify: 1) the prevalence and severity of CF risk among a sample of registered nurses; and 2) the differences in demographic characteristics correlated with CF risk.

RESULTS

Forty-six percent of nurses reported moderate to high CF risk. Compassion fatigue risk was significantly associated with years of employment, unit worked, job changes, and use of sick days.

CONCLUSION

This study reports new knowledge about compassion fatigue, established risk profiles across clinical units, and clarified optimal timing for interventions for those at the highest risk for CF.

The Impact of a Stress Management Program on the Stress Response of Nurses in Neonatal Intensive Care Units: A Quasi-Experimental Study

This study was conducted with the aim to determine the effect of a stress management program on the response to stress by nurses working in neonatal intensive care units. This quasi-experimental study was conducted on 70 nurses in Iran. The nurses were assigned to the 2 groups: experimental and control groups, with each group comprising 35 participants. The McNamara education program was used for nurses in the experimental group. The response to stress in both groups was reviewed pre- and postintervention and 8 weeks after the intervention using the Stress Response Inventory. The 2 groups had no significant differences in terms of stress response preintervention (t = 0.668, P = .506). The mean scores in the experimental group were higher preintervention than those obtained postintervention, and the difference between them was significant. These findings indicate that the program has led to stress reduction in the experimental group.

Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project

AIM

The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families.

METHODS

A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU.

RESULTS

Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days.

CONCLUSION

Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.

Personality Traits, State Positive and Negative Affect, and Professional Quality of Life in Neonatal Nurses

OBJECTIVE

To explore the relationships of core self-evaluations of personality (self-esteem, generalized self-efficacy, emotional stability, and internal locus of control), the five-factor model personality traits (neuroticism, agreeableness, extraversion, conscientiousness, and openness), and positive and negative affect with neonatal nurses' professional quality of life (burnout, secondary traumatic stress, and compassion satisfaction).

DESIGN

Cross-sectional cohort study.

SETTING

Four Level 3-4 NICUs in New South Wales, Australia.

PARTICIPANTS

One hundred forty-two (35%) of 405 eligible neonatal nurses.

METHODS

Online self-report measures of personality traits, positive and negative affect, and professional quality of life.

RESULTS

Core self-evaluations explained 33%, 21%, and 26% of the variance in burnout, secondary traumatic stress, and compassion satisfaction, respectively. After controlling for core self-evaluations, agreeableness, neuroticism, and extraversion contributed to the respective variances in burnout, secondary traumatic stress, and compassion satisfaction. After controlling for core self-evaluations and the five-factor model personality traits, positive affect contributed to the variance in burnout and compassion satisfaction, whereas negative affect contributed to the variance in secondary traumatic stress. No five-factor model personality trait contributed to the variance in professional quality of life in the final regression models. Positive affect mediated the effect of core self-evaluations on burnout and compassion satisfaction, whereas negative affect mediated the effect of core self-evaluations on secondary traumatic stress.

CONCLUSION

Neonatal nurses should be aware of and accept responsibility for personality traits and moods that benefit or detract from their professional quality of life. NICU nurse managers should ensure that neonatal nurses have ready access to psychological support services.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review

INTRODUCTION

The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role.

OBJECTIVES

To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses.

REVIEW METHODS

A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings.

DATA SOURCES

The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment.

RESULTS

Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,⁷¹ a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,⁷² and the Mixed Methods Appraisal Tool for mixed-method studies.⁷³ The critical review guidelines by Shenton⁷⁴ and Polit and Beck⁷⁵ were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'.

CONCLUSION

Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.