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

Personality Traits, Burnout, and Psychopathology in Healthcare Professionals in Intensive Care Units-A Moderated Analysis

This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5-10 years, and more than 10 years), profession (nurses versus intensivists), and the urban size of the city where the ICU is located (metropolitan cities versus smaller urban cities). This cross-sectional investigation's outcomes are based on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 ICU departments in Greece. Participants underwent a comprehensive assessment involving a sociodemographic questionnaire, the Eysenck Personality Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom Checklist-90 (SCL-90). To analyze the interplay among critical care experience, burnout status, and psychopathology, a moderation analysis was conducted with personality dimensions (i.e., psychoticism, extraversion, and neuroticism) serving as the mediator variable. Profession and the urban size of the ICU location were considered as moderators influencing these relationships. Male healthcare professionals showed higher psychoticism levels than females, aligning with prior research. Experienced nurses reported lower personal achievement, hinting at potential motivation challenges for professional growth. Psychoticism predicted high depersonalization and low personal achievement. Neuroticism and psychoticism negatively impacted ICU personnel's mental well-being, reflected in elevated psychopathology scores and burnout status. Psychoticism appears to be the primary factor influencing burnout among the three personality dimensions, particularly affecting intensivists. In contrast, nurses are more influenced by their critical care experience on their mental health status.

Comparing nursing workload for critically ill adults with and without COVID-19: Retrospective cohort study

BACKGROUND

Intensive care environments already required complex work, and, furthermore, the recent COVID-19 pandemic increased health care demands, disorganized work teams and limited resources. Nonetheless, the real workload of nursing workers in the care for critical patients during this period was seldom investigated.

AIM

To compare the workload of nursing workers, estimated using the Nursing Activities Score (NAS), in patients with and without COVID-19 who had been hospitalized in an adult intensive care unit (ICU).

STUDY DESIGN

This study was developed in the ICU of a public university hospital in the south of Brazil. The workload of nursing workers was estimated using the NAS, which was developed through a retrospective cohort using reports of the assistance registered in electronic records, including the first 10 days of hospitalization of all patients admitted into the ICU in 2020 and 2021, who had at least one NAS evaluation; then, the workload was compared between patients with and without COVID-19. Generalized estimating equations models were used. The project was approved by the research ethics committee of the institution where the study took place.

RESULTS

The follow-up of 3485 patients resulted in 20 506 days of observation during the first 10 days of ICU hospitalization. The mean NAS score for the entire patient/day sample was 85.6 ± 18.1%, with 87.8 ± 17.8% in the COVID-19 group and 82.6 ± 18.2% in the non-COVID-19 group (p < .001). The use of mechanical ventilation, noradrenaline, sedation and neuromuscular blocking drugs, extracorporeal membrane oxygenation and haemodialysis increased the value of NAS for patients with or without COVID-19.

CONCLUSIONS

The workload of nursing professionals was higher for COVID-19 patients than for patients who did not present the disease in the first 10 days of ICU hospitalization.

RELEVANCE TO CLINICAL PRACTICE

This study presents the impact of COVID-19 on the ICU nursing workload in Brazil. The high workload found can support management decisions regarding quantity and quality of workforce composition.

The stress of nursing: exploring communicatively restricted organizational stress (CROS), effort-reward imbalance, and organizational support among a sample of U.S. working nurses

BACKGROUND

Nurses experience a constellation of negative outcomes such as lost productivity, based on their high levels of organizational stress. Following recommendations for best practices in health communication can dramatically improve the organizational climate for nurses and can have a significant effect on patient outcomes. In this study, we evaluate the impact of Communicative Restricted Organizational Stress (CROS) and effort-reward imbalance (ERI).

METHODS

A mixed-methods approach was employed. A professional survey research vendor was contracted to obtain an appropriate national sample (N = 299) of working nurses in the United States of America. Participants completed an online closed-ended questionnaire for the quantitative portion of the study. Qualitative data were gathered from member-checking follow-up interviews.

RESULTS

Results of the quantitative analysis indicated that nurses experience CROS, that these experiences are distressing, that CROS functions as an effort in the effort-reward-imbalance model, and that CROS and ERI contribute to negative outcomes such as insomnia, productivity lost, and poor general health. Specifically, a moderated moderation model accounted for 53% of the variance [F (7,290) = 47.363, p < .001] indicating that nurses with high levels of CROS distress and low levels of organizational support experienced the highest level of ERI in the presence of high nursing stress, t (296) = 3.05, p = .03, 95% CI [0.0038, 0.0178]. These findings were validated through member-checking qualitative interviews and specific overarching themes were explicated.

CONCLUSIONS

CROS is an important variable in understanding the experience of nursing stress. Furthermore, CROS serves as an effort in the ERI Model and serves to exacerbate nursing stress. We recommend practical implications for the improvement of psychosocial stress in an occupational environment for nurses.

The impact of organizational justice on psychological distress among Chinese public hospitals nurses: A cross-sectional study

Few studies have explored the association between organizational justice and mental health, particularly in collectivist countries. Hence, the aim of the present study was to evaluate the impact of organizational justice on psychological distress and to discuss the findings in collectivist culture. A cross-sectional survey was conducted among nurses from public hospitals in western of China, July 2022, which followed the STROBE guidelines. This study used Chinese versions of the Organizational Justice Scale and Kesseler Psychological Distress Scale to assess the perceptions of organizational justice and mental health levels, respectively. A total of 663 nurses completed the questionnaires. The psychological distress of university-educated and low-income nurses was poor. There was a moderately positive relationship between organizational justice and psychological distress (R = 0.508, P < .01), indicating that the greater level of organizational injustice, the poorer mental health. Hierarchical regression analysis showed that organizational justice was an strong predictor of psychological distress, accounting for approximately 20.5% of the psychological distress. The findings of this study highlight the importance of interpersonal injustice and distributive injustice on psychological distress specific in Chinese culture, suggesting that nursing management or leaders should notice that the most being taken seriously by nurses is their recognition and respect for subordinate, meanwhile, alerting nurses, in some sense, a negative relationship with leaders as a kind of workplace bullying could harm their mental health. The promulgation of organizational justice policy to protect employees from the government and the real role of employee labor union organizations are urgently needed.

Leadership Behavior Associations with Domains of Safety Culture, Engagement, and Health Care Worker Well-Being

BACKGROUND

Leadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey.

METHODS

The SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics.

RESULTS

Of the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics.

CONCLUSION

Local leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.

Does perceived organization support moderates the relationships between work frustration and burnout among intensive care unit nurses? A cross-sectional survey

BACKGROUND

Intensive care unit (ICU) nurses are at high risk of burnout and warranting attention. Existing literature found that work frustration was related to burnout, whilst perceived organization support influenced the association of work frustration with burnout. The purpose of this study was to investigate the relationship of work frustration and burnout among ICU nurses, and to examine the moderating effect of perceived organization support in their relationship.

METHODS

The cross-sectional study was conducted with a convenience sample of 479 ICU nurses from several 3 tertiary hospitals during December 2021 to May 2022. The Maslach Burnout Inventory-Human services survey (MBI-HSS), National Aeronautics and Space Administration Task Load Index (NASA-TLX) and perceived organization support Scale (POSS) were used to collect data. The PROCESS macro was performed to test the moderation effect of perceived organization support.

RESULTS

The total score of burnouts was (55.79 ± 17.20), the total score of work frustration was (7.44 ± 1.86). Burnout was positively correlated with work frustration (r = 0.301, P < 0.001) and negatively correlated with perceived organizational support (r = -0.430, P < 0.001). The moderation model analysis showed that perceived organizational support could moderate the relationship between work frustration and burnout (β = -0.111, ΔR2 = 0.011, P = 0.007).

CONCLUSIONS

The findings highlight the moderating role of perceived organizational support in the relationship between work frustration and burnout. Hence, interventions to reduce burnout among ICU nurses should consider targeting organizational support and work frustration.

Does the economic crisis contribute to the burnout and engagement of Spanish nurses?

The national and European economic crisis has caused significant changes in the National Health System in Spain, among others a considerable deterioration in the working conditions of nursing professionals. The aim of this study was to analyse whether the economic crisis situation influenced the burnout and engagement of Spanish nursing professionals. The research design was a transversal study based on descriptive and inferential statistical analysis. Because the variable "economic crisis" is not susceptible to direct experimental manipulation, to explore its possible influence on the burnout and engagement of nursing staff, we use an indirect strategy of "priming". That is, we presented a group of participants with news about how the economic crisis was affecting healthcare personnel, in order to facilitate their cognitive accessibility, while another control group did not read any news. The participants were 66 nursing professionals from two public hospitals in the north of Spain completed various questionnaires that allowed information to be collected on the factors of interest in the study. The work experience of the participants contributes significantly to their burnout levels. The economic crisis situation helps to explain the burnout of Spanish nurses, but not their engagement levels.

Documentation Burden in Nursing and Its Role in Clinician Burnout Syndrome

OBJECTIVES

The purpose of this study is to understand the relationship between documentation burden and clinician burnout syndrome in nurses working in direct patient care. The Office of the National Coordinator considers documentation burden a high priority problem. However, the presence of documentation burden in nurses working in direct patient care is not well known. Furthermore, the presence of documentation burden has not been linked to the development of clinician burnout syndrome.

METHODS

This paper reports that the results of a cross-sectional survey study comprised of three tools: (1) The burden of documentation for nurses and mid-wives survey, (2) the system usability scale, and (3) Maslach's burnout inventory for medical professionals.

RESULTS

Documentation burden has a weak to moderate correlation to clinician burnout syndrome. Furthermore, poor usability of the electronic health record (EHR) is also associated with documentation burden and clinician burnout syndrome.

CONCLUSION

This study suggests that there is a relationship between documentation burden and clinician burnout syndrome. The correlation of poor usability and domains of clinician burnout syndrome implies the need for more work on improving the usability of EHR for nursing documentation. Further study regarding the presence of documentation burden and its correlation to clinician burnout syndrome should focus on specific areas of nursing to understand the drivers of documentation burden variation within and across specialty domains.

Effects of Work Stress and Period3 Gene Polymorphism and Their Interaction on Sleep Quality of Non-Manual Workers in Xinjiang, China: A Cross-Sectional Study

Work stress has been found to be associated with sleep quality in various occupational groups, and genetic factors such as variable number tandem repeat polymorphism in the Period3 (Per3) gene also influence the circadian sleep-wake process. Therefore, the present study aimed to evaluate the sleep quality status of non-manual workers in Xinjiang, China and to analyse the effects of work stress and Per3 gene polymorphism and their interaction on sleep quality. A cluster sampling method was used to randomly select 1700 non-manual workers in Urumqi, Xinjiang. The work stress and sleep quality of these workers were evaluated using the Effort−Reward Imbalance Inventory (ERI) and the Pittsburgh Sleep Quality Index (PSQI). Next, 20% of the questionnaire respondents were randomly selected for genetic polymorphism analysis. The polymerase chain reaction-restriction fragment length polymorphism technique was used to determine Per3 gene polymorphism. The detection rate of sleep quality problems differed between the different work stress groups (p < 0.05), suggesting that non-manual workers with high levels of work stress are more likely to have sleep quality problems. Regression analysis revealed that the Per3 gene (OR = 3.315, 95% CI: 1.672−6.574) was the influencing factor for poor sleep quality after adjusting for confounding factors, such as occupation, length of service, education, and monthly income. Interaction analysis showed that Per34/5,5/5 × high work stress (OR = 2.511, 95% CI: 1.635−3.855) had a higher risk of developing sleep quality problems as compared to Per34/4 × low work stress after adjusting for confounding factors. The structural equation modelling showed no mediating effect between work stress and Per3 gene polymorphism. The results of this study show that both work stress and Per3 gene polymorphism independently affect sleep quality of nonmanual workers from Xinjiang, and the interaction between these two factors may increase the risk of sleep quality problems. Therefore, to improve sleep quality, individuals with genetic susceptibility should avoid or reduce as much as possible self-stimulation by work-related exposures such as high levels of external work stress.

Compassion satisfaction and compassion fatigue in haematology cancer nurses: A cross‐sectional survey

Aim

This study aimed to investigate compassion satisfaction (CS) and compassion fatigue (CF) in haematology nurses and their associated factors.

Design

A cross‐sectional survey.

Methods

The survey was conducted on 336 haematology nurses from 21 hospitals in Sichuan, China. The CS and CF were assessed by the Professional Quality of Life Scale version 5. The CF was determined by burnout and secondary traumatic stress.

Results

Haematology nurses in China had moderate levels of CS and moderate‐to‐low CF. Better nursing competence of teaching/consultation and communication/coordination and the percentage of critically ill patients >60% predicted higher CS. The permanent nurse, better nursing competence of communication/coordination and specialized clinical practice predicted less burnout, while working >40 hr per week or more nurse‐patient conflict events predicted more burnout. In addition, working >40 hr per week, more nurse‐patient conflict events and having the need of psychological support predicted higher secondary traumatic stress.

Translation, validation and psychometric properties of Effort-Reward Imbalance questionnaire among nurses in Vietnam

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Effort-Reward imbalance scale helps measure and manage work stress and mental issue.

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It is validated using confirmatory factor analysis and logistic regression model.

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The scale has adequate reliability and validity to be used among Vietnamese nurses.

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Poor self-rated health is more often reported among nurses with higher ER-ratio.

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Vietnamese scale is available for managing health forces, toward Health for All.

We translated the Effort-Reward imbalance questionnaire, an instrument for measuring work stress, into the Vietnamese language and investigated its psychometric properties among nurses in Vietnam. In a hospital-based cross-sectional study design, we sampled and interviewed 207 nurses working full-time (response rate 83%). We evaluated the internal consistency using standardized Cronbach's alpha coefficients and structural validity using confirmatory factor analysis. Discriminative validity was assessed by comparing the measured scores between age groups, gender, education levels, income groups, and job positions. In addition, we confirmed the criterion validity by investigating its association with self-reported health using simple and multiple logistic regression models. Most of the participants were female (73.3%), young (average 28.5 years old), and had education levels of college or higher (53.5%). We observed sufficient internal consistency in effort, reward, and over-commitment scales (Cronbach's alpha 0.80, 0.76, and 0.68, respectively). Confirmatory factor analysis of the three-factor hierarchical model showed an acceptable fit and fair construct validity with most moderate or stronger (>0.3) factor loading coefficients. Poor self-rated health was more likely in respondents in both Effort-Reward ratio's middle tertile (adjusted Odd-Ratio = 2.80, p-value = 0.031) and highest tertile (adjusted Odd-Ratio = 2.64, p-value = 0.05), adjusting for age, gender, and education levels. The Effort-reward imbalance scale has adequate reliability and validity for assessing work stress among nurses in Vietnam. Its significant association with poor self-rated health warrants further investigation. The validated instrument can help measure the effort-reward imbalance to manage better work-related emotional strains and mental health issues among nurses and ensure human resources' stability in healthcare in Vietnam.

Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis

Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as the intensive care unit (ICU), can be stressful due to high levels of morbidity and mortality and ethical dilemmas. Burnout causes a deterioration in quality of care, increasing the risk of mortality in patients due to poor performance and errors in the healthcare environment. The aim of this study was to analyse the levels, prevalence and related factors of burnout in ICU nurses. A systematic review and meta-analysis were carried out in the Medline, Scopus and CINAHL databases. Fifteen articles were found for the systematic review and four for the meta-analysis. With a sample of n = 1986 nurses, the meta-analytic estimate prevalence for high emotional exhaustion was 31% (95% CI, 8-59%), for high depersonalization was 18% (95% CI, 8-30%), and for low personal accomplishment was 46% (95% CI, 20-74%). Within the dimensions of burnout, emotional exhaustion had a significant relationship with depression and personality factors. Both sociodemographic factors (being younger, single marital status, and having less professional experience in ICU) and working conditions (workload and working longer hours) influence the risk of burnout syndrome.

Evaluating effort-reward imbalance among nurses in emergency departments: a cross-sectional study in China

BACKGROUND

Effort-reward imbalance is an adverse psychological response to working conditions that has several negative effects on nurses. However, there is little research on effort-reward imbalance and its influencing factors among nurses in emergency departments. This study aimed to understand the current situation of effort-reward imbalance and explore its influencing factors among emergency department nurses in China.

METHODS

From July to August 2018, a structured online questionnaire survey was conducted among emergency department nurses in China. Data were collected from emergency department nurses employed in hospitals providing pre-hospital care in China. The questionnaire consisted of sociodemographic characteristics, work-related factors and effort-reward imbalance. A descriptive analysis and a binary logistic regression were conducted to explore the effort-reward imbalance and its influencing factors among emergency department nurses.

RESULTS

The study involved 17,582 emergency department nurses; notably, the prevalence of effort-reward imbalance was 59.66%. The participating nurses who were males, aged 25 to 34 years, whose educational level was a bachelor degree or above, who had a junior or above title, who had longer years of service, and who had suffered verbal or physical violence in the past year had a higher risk of effort-reward imbalance. Furthermore, the nurses with a high monthly income, who believed that the number of nurses met the department's demand had a lower risk of effort-reward imbalance.

CONCLUSIONS

Effort-reward imbalance was prevalent among emergency department nurses in China. Measures such as adjusting the night shift frequency, increasing the number of nurses, raising salaries and reducing workplace violence should be considered to reduce the level of effort-reward imbalance.

The prevalence of burnout syndrome among critical care nurses in a tertiary hospital in Pahang, Malaysia

Recent studies provide an alarming view on the prevalence of burnout that has increased worldview markedly. This study aims to determine the level of burnout, association between socio-demographic characteristics and the correlation between burnout elements. A cross-sectional study was conducted on 118 critical care nurses using Maslach Burnout Inventory-Human Services Survey (MBI-HSS) to assess their emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). It consists of 22 items with a 7-point Likert type rating scale. No significant difference between socio-demographic characteristics and the levels of burnout. 64.4% of participants scored high on emotional exhaustion, most of the participants (72.9%) had high levels of depersonalization and 37.3% of the participants reported high levels of personal accomplishment. Despite having high levels of emotional exhaustion and depersonalization, critical care nurses in the tertiary hospital can maintain a positive evaluation of their accomplishment.

Cross-Sectional Study of the Effects of Job Burnout on Immune Function in 105 Female Oncology Nurses at a Tertiary Oncology Hospital

Background

Nurses who work in hospitals experience a high level of burnout and the relationship between immune variables and burnout syndrome has yet to be elucidated. The aim of the present study was to investigate the effects of job burnout on immune function in female oncology nurses in a tertiary oncology hospital in Guangxi, China. The aspects of the human immune system evaluated were humoral and cellular immunity and complement components 3 (C3) and 4 (C4).

Material/Methods

We administered the Maslach Burnout Inventory-General Survey (MBI-GS), which includes scales for emotional exhaustion, depersonalization (DP), and personal accomplishment (PA), to measure variables related to immune function in 105 female nurses in a tertiary oncology hospital in Guangxi, China. Levels of humoral immunity and C3 and C4 were detected with immune turbidimetry. Cellular immunity was assessed with indirect immunofluorescence.

Results

A Spearman rank correlation analysis revealed that levels of C3, C4, and CD4- and CD8-positive T cells were significantly associated with burnout symptoms (P<0.05, P<0.01, and P<0.05, respectively). Furthermore, there was a correlation between demographic data and humoral and cellular immunity (both P<0.05). Multivariable linear regression analysis showed that C4 levels were closely related to DP (P<0.05) and that CD4 and CD8 levels were closely related to PA (P<0.01).

Conclusions

These results suggest that DP and PA have an impact on immune function, and that timely psychological and behavioral interventions can be used to reduce the degree of job burnout among nurses and regulate their immunity, thus enabling them to better serve patients.

Psychological impact of the COVID-19 pandemic on hospital workers over time: Relationship to occupational role, living with children and elders, and modifiable factors

OBJECTIVE

The COVID-19 pandemic is expected to have a sustained psychological impact on healthcare workers. We assessed individual characteristics related to changes in emotional exhaustion and psychological distress over time.

METHODS

A survey of diverse hospital staff measured emotional exhaustion (Maslach Burnout Inventory) and psychological distress (K6) in Fall 2020 (T₁) and Winter 2021 (T₂). Relationships between occupational, personal, and psychological variables were assessed using repeated measures ANOVA.

RESULTS

Of 539 T₁ participants, 484 (89.9%) completed T₂. Emotional exhaustion differed by occupational role (F = 7.3, p < .001; greatest in nurses), with increases over time in those with children (F = 8.5, p = .004) or elders (F = 4.0, p = .047). Psychological distress was inversely related to pandemic self-efficacy (F = 110.0, p < .001), with increases over time in those with children (F = 7.0, p = .008). Severe emotional exhaustion occurred in 41.1% (95%CI 36.6-45.4) at T₁ and 49.8% (95%CI 45.4-54.2) at T₂ (McNemar test p < .001). Psychological distress occurred in 9.7% (95%CI 7.1-12.2) at T₁ and 11.6% (95%CI 8.8-14.4) at T₂ (McNemar test p = .33).

CONCLUSIONS

Healthcare workers' psychological burden is high and rising as the pandemic persists. Ongoing support is warranted, especially for nurses and those with children and elders at home. Modifiable protective factors, restorative sleep and self-efficacy, merit special attention.

Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study

BACKGROUND

The subject of emotional exhaustion organisations has become important because of the emerging trends in employment and its associated challenges. Unhealthy practice environment is a major threat in the incidence of emotional exhaustion among nurses; and any organisational culture that do not support its personnel has huge burnout costs. The study aimed at assessing rate of emotional exhaustion; determining factors that accounts for it and also ascertaining the coping strategies used by nurses to overcome it in the Ghanaian health care setting.

METHODS

A cross-sectional study with a proportionate stratified sampling was used to draw a sample from five health facilities. A standardized questionnaire of Professional Practice Environment Scale of Nursing Work Index, Maslach Burnout Inventory and Coping Scale were used to assess variables under study. The STROBE guidelines were followed in reporting this study.

RESULTS

Out of the 232 registered nurses studied, 91.1% of them reported experiencing moderate to high rate of emotional exhaustion. The practice environment of the nurses explained 39.6% of the variance in emotional exhaustion. Emotion-focused and problem-focused approaches were identified to be used by registered nurses to cope with emotional exhaustion.

CONCLUSION

When appropriate and effective intervention are employed, emotional exhaustion will be reduce and this will enrich the effectiveness of quality care delivery to patients.

When and how do hospital nurses cope with daily stressors? A multilevel study

BACKGROUND

During their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses.

OBJECTIVES

To identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses.

DESIGN

This study uses descriptive, correlational, two-level design with repeated measures.

SETTINGS

Wards of two University hospitals.

PARTICIPANTS

A random cohort of 113 nurses was studied.

METHODS

An ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships.

RESULTS

Different momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task.

CONCLUSIONS

The choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

How the Lagged and Accumulated Effects of Stress, Coping, and Tasks Affect Mood and Fatigue during Nurses' Shifts

Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses' mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.

Influential factors of well-being among Hungarian female hospice workers examined through structural equation modelling

According to national hospice data in Hungary, approximately 1,600 healthcare employees and volunteers work in hospice care (country population of 9.9 million). The aim of the study was to identify and examine influential relationships among several variables that may affect well-being among female hospice workers. Structural equation modeling analysis was conducted utilising survey responses of 179 female hospice workers, including 79 nurses. Path analysis revealed that work over-commitment (being employed in more than one job) contributed to decreased psychological well-being through increased perceived stress, sleep difficulties and vital exhaustion. A greater sense of coherence was associated with lower levels of subjective stress, depressive symptoms and vital exhaustion and negatively correlated with over-commitment. Overall, even though the physical and mental burden of the workers is increasing because of increased use of hospice, according to these results, most still engaged in hospice work. Deeper analysis of the sense of coherence may point to development of effective interventions that can help maintain well-being of hospice workers and reduce attrition.

The Development of Critical Care Medicine in China: From SARS to COVID-19 Pandemic

BACKGROUND

Critical care medicine is a branch of medical science that deals with the characteristics and regularity of life-threatening processes initiated by any injury or disease and, accordingly, relevant treatment for patients with critical illness. Conceptions of critical care medicine in China stemmed in the early 1970s. Ever since the establishment of the first intensive care unit (ICU) along with the increasingly incomparable role of ICU in medical practices, critical care medicine has become an indispensable part of the Chinese medical and health system. Currently, critical care medicine as a secondary clinical discipline and a well-constructed science is in sustainable development on the way towards systematization and standardization.

METHODS

The gross domestic product (GDP) and population data were obtained from the National Bureau of Statistics. The number of ICUs, ICU beds, and hospital beds and other data regarding ICU staffing and facility resources were obtained from the Yearbook of Health in the People's Republic of China and National Bureau of Statistics. The mortality rates of SARS and COVID-19 and the number of health workers aiding Hubei amid COVID-19 pandemic were obtained from the National Health Commission. Findings. Critical care medicine in mainland China has made significant strides: both quantity and quality are progressing at a fast pace after SARS in 2003. Although there exist some disparities in healthcare personnel and medical resources, they have not hindered the country from mobilizing its healthcare workers and resources against a public health emergency.

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.

A Cross Sectional Study Evaluating Psychosocial Job Stress and Health Risk in Emergency Department Nurses

Nurses experience psychosocial work stress that may negatively affect physical and mental health over time. In this cross-sectional study we investigated prevalence of job stress and oxidative stress in nurses, and determined if significant relationships exist between higher job stress scores and demographic factors and working conditions. Emergency department nurses (n = 42) were recruited from a University Hospital following Institutional Review Board approval. Job stress indicators, effort-reward ratio and overcommitment were evaluated from survey questionnaires using the effort-reward imbalance model, and associations with age, sex, body mass index, and working conditions were measured by logistic regression analysis. Oxidative stress biomarkers, 8-isoprostane, malondialdehyde, and antioxidant levels were measured from urine specimens. Job stress was prevalent with effort-reward ratio > 1 in 93% and overcommitment > 50 in 83% of the study participants. Age, body mass index, years of experience, weekend work, work hours per week, and shift work showed strong associations with effort-reward ratio and overcommitment scores. Malondialdehyde was higher in participants with high overcommitment. We report that psychosocial job stress is prevalent among nurses, as revealed by the high effort-reward and overcommitment scores. Job stress may be reduced through implementation of appropriate stress reduction interventions.

Burnout in Brazilian Intensive Care Units: A Comparison of Nurses and Nurse Technicians

Job-related burnout has been reported by intensive care nurses worldwide; this study was performed to examine burnout in intensive care unit bedside nurses and nurse technicians in Brazil. A cross-sectional survey that included the Practice Environment Scale and the Maslach Burnout Inventory was completed by 209 nurses and nurse technicians working in 4 Brazilian intensive care units in 3 teaching hospitals. Compared with nurse technicians, nurses reported higher levels of emotional exhaustion and depersonalization, and a lower level of personal accomplishment. A 1-unit increase in the quality of nurse practice environment was associated with a decrease in high levels of emotional exhaustion and low levels of personal accomplishment. Each additional patient added to a nurse’s workload was associated with an increase in high emotional exhaustion and low personal accomplishment. Approximately one-third of Brazilian nurses working in intensive care units report job-related burnout; the practice environment and staffing appear to be contributing factors.