Nurses' extended work hours: Patient, nurse and organizational outcomes

Analysis of factors associated with needlestick injuries of clinical nurses by applying a human factor analysis and classification system: A nationwide cross-sectional survey

AIMS

This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS).

DESIGN

A nationwide cross-sectional survey was conducted.

METHODS

Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors.

RESULTS

A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs.

CONCLUSION

The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere.

NO PATIENT OR PUBLIC CONTRIBUTION

Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.

Uneven distribution of stressful working conditions among Japanese nurses: a secondary analysis of nurses with and without children

Supportive measures for employees raising children may have increased workloads on other nurses, causing psychological stress. This study aimed to clarify the differences in working conditions and psychological status among female Japanese nurses based on child-rearing attributes. We used data from 1,600 female nurses at 10 Japanese hospitals collected by the study of the Work Environment for Hospital Nurses in Japan conducted in 2016. The variables included work conditions (number of night shifts per month, daily overtime, number of paid holidays per year, and social support received), psychological status (sense of coherence, emotional exhaustion, and work engagement), and sociodemographic characteristics. An analysis of covariance was performed on the differences between the three groups (without children, with preschool-age children, and with children of other ages groups). The group without children had a relatively higher workload (p<0.01) and lower social support (p<0.01 and p<0.05). Additionally, they had higher emotional exhaustion and lower work engagement (p<0.01). This study confirmed the uneven distribution of work environment by work-life balance measures.

Individual Attributes and Environmental Conditions of Registered Nurses Working in Freestanding Emergency Departments in the United States: A Descriptive Exploratory Study

INTRODUCTION

Freestanding emergency departments (FSEDs) are emergency facilities not connected to inpatient services. The percentage of FSEDs of all EDs grew from 1% in 2001 to 12% in 2017, making FSEDs a substantial subset of US emergency care. The purpose of this study was to describe the individual attributes and environmental conditions of registered nurses working in FSEDs in the US.

METHODS

A quantitative descriptive exploratory design with cross-sectional survey methodology.

RESULTS

A total of 364 emergency nurses responded to the survey. Most reported their FSED was open 24 hours/day (99.5%), with board-certified emergency physicians onsite (91.5%) and a mean of 3.6 RNs working per shift. Resources immediately available in more than 50% of FSEDs included laboratory and imaging services, and in fewer than 30% of FSEDs included behavioral health care, MRI, obstetric care, orthopedic care, neurologic care, and surgical consult care. Respiratory therapy was reported by 39.6% of respondents as being immediately available. A significant minority of respondents expressed concerns about adequacy of resources and training and the effect on patient care in both survey (30% of respondents) and open-ended questions (42.5% of respondents).

DISCUSSION

The practice environment of emergency nurses in FSEDs was reported as having positive elements; however, a substantial subpopulation reported serious concerns. FSEDs adhere to some of the standards put forward by the American College of Emergency Physicians, with notable exceptions in the areas of staffing RNs, staffing ancillary staff, and availability of some resources.

Effect of compassion fatigue on emotional labor in female nurses: Moderating effect of self-compassion

Emotional labor is common in nursing but may be affected by the mental state of nurses. This study explored the effect of compassion fatigue on emotional labor and whether self-compassion moderates this effect of compassion fatigue.

METHODS

A two-stage survey design with a convenience sample. Participants were female nursing staff recruited from emergency departments, intensive care units, ward nursing units, and outpatient departments of medical centers, regional hospitals, and district hospitals in Taiwan. A total of 300 questionnaire copies in each of the first and second stages were distributed, and 272 pairs of responses were retrieved (valid response rate = 91%). The reliability and validity of the questionnaire were tested, and confirmatory factor analysis was conducted with AMOS 21. The proposed hypotheses were verified using hierarchical regression conducted with SPSS version 25.0.

RESULTS

This study revealed that compassion fatigue positively predicted surface acting (β = 0.12, p < 0.05) and negatively predicted deep acting (β = -0.18, p < 0.01) and expression of genuine emotions (β = -0.31, p < 0.01). In addition, self-compassion negatively moderates the relationships between compassion fatigue and surface acting (β = -0.12, p < 0.05), and positively moderates the relationships between compassion fatigue and expression of genuine emotions (β = 0.15, p < 0.01).

CONCLUSIONS

To avoid excessive consumption of emotional resources, nurses with high compassion fatigue may employ surface acting by engaging in emotional labor without making an effort to adjust their feelings. Nurses need also be sympathized with, and such sympathy can come from hospitals, supervisors, colleagues, and, most crucially, the nurses themselves. Hospital executives should propose improvement strategies that can prevent the compassion fatigue on nurses, such as improving nurses' self-compassion.

Relationships among meal time, break time and workplace characteristics of nurses who work day, evening and night shifts: a cross-sectional study

Objectives. This study aimed to examine the relationships among shift-working nurses' meal time, break time and workplace characteristics. Methods. The cross-sectional study analyzed 351 questionnaires from 117 nurses who worked three shifts, drawn from eight nursing units in two tertiary hospitals located in South Korea. Meal time and break time during work were investigated through a questionnaire that participants completed immediately after the end of each shift. Regression analysis was conducted to investigate the associations between nurses' work characteristics and meal time and break time. Results. Meal time and break time were less than 30 min on all shifts and significantly longer on the night shift than on the other shifts. As patients' average length of stay increased, meal time increased on day and night shifts, while break time decreased on evening shifts. Overall, a higher nursing staff-to-patient ratio was associated with shorter meal and break times. Conclusions. It was found that nurses were not able to take proper time for meals and breaks while working. A realistic and specific strategy should be prepared to address this issue, with appropriate consideration of the specific characteristics of nurse staffing, patients' conditions and shifts.

Relationships between job burnout, ethical climate and organizational citizenship behaviour among registered nurses: A cross-sectional study

AIM

This study aimed to investigate the levels of nurses' organizational citizenship behaviour and the associations between job burnout and ethical climate with organizational citizenship behaviour.

BACKGROUND

Organizational citizenship behaviour improves adverse outcomes led by nursing shortage. However, the associations between three dimensions of job burnout and organizational citizenship behaviour are inconsistent, and little is known about whether ethical climate is related to organizational citizenship behaviour in nurses.

METHODS

In this cross-sectional study, 1157 nurses were selected using convenience sampling from April to October 2019. Self-report surveys assessed nurses' organizational citizenship behaviour, emotional exhaustion, depersonalization, personal accomplishment and perceptions of ethical climate.

RESULTS

Mean organizational citizenship behaviour was high among nurses. The regression model showed that job burnout and ethical climate explained an additional 38.6% of the variance in organizational citizenship behaviour over and above sociodemographic factors, with 44.9% of the total variance.

CONCLUSION

Nurses' organizational citizenship behaviour was at a relatively high level. Depersonalization was negatively associated with organizational citizenship behaviour while personal accomplishment and ethical climate were positively related to organizational citizenship behaviour. Therefore, nurse leaders are encouraged to take measures to help nurses reduce job burnout and create a favourable ethical climate for increasing nurses' organizational citizenship behaviour.

Impact of Target Management Card on Patient Safety in the Emergency Department: A Mixed Methods Study

Purpose

This study aimed to investigate the potential impact of the Target Management Card on patient safety in the emergency department.

Patients and Methods

A mixed method design was developed, combining a one-group pretest-posttest design with a qualitative study. Target Management Cards were formulated for 32 emergency nurse practitioners and focus group interviews were conducted after the intervention. Wilcoxon's signed rank test was used to compare pre-test and post-test scores. The interview data were subject to content analysis.

Results

After developing the Target Management Card, there were significant improvements in safety behaviors (Z = 4.709, p < 0.01) and perception of patient safety (Z = 4.257, p < 0.01) among emergency nurse practitioners. The nurses in the focus group interviews agreed that the Target Management Card could improve patient safety by warning and supervising nursing work in the emergency department, promoting a positive change in nurses' attitudes and behaviors toward patient safety.

Conclusion

Our study found that nurses and nursing managers jointly formulating Target Management Cards in emergency departments significantly enhances patient safety.

DEVELOPMENT, RELIABILITY, AND VALIDITY OF NURSES' WORK-LIFE BALANCE SCALE IN REGIONAL THAI HOSPITALS

Background and Purpose: Factors influencing work-life balance of regional hospital nurses are different from other professions. This study aimed to develop an instrument to measure work-life balance, and examine its psychometric properties. Methods: Psychometric properties were tested with content validity, construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and reliability with 598 professional nurses recruited using multi-stage sampling. Results: The Nurses' Work-life Balance Scale (NWLBS) had 38 items and seven components, explaining 64.46% of total variance. Content Validity Index was 0.94. CFA results indicated good fit with empirical data. Cronbach's alpha ranged from 0.53 to 0.94 for the seven subscales in 30 professional nurses. Conclusions: NWLBS demonstrated good content validity, construct validity, and reliability for assessing nurses' work-life balance.

Mindfulness and compassion training for health professionals: A qualitative study

Background

Compassion is a key component of quality care. Encouraging Health Care Professionals (HCPs) to develop a patient-centered care relationship through mindfulness and compassion training may be beneficial for both patients and HCPs.

Method

We assessed the impact of a compassion-centered mindfulness program [i.e., the Mindfulness Based (MB) CARE program] on healthcare practice conducting 10 phone interviews with HCPs who experienced the program.

Results

The training had an overall positive impact on the HCPs ability to feel compassion toward their patients and themselves, helped them develop kindness toward themselves and their patients, and enhanced their attention to their patient's needs and theirs. Participants were better able to accept the difficult work experiences or those their patients experienced, with more perceived equanimity and less reactivity.

Conclusion

Professional mindfulness and compassion training programs could be operational levers for institutions aiming at fostering more compassionate HCPs-patients relationships.

Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment

AIMS AND OBJECTIVES

This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts.

BACKGROUND

Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work.

DESIGN

A prospective observational study was employed. The study followed STROBE checklist for observational studies.

METHODS

Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness.

RESULTS

A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts.

CONCLUSIONS

The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty.

RELEVANCE TO CLINICAL PRACTICE

Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

A National Study of Patient Safety Culture and Patient Safety Goal in Chinese Hospitals

OBJECTIVES

This study aimed to measure the patient safety culture and the current practice of patient safety goals in China.

METHODS

This cross-sectional survey was conducted between November 2020 and November 2021. The 12-dimensions Hospital Survey on Patient Safety Culture questionnaire and the 14-items Survey on the Current Practice of Patient Safety Goal questionnaire were electronically distributed to 8164 healthcare providers across 26 provinces in China. Data were analyzed using descriptive statistics, correlation analysis, and multivariate linear regression.

RESULTS

A total of 8164 surveys were received, of which 7765 were valid and analyzed. The average positive response rate for the Hospital Survey on Patient Safety Culture survey was 69.68% (43.41%-91.54%). The percentage of positive responses in 5 dimensions (organizational learning, teamwork within units, feedback about error, management support for safety, and teamwork across units) was above the control limits, and 3 (nonpunitive response to error, staffing, and frequency of event reporting) were below the control limits. The average positive response rate for the Survey on the Current Practice of Patient Safety Goal survey was 96.11%. Patient safety culture was positively related to the current practice of patient safety goals ( r = 0.34, P < 0.001).

CONCLUSIONS

Our study concludes that although healthcare providers in China feel positively toward patient safety culture and practicably toward patient safety goals, considerable work is still needed to promote a patient safety movement.

Factors associated with poor mental health outcomes in nurses in COVID-19-designated hospitals in the postepidemic period in Guangdong Province: a cross-sectional study

OBJECTIVE

The early days of the COVID-19 pandemic placed enormous pressure and subsequent negative psychological problems on nurses, but at this stage of the year-long COVID-19 outbreak, the level of stress and negative emotions that nurses experience is unclear. Our study attempted to assess the factors influencing mental health status in nurses during the postepidemic period of COVID-19.

DESIGN

Cross-sectional study.

SETTING

COVID-19 designated hospitals.

PARTICIPANTS

1284 Chinese nurses.

MAIN OUTCOME MEASURES

Electronic questionnaires, including the Chinese version of the Perceived Stress Scale (CPSS) and Symptom Checklist-90 (SCL-90), were distributed for self-evaluation. Regression analysis was used to analyse the associated factors of psychological stress among variables such as age, years of nursing experience, weekly working hours, anxiety symptoms, somatisation symptoms and compulsive symptoms.

RESULTS

A total of 1284 respondents from COVID-19-designated hospitals in Guangdong Province were studied. The average CPSS score for all respondents was 22.91±7.12. A total of 38.5% of respondents scored ≥26 on the CPSS, indicating a significant degree of psychological stress. Nurses with high psychological stress had higher levels of anxiety symptoms (41.7% vs 8.0%), somatisation symptoms (31.4% vs 7.7%) and compulsion symptoms (62.3% vs 27.0%) than nurses with low psychological stress. Stepwise multiple linear regression revealed that weekly working hours, years of nursing experience, anxiety symptoms, somatisation symptoms and compulsion symptoms had a linear relationship with the participants' psychological stress scores.

CONCLUSION

Nurses experienced significant physical and psychological risk while working in the postepidemic period. Our findings suggest that nurses still need support to protect their physical and mental health.

Nurses and physicians attitudes towards factors related to hospitalized patient safety

INTRODUCTION

The attitudes of healthcare staff towards patients' safety, including awareness of the risk for adverse events, are significant elements of an organization's safety culture.

AIM OF RESEARCH

To evaluate nurses and physicians' attitudes towards factors influencing hospitalized patient safety.

MATERIALS AND METHODS

The research included 606 nurses and 527 physicians employed in surgical and medical wards in 21 Polish hospitals around the country. The Polish adaptation of the Safety Attitudes Questionnaire (SAQ) was used to evaluate the factors influencing attitudes towards patient safety.

RESULTS

Both nurses and physicians scored highest in stress recognition (SR) (71.6 and 80.86), while they evaluated working conditions (WC) the lowest (45.82 and 52,09). Nurses achieved statistically significantly lower scores compared to physicians in every aspect of the safety attitudes evaluation (p<0.05). The staff working in surgical wards obtained higher scores within stress recognition (SR) compared to the staff working in medical wards (78.12 vs. 73.72; p = 0.001). Overall, positive working conditions and effective teamwork can contribute to improving employees' attitudes towards patient safety.

CONCLUSIONS

The results help identify unit level vulnerabilities associated with staff attitudes toward patient safety. They underscore the importance of management strategies that account for staff coping with occupational stressors to improve patient safety.

Factors affecting the quality of work-life of nurses: a correlational study

BACKGROUND

Quality of work-life is an important factor in the recruitment and retention of the nursing workforce and their work productivity.

AIMS

This study aimed to identify factors that affect the quality of work-life of nurses.

METHODS

In this correlational study, 239 nurses employed in a tertiary teaching hospital in Iran completed the study questionnaires, including the quality of work-life questionnaire. The associations between potential independent variables and quality of work-life were examined using multivariate regression analysis.

RESULTS

Participants were mostly women (80.33%) and within the age range of 30-45 years (71.54%). Working in other hospitals, having a second job and health information-seeking behaviours were significant predictors of quality of work-life, explaining 28.68% of the total variance in quality of work-life of nurses.

CONCLUSIONS

Improving working standards may prevent nurses from working extra hours or in different occupations. This, along with facilitating the health information-seeking behaviours of nurses, may help improve their quality of work-life by maintaining a better work-life balance and acquiring knowledge and skills that can help with effective management of work and life commitments.

Work hours and overtime of nurses working in Cambodian hospitals

Aim

To examine the nature and prevalence of Cambodian nurses’ work hours and overtime and related factors

Background

The chronic shortage of nursing workforce is a major cause of overtime among nurses.

Introduction

Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses’ work hours and overtime in Cambodia have not been comprehensively examined.

Methods

A multicenter cross‐sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study.

Results

More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on‐call or 24‐h on‐call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more.

Conclusion

Overtime work and adverse nurse scheduling are common in Cambodia.

Implications for nursing and health policy

Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses’ work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24‐h on‐call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.

Comparison of 12 and 24-hours shift impacts on ICU nursing care, efficiency, safety, and work-life quality

BACKGROUND

Nursing care quality is a central concern of health policy, and nurses' shift schedules affect the quality of care and their work-life status internationally. A lack of reliable information on the differences between 24- and 12-h shifts on care quality, nursing care quality, patient safety, and adverse and missed events warranted investigation in Cambodia.

AIM

We aimed to examine the impacts of 12-h shifts compared with 24-h shifts. The purpose was to find evidence to support the use of maximum 12-h shifts by registered nurses working in ICU contexts.

METHOD

A convergent mixed-method approach was chosen to highlight the issues around the long hours of shift work. We designed a 12-week coaching course during the implementation of 12-h shifts and assigned 30 nurses each to an experimental group and a control group. Data from quantitative surveying of 58 participants were combined with focus group discussions of 20 participants to gather qualitative insights. Pre- and post-test analysis involved descriptive statistics and the Wilcoxon sign rank test for quantitative analysis and then merged with qualitative findings from content analysis. Reporting of this study was steered by the STROBE and COREQ guidelines for quantitative and qualitative findings, respectively.

RESULTS

Quantitative results showed the increased quality of nursing work-life, nursing care quality, and patient satisfaction; decreased missed care and adverse events were significantly associated with the 12-h shift. Qualitative data supported nurses preferring 12-h rather than 24-h shift options.

DISCUSSION AND CONCLUSIONS

Changing rosters to 12-h shifts in the intervention caused increases in the study variables' scores. Results indicate the benefits of 12-h shifts on the quality of nursing work-life, nursing care quality, missed care, adverse events, and patient safety.

IMPLICATIONS FOR NURSING AND NURSING POLICY

We found that 24-h shifts had deleterious impacts on care quality and safety and nurse satisfaction with work. Health and nursing policymakers are urged to provide resources and strategize to implement 12 h shifts as soon as possible since the current 24-h shifts of nurses affect the patient quality of care and their health and safety and that of the nurses.

Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement

Purpose

The objective of the present study is to explore the perceptions of patient safety culture (PSC) among King Fahd University Hospital’s (KFUH) employees and to develop recommendations to overcome the factors that impede the integration of PSC in the study setting.

Methods

This is a cross-sectional study that assessed the level of PSC at KFUH. This study used the Hospital Survey on Patient Safety Culture tool from all KFUH healthcare workers (n=900) in 2018.

Findings

The response rate of the study was 67%. Findings show that KFUH excelled in three PSC composites: continuous organizational learning, feedback and communication about error, and frequency of events reported. In contrast, staffing, teamwork within units, and non-punitive response to error yielded low composite scores.

Originality/Value

The strength of the present study was the use of a valid questionnaire that has been used widely in the literature with a large sample size, which yielded valid results. It is, to our knowledge, the first research study that analyzes health workers’ perceptions on patient safety culture in a teaching hospital in Eastern Province in KSA and compares it with Agency for Healthcare Research and Quality (AHRQ) and Saudi Hospital Survey on Patient Safety Culture (HSPSC). Results from the study highlight the need to employ an adequate number of workers, implement continuous patient safety training programs, and adopt safety programs and policies.

Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic?

BACKGROUND

Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses' globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom.

MAIN BODY

Nurses' health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses' workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses' employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health.

CONCLUSION

The protection of nurses' health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work-life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses' health and monitor the progress towards nurses' health equity.

Sleep quality and common mental disorder in the hospital Nursing team

Objective:

to determine the prevalence of sleep quality and common mental disorder in Nursing professionals and factors associated with sleep change.

Method:

a cross-sectional, analytical and quantitative study developed with 196 Nursing professionals of a public hospital and a mixed one. Data was collected by means of an instrument of sociodemographic characterization, by the Self-Report Questionnaire 20 and Pittsburgh Sleep Quality Index and were analyzed by descriptive and inferential statistics to identify possible factors associated with sleep changes.

Results:

sleep changes were identified among the Nursing professionals with a frequency of 76.5% (70.4-82.1). Sleep quality was classified as poor in 41.8% (41.8-55.6) and sleep disorder in 27.6%. (21.4-34.2). The prevalence of common mental disorder was identified in 36.7% (30.1-43.9). The main factor for poor sleep quality was the presence of common mental disorder (Odds Ratio: 5.15; p<0.001).

Conclusion:

sleep changes were prevalent and the characteristics of the work environment and the presence of mental disorder showed relevance in the changes.

Behaviours and experiences of nurses during the COVID-19 pandemic in Turkey: A mixed methods study

Aim

The aim of this work is to present behaviours and experiences of nurses in Turkey during the current coronavirus pandemic.

Background

The coronavirus pandemic leads to difficulties for most health care workers, especially for nurses who mostly accompany patients and are on the front line.

Methods

In the study, a parallel mixed pattern converging quantitative and qualitative research methods was used.

Results

The model revealed that 41 years old or older, diabetic, female, single professionals, working in the pandemic department took more personal measures. Five main themes appeared regarding the experiences of the nurses during the pandemic period: (1) psychological and mental strain; (2) personal protective equipment; (3) organizational, physical, and social strains; (4) change in professional values; (5) turning the crisis into an opportunity.

Conclusions

Personal measures are associated with the risk status. There is a need to protect nurses with significant measures by providing psychosocial support, meeting their basic needs, and preventing all complications likely to occur due to increasing workload.

Implications for Nursing Management

More efforts should be made to ensure good work, fair treatment, no tolerance for discrimination, and equal compensation conditions.

Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review

OBJECTIVE

The objective of this review was to determine the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings within low- and middle-income countries.

INTRODUCTION

Health care systems in low- and middle-income countries experience a high proportion of the global burden of disease, which is aggravated by several health care constraints. The high rates of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources make the provision of quality health care challenging in low- and middle-income countries. Health care systems in low- and middle-income countries, however, are still expected to address universal health care access and provide high-quality health care. Systematic reviews examining nurse staffing and its effect on patient and nurse workforce outcomes are largely from the perspective of high-income countries. There is a need to understand the evidence on nurse staffing and its impact in the context of low- and middle-income countries.

INCLUSION CRITERIA

Empirical studies that addressed acute care nurse staffing levels, such as nurse-to-patient ratio or nurses' qualifications, experience, and skill mix, and their influence on patient and nurse workforce outcomes were included in the review. Studies conducted in a low- or middle-income country were included. Outcomes must have been measured objectively using validated tools.

METHODS

Studies published until July 2019 were identified from CINAHL, PubMed, Scopus, Embase, PsycINFO, Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. Narrative synthesis was conducted due to high heterogeneity of included studies. The level of evidence was determined using GRADEpro.

RESULTS

Twenty-seven studies were included in this review and the level of evidence was low, mainly due to the design of included studies. Low nurse-to-patient ratio or high nurse workload was associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls, and abandonment of treatment. Findings on the effect of nurse staffing on length of hospital stay and incidence of pressure ulcers were inconsistent. Extended work hours, less experience, and working night or weekend shifts all significantly increased medication errors. Higher nurse workload was linked to higher levels of nurses' burnout, needlestick and sharps injuries, intent to leave, and absenteeism.

CONCLUSIONS

Lower nurse-to-patient ratios and higher nurse workload are linked to in-hospital mortality, hospital-acquired infections, and medication errors among patients, and high levels of burnout, needlestick and sharps injuries, absenteeism, and intention to leave their job among nurses in low- and middle-income countries. The results of this review show similarities with the evidence from high-income countries regarding poor outcomes for patients and nurses. These findings should be considered in light of the lower nurse-to-patient ratios in most low- and middle-income countries.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018119428.

Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey

Background

The Coronavirus disease (COVID-19) pandemic is an ongoing pandemic all over the world, leading to 126, 372, 442 people diagnosed and 2, 769, 696 deaths globally as of March 28, 2021. Nurses are providing care to patients with COVID-19 who require hospitalization. To ensure adequate response capacity and to maintain the health of nurses, it is important to analyse the actual work hours and the nurses reported preferred work hours per shift among frontline nurses.

Objective

To analyse the actual work hours and preferred work hours per shift of nurses reports among frontline nurses fighting the COVID-19 epidemic and to explore the influencing factors on the nurses reported preferred work hours.

Design

Cross-sectional survey.

Settings

This study was conducted in 10 designated hospitals providing treatments to patients with COVID-19 in China.

Participants

Nurses providing care to patients with COVID-19 in designated hospitals in China.

Methods

A questionnaire with open-ended questions was used to assess frontline nurses caring for COVID-19 cases in 10 designated hospitals. Quantitative and qualitative methods were used to analyse the actual work hours, the nurses reported preferred work hours and factors influencing nurses reported preferred work hours among the frontline nurses.

Results

A total of 109 nurses responded to the survey. The shift length exceeded the nurses' preferred work hours [Median (interquartile range): 5.00 (2.00) h vs 4.00 (2.00) h; Minimum-Maximum: 4-12 h vs 4-8 h], and 60.55% (66/109) of the nurses regarded 4 h as the preferred number of work hours per shift. Five key themes associated with the influencing factors emerged, including circumstances; personal preventable equipment; the nurses' physical and emotional needs of nurse; and the nurses' safety needs and work intensity.

Conclusions

These findings suggest that there is a gap between the actual work hours and the nurses preferred work hours among frontline nurses in different units and different posts. The main influencing factors were circumstances, personal protective equipment, the nurses' physical and emotional needs, and the nurses' safety needs and work intensity.

Relationships between comprehensive characteristics of nurse work schedules and adverse patient outcomes: A systematic literature review

AIMS

To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes.

BACKGROUND

To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses' work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety.

DESIGN

A systematic review of nursing and healthcare literature was conducted in this study.

METHODS

Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

RESULTS

From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes.

CONCLUSIONS

This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.

Individual differences and emotional labor: the effects of core self-evaluations on depersonalization

This paper examines the role of core self-evaluations (CSEs) in the relationships among emotional demands, emotional dissonance, and depersonalization. Data were collected from a non-random sample of 423 teachers who worked in primary, secondary, and higher education institutions. Results from structural equation modeling analysis showed that CSEs displayed both direct and indirect effects on depersonalization through employees' perceptions and reactions to emotional labor. Specifically, those individuals with more positive CSEs tended to perceive the emotional aspects of their job as less demanding, thus being less likely to experience emotional dissonance and, in turn, depersonalization. This research demonstrated that CSEs play a vital role in explaining employees' reactions to emotional labor and, therefore, their effects should be properly accounted for in future studies. Implications for practice and future lines of research are discussed in this paper.

End-of-Life Care Related Distress in the PICU and NICU: A Cross-Sectional Survey in a German Tertiary Center

Objective: To investigate and compare nurses' perceived care-related distress and experiences in end-of-life situations in neonatal and pediatric intensive care units. Study design: Single-center, cross-sectional survey. Administration of an anonymous self-report questionnaire survey to nurses of two tertiary neonatal intensive care units (NICUs), and two tertiary pediatric intensive care units (PICUs) in Berlin, Germany. Results: Seventy-three (73/227, response rate 32.2%) nurses completed surveys. Both, NICU (32/49; 65.3%) and PICU (24/24; 100.0%) nurses, reported "staffing shortages" to be the most frequent source of distress in end-of-life situations. However, when asked for the most distressing factor, the most common response by NICU nurses (17/49) was "lack of clearly defined and agreed upon therapeutic goals", while for PICU nurses (12/24) it was "insufficient time and staffing". No significant differences were found in reported distress-related symptoms in NICU and PICU nurses. The interventions rated by NICU nurses as most helpful for coping were: "discussion time before the patient's death" (89.6%), "team support" (87.5%), and "discussion time after the patient's death" (87.5%). PICU nurses identified "compassion" (98.8%), "team support", "personal/private life (family, friends, hobbies)", and "discussion time after the patient's death" (all 87.5%) as most helpful. Conclusions: Distress-related symptoms as a result of end-of-life care were commonly reported by NICU and PICU nurses. The most frequent and distressing factors in end-of-life situations might be reduced by improving institutional/organizational factors. Addressing the consequences of redirection of care, however, seems to be a more relevant issue for the relief of distress associated with end-of-life situations in NICU, as compared to PICU nurses.

Burnout among Nurses during Coronavirus Disease 2019 Outbreak in Shiraz

BACKGROUND

The function of healthcare workers, particularly nursing staff, in taking care of coronavirus disease 2019 (COVID-19) patients, cannot be overemphasized. As the pandemic lasts, burnout among the nursing staff needs to be considered as an important challenge. This was aimed to assess the nurses' burnout and factors affecting this variable.

MATERIALS AND METHODS

In this cross-sectional study, Maslach Burnout Inventory was completed by 261 nurses in Shiraz hospitals (Iran) in April 2020. This questionnaire addresses different aspects, including emotional exhaustion, personal achievement, and depersonalization, to determine the intensity of perceived burnout among nurses during the outbreak.

RESULTS

Our data demonstrated that the nurses' burnout in Shiraz hospitals during the COVID-19 pandemic was high (64.6%). Emotional exhaustion and depersonalization were observed in 63.6 and 53.3 percent of the participants, respectively. Moreover, the rate of successful personal achievement among these nurses was >97%. Work experience <10 years (P=0.016), hospital ward (P=0.044), the number of deaths observed by nurses during the COVID-19 pandemic (P<0.001), and the total number of shifts during the COVID-19 pandemic (P=0.006) had a positive correlation with emotional exhaustion.

CONCLUSION

Workload and stress resulting from the COVID-19 outbreak seem to be one of the major causes of emotional exhaustion in nurses. The emotional exhaustion among nurses must be considered in epidemics, such as COVID-19.

Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea

PURPOSE

This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment.

DESIGN

This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018.

METHODS

A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods.

FINDINGS

The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment.

CONCLUSIONS

This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes.

CLINICAL RELEVANCE

Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.

Strategies to prevent missed nursing care: An international qualitative study based upon a positive deviance approach

AIM

To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis.

BACKGROUND

Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place.

METHOD(S)

An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC.

RESULTS

Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC.

CONCLUSION

Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other.

IMPLICATIONS FOR NURSING MANAGEMENT

Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required.

Work environment-related factors and nurses' health outcomes: a cross-sectional study in Lebanese hospitals

Background

Worldwide, studies show a relationship between nurses’ health and some work environment factors; however, data on nurses’ health and self-perceived workload and nursing task allocation are lacking, particularly for Lebanese nurses. We assessed the relationship of several work environment factors: overall workload and specific temporal, physical, mental, effort, frustration, and performance demands (NASA Task Load Index), staffing resources and adequacy and leadership (Practice Environment Scale of Nursing Work Index), teamwork climate (Safety Attitudes Questionnaire), and nursing task allocation (Basel Extent of Rationing of Nursing Care)) with self-reported musculoskeletal, cardiovascular, skin, and mental health diseases (Work Ability Index) and emotional exhaustion (Maslach Burnout Inventory) among Lebanese nurses.

Methods

A cross-sectional self-report survey was distributed to all 289 registered nurses (RNs) in the medical, surgical, and pediatric units in two Lebanese university-affiliated hospitals; 170 RNs had complete data. Adjusted multivariable logistic regression models were used to estimate the association between work environment factors and health outcomes.

Results

The most prevalent outcomes were musculoskeletal disease (69%), emotional exhaustion (59%), and mental health problems (56%); 70% of RNs had ≥2 and 35.29% had ≥4 co-occurring health problems. Musculoskeletal disease was associated with higher overall (OR = 1.36 (95%CI = 1.03, 1.80)), temporal (OR = 1.30 (95%CI = 1.09, 1.55)), and physical demands (OR = 1.20 (95%CI = 1.03, 1.49)), higher task allocation to RNs (OR = 1.11 (95%CI = 1.01, 1.23)) and lower teamwork climate (OR = 0.60 (95%CI = 0.36, 0.98). Higher odds of mental/emotional problems were associated with higher overall, temporal, frustration, and effort demands, and lower teamwork climate, performance satisfaction, and resources adequacy (increased odds ranging from 18 to 88%). Work environment indicators were associated with higher co-occurrence of health problems.

Conclusions

Results show elevated health burden and co-morbidity among Lebanese RNs and highlight the value of comprehensive approaches that can simultaneously improve several work environment factors (namely self-perceived workload, teamwork,, resources, and nursing task allocation) to reduce this burden.

"It is really so exhausting": Exploring intensive care nurses' perceptions of 24-hour long shifts

AIM AND OBJECTIVES

To explore the perceptions and experiences of Cambodian ICU registered nurses regarding their working 24-hr shifts.

BACKGROUND

In Europe and the USA, nurses are moving to a 12-hr shift, and numerous studies have revealed the positive and negative effects of these. However, lesser known is the impact of 24-hr nursing shifts on care quality, and health and safety. In Cambodia, 100% of nurses are rostered for these in their shift patterns, but until this study no research had been conducted on such shifts.

DESIGN

A qualitative descriptive study.

METHOD

Three focus group discussions were conducted with 30 registered nurses in July 2019, ten in each group, from three intensive care units of three hospitals in Cambodia. Data saturation was obtained. Data were analysed using content analysis, and the COREQ was applied for reporting this study.

FINDINGS

The ICU nurses' perspectives revealed significant and unacceptable effects of working shifts of ~25-hr length, taking into account staff handover. Two major themes arose: It is so exhausting and Compromised hospital care. Alarmingly, participants worked on average 72 hr per week, were exhausted, and nursed between 6 and 10 critically ill patients per shift.

CONCLUSION

To our knowledge this is the first study on nurses working 24-hr shifts, revealing unacceptable, high risks for the health and safety of nurses and patients, with nursing activities left undone, and a lack of quality care.

RELEVANCE TO CLINICAL PRACTICE

Improving nurse and patient health and safety, and quality of care requires hospital leaders to work with government and nursing organisations to develop better shift strategies. Resources need to be provided so that: nurses can work a maximum 12-hr shifts; the ratio of nurses to patients is improved; and nurses can have decent break times. This has major implications, for not only practice, but also management, administration, budgets and education.

WITHDRAWN: Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Factors affecting the occupational accident rates among nurses

OBJECTIVE

In this hospital-based study, we aimed to determine occupational accident perceptions and occupational accident reasons in sample of Turkish nurses.

METHOD

In the study, the Epworth Sleepiness Scale, the Workload Scale and a Study Questionnaire Form including the employment characteristics of the nurses, their socio demographic characteristics, and the occupational accidents they encountered.

RESULTS

108 nurses (90 females, 18 males; mean age, 26.42±5.5 years) participated in the study. 68.5% of nurses have undergone at least once a occupational accident. Most of the participants were found to have experienced occupational accidents with approximately half evaluating their occupational accidents risk as high. Most of the nurses worked overtime and in shifts. The mean total scores for the Epworth Sleepiness Scale and Workload Scale were respectively 9.09±3.33 and 36.94±6.42. Statistically significant differences in occupational accidents were found with regard to Epworth Sleepiness Scale and Workload Scale scores, working in shifts, and working overtime (p<0.05).

CONCLUSION

It was concluded that nurses had very high rates of occupational accidents and that the heavy work conditions affected occupational accidents.

Psychometric properties of the Korean version of the Occupational Fatigue Exhaustion Recovery Scale in a nurse population

Most nurses in Korea work rotating shifts, an important contributor to fatigue. The Occupational Fatigue Exhaustion Recovery (OFER) Scale assesses work-related fatigue among nurses. In this study, we aimed to translate and culturally adapt the Korean version of this scale (OFER-K) with nurses working rotating shifts in Korea. Instrument adaptation was performed using committee-based translation, cognitive interviewing, and expert panel interviewing. Criterion validity, convergent validity, construct validity, internal consistency, and test-retest reliability were examined as psychometric properties of the OFER-K. An online survey was completed by 331 nurses; 107 of these nurses completed a second survey after 1 month to assess test-retest reliability. The overall Cronbach's alpha was 0.88. The correlation between participants' initial and retest responses for the total scale was 0.64 (p < .001). The chronic fatigue subscale was stable over time, t(106) = -1.76, p = .08. Criterion and convergent validity were supported by correlations between the OFER-K scale and the Chalder Fatigue Questionnaire, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. Confirmatory factor analysis showed a good fit using a three-factor model. The findings of this study showed that the OFER-K scale is a reliable and valid instrument for assessing chronic fatigue, acute fatigue, and inter-shift recovery in Korean nurses. Future research using this scale may lead to a better understanding of the antecedents and consequences of nurse fatigue and could provide important information to nurse researchers, administrators, and policymakers for developing interventions to reduce nurse fatigue.

Exploring nurses' work-related stress in an acute care hospital in KSA

Objectives

This study aimed to assess the perceived work-related-stress of staff nurses and determine the relationship between work-related stress and demographic profile.

Methods

This study used a descriptive cross-sectional design and was conducted in a secondary public hospital (staff nurses = 178, bed capacity = 225) in Riyadh, KSA. The hospital provides medical and surgical services that are important to achieve optimum quality patient care and services. In total, 178 staff nurses were interviewed, but 15 responses were excluded because of missing data (response rate: 92.52%).

Results

Nurses reported a moderately stressful work environment. Nationality was found to be a significant predictor of nurses' stress levels. Indian nurses had higher stress levels compared with nurses of other nationalities. Working hours per week was another significant predictor of stress.

Conclusion

This study highlighted perceived work-related stress of staff nurses and determined the relationship between work-related stress and demographic profile. Most nurses were moderately stressed. Working hours were associated directly with stress level. The study findings can serve as a guide for establishing human resources policies aiming at reducing nurses' stress and, thereby, promoting improved health care and task force work performance.

Sleep disturbances and related factors among nurses

The aim of this study was to describe patterns and potential risk factors for sleep disturbances, including that of sleep apnea, among Thai registered nurses. A descriptive, cross-sectional design was implemented. A sample of 233 registered nurses was recruited from 10 nursing departments from a tertiary hospital. Participants completed a one-time, self-report questionnaire and a 1 week-long sleep diary. Descriptive and logistic regression statistics were used for the analysis. Approximately 76% of nurses slept less than 7 h, 12.3% had difficulty initiating sleep, and 5% had difficulty maintaining sleep. Short sleep duration was prevalent, and night shift work schedules that exceeded 10 episodes/month were perceived as contributing to difficulties with initiating sleep. After excluding males from the analysis, the risk for depression related to short sleep duration becomes statistically significant. Organizational policies for registered nurses' shift work should include effective management of night shift assignments, as well as interventional strategies and policy directions, to promote sleep quality and mental health to ensure nurse well-being and patient safety.

Subtypes of overtime work and nurses' fatigue, mental status, and work engagement: A latent class analysis of Japanese hospital nurses

AIMS

To clarify the subgroups of overtime work motivations and to determine how fatigue, mental status, and work engagement differ among the subgroups.

DESIGN

Cross-sectional.

METHODS

Questionnaires were distributed to 1,075 full-time nurses working in four hospitals in Japan from October 2015 - February 2016. Nurses were categorized into subgroups of overtime work motivation by latent class analysis. An analysis of covariance was conducted to examine how fatigue, mental status, and work engagement differ among subgroups.

RESULTS/FINDINGS

We identified five types of overtime workers differing greatly in fatigue, mental status, and work engagement.

CONCLUSIONS

Even when nurses worked approximately the same work hours, the difference in motivation corresponded to different degrees of fatigue, mental status, and work engagement. When introducing policies to reduce overtime work, managers should consider the different groups of overtime workers, as effective measures may differ.

Attitudes towards patient safety culture among postgraduate nursing students in China: A cross-sectional study

Patient safety is crucial to healthcare quality. It is important to assess the nursing students' safety attitudes to identify the weaknesses for developing education program and fostering students' engagement in patient safety practices. This study aimed to assess attitudes towards patient safety culture among postgraduate nursing students in China, and explore the factors that affect their safety attitudes and the relationships of safety attitudes and safety-related behaviors. This study used a cross-sectional survey design. A convenience sample of 231 postgraduate nursing students from ten medical universities in China completed the Chinese version of Safety Attitude Questionnaire, including six domains: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions and stress recognition. The mean scores of the six domains ranged from 65.22 to 70.75 on a 100-point scale. Percentages of positive responses for the six domains were below 55%, with the two lowest percentages for working conditions (35.9%) and safety climate (30.7%). Significantly lower domain scores were found in students with younger age, no work experience, higher workload and received safety education. There were positive correlations between the six domains and safety-related behaviors except for stress recognition. Nursing educators should focus more on the improvement of patient safety education and establishment of supportive work environment to enhance postgraduate nursing students' attitudes towards safety culture.

Multidimensional Rasch Analysis of the Arabic Occupational Fatigue Exhaustion Recovery Subscales

Background and Purpose

Investigation of the psychometric properties of the Arabic version of the Occupational Fatigue Exhaustion Recovery (A-OFER) subscales.

Methods

Partial credit model (PCM) analyses of 2037 Lebanese nurses' responses to the chronic fatigue (CF), acute fatigue (AF), and intershift recovery (IR) subscales.

Results

The data were a better fit to the three-dimensional Rasch PCM; difference, χ2 = 2199.3, df = 5, p = .01; unidimensional Akaike information criterion (AIC) = 107355; multidimensional AIC = 105166. Rating categories were disordered and there was item dependence among negatively-keyed items. All items were free of subgroup bias. Inter-subscale correlations were contrary to expectations.

Conclusion

The CF subscale has sufficient reliability for screening nurses in Lebanon and the Eastern Mediterranean region for low to moderate levels of occupational fatigue. The construct validity of the A-OFER requires further investigation.

Healthy working time arrangements for healthcare personnel and patients: a systematic literature review

BACKGROUND

A number of working time arrangements have been linked to negative consequences for both health personnel and their patients. A common hypothesis put forth to explain these findings suggests that certain working time arrangements lead to negative patient consequences due to the adverse impact they have on employee health. The purpose of this study is to use systematic reviews to investigate whether employee health explains the relationship between working time arrangements and patient safety.

METHODS

A systematic literature review was performed including published reviews and original studies from MEDLINE, PsycINFO, Cinahl and Web of Science investigating working time arrangements for healthcare personnel, employee health and patient safety. In addition, we screened reference lists of identified reviews. Two reviewers independently identified relevant publications according to inclusion criteria, extracted findings and assessed quality.

RESULTS

Six thousand nine hundred thirty papers were identified, of which 52 studies met our criteria. Articles were categorized into five groups according to how they approached the research question: 1) independent analyses of relationship between working time arrangements and employee health, and of working time arrangements and patient safety (5 studies); 2) relationship between working time arrangements on both employee health and patient safety (21 studies); 3) working time arrangements and employee health as two explanatory variables for patient safety (8 studies); 4) combinations of the above analyses (7 studies); 5) other relevant studies (5 studies). Studies that find that working time is detrimental to employee health, generally also find detrimental results for patient safety. This is particularly shown through increases in errors by health personnel. When controlling for employee health, the relationship between working time arrangements and patient safety is reduced, but still significant.

CONCLUSIONS

Results suggest that employee health partially (but not completely) mediates the relationship between working time arrangements and patient safety. However, there is a lack of studies directly investigating employee health as a mediator between working time arrangements and patient safety. Future studies should address this research gap.

Skills and Practices of European Orthopedic Nurses in Empowering Patient Education

Purpose: This study provides an overview of the self-defined skills and practices of European orthopedic nurses in empowering patient education. Nurses themselves have highlighted the necessity to enhance their own skills, but possibilities for further education have been limited. Methods: The data (n = 317 nurses) from a structured survey were collected during the years 2009–2012 in seven European countries with an EPNURSE—questionnaire (Empowering Patient Education from the point of view of Nurses). Results: Nurses considered patient education as an important part of their work and evaluated their own skills as good. However, their patient education practices were based more on practices on their ward and their own experience than on further education or evidence-based knowledge. On the other hand, lack of time for patient education and experienced overload were the major barriers experienced by nurses. Implications for Practice: Further education of orthopedic nurses in empowering evidence-based patient education is highly needed. Nurse leaders need to acknowledge the strong need for supporting nurses within clinical practice, improve their evidence-based knowledge and support practices that prioritize patient education within the hospital environment. Further international collaboration in nursing research and health-care organizations is desirable to reach these patient educational goals in clinical nursing practice.

Self-reported environmental health risks of nurses working in hospital surgical units

AIM

This study investigated the occupational health risk factors among nurses who work in public hospital surgical units.

BACKGROUND

Nursing has a significant place in healthcare systems around the world. Surgical units are environments with certain risks, especially because of the possibility of exposure to various chemical, biologic or physical hazards.

METHODS

This study was conducted with 229 nurses who were working in the 11 surgery units of a big university hospital. In this cross-sectional study, a personal information form and an occupational risk factors scale were administered to respondents. We performed factor and reliability analyses for the scale; the overall reliability of the 41 items was α = 0.924, and the factor analysis found the scale was feasible.

RESULTS

Biologic and psychological risk factor levels were found to be high. Physical, chemical, ergonomic and radiation risk factor levels were moderate. The general occupational risk factor score was moderate. Nurses working night duty were confronted with physical and psychological risk factors at a higher rate compared with those working in the daytime.

CONCLUSION

Reported occupational health problems by nurses were correlated with the descriptive properties of the nurses including age, sex, marital status, education level, working hours, mode of working and status of occupational health and safety training.

IMPLICATIONS FOR NURSING

Nurses experience different occupational risks. If these risks are identified, healthier working environments can be provided to the nurses by taking necessary precautions.

IMPLICATIONS FOR SOCIAL POLICY

The health care provided by nurses who work in a healthy environment would be more efficient and of better quality, which will result in better economic and social outcomes for individual and communities.

Satisfaction, burnout and intention to stay of emergency nurses in Shanghai

Background

Stability of the nursing workforce is considered a key factor for high-quality healthcare. Satisfaction and burnout are reported to be closely related to staff turnover. This study investigates satisfaction and burnout of ED nurses in Shanghai and association of these factors with intention to stay on the job.

Methods

This is a cross-sectional descriptive survey study conducted between October and December 2015. Our own questionnaire and the Maslach Burnout Inventory were used to construct the survey. The convenience sampling method was used. The survey targeted ED nurses in 30 Shanghai hospitals. Data were analysed using descriptive, non-paired t-tests, analysis of variance and multivariable logistic regression to decipher possible causes for burnout and identify reasons for continued interest in staying on the job by ED nurses.

Results

Of 1137 nurses who received surveys, 976 (87%) responded. Among the respondents, 75% reported being very satisfied or satisfied with their jobs, but there was a high level of burnout, and 22.5% of the nurses expressed their intention to leave the ED within the following year (p<0.05). Nurses’ satisfaction and burnout were associated with intention to leave. Salary, nurse–patient relationships, nurse staffing and work environment were areas where nurses were less satisfied, while group cohesion was associated with greater satisfaction.

Conclusion

ED nurses in Shanghai report a high level of burnout, which is associated with an intention to leave their jobs. Interventions are needed to improve satisfaction and reduce burnout to maintain the stability of the nursing workforce.

Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections

OBJECTIVE

To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates.

STUDY DESIGN

Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects.

RESULTS

We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34).

CONCLUSION

Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.

Nursing perceptions of patient safety climate in the Gaza Strip, Palestine

AIMS

This study was undertaken to assess the perception of nurses about patient safety culture and to test whether it is significantly affected by the nurses' position, age, experience and working hours.

BACKGROUND

Patient safety has sparked the interest of healthcare mangers, yet there is limited knowledge about the current patient safety culture among nurses in the Gaza Strip.

METHODS

This was a descriptive cross-sectional study, administering the Arabic Safety Attitude Questionnaire (Short Form 2006) to 210 nurses in four public general hospitals.

RESULTS

Job Satisfaction was the most highly perceived factor affecting patient safety, followed by Perception of Management. Safety culture varied across nursing position, age, work experience and working hours. Nurse Managers had more positive attitudes towards patients than frontline clinicians did. The more experience nurses had, the better their attitudes towards patient safety. Nurses who worked the minimum weekly required hours and who were 35 years and older had better attitudes towards all patient safety dimensions except for Stress Recognition. Nurses with a positive attitude had better collaboration with healthcare professionals than those without a positive attitude.

LIMITATION

Generalization is limited, as nurses who worked in private and specialized hospitals were excluded.

CONCLUSION

Evaluation of the safety culture is the essential starting point to identify hindrances or drivers for safe patient care. Job Satisfaction, Perception of Management and Teamwork necessitate reinforcement, while Working Conditions, Stress Recognition and Safety Climate require improvement.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Ensuring job satisfaction through adequate staffing levels, providing incentives and maintaining a collegial environment require both strategic planning and institutional policies at the higher administrative level. Creation of a non-punitive and learning environment, promoting open communication and fostering continuous education should be fundamental aspects of hospital management. A policy of mixing experienced nurses with inexperienced nurses should be considered.