Disentangling the effects of psychological and physical work demands on sleep, recovery and maladaptive chronic stress outcomes within a large sample of Australian nurses

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BACKGROUND

Staff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.

METHODS

A comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).

RESULTS

A total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.

CONCLUSION

Current evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.

Tagesschläfrigkeit bei Pflegepersonal

Hintergrund

Aufgrund von Arbeitszeiten, die außerhalb der normalen Tagesarbeitszeit liegen, kann es bei Pflegepersonal zu Störungen der inneren Uhr kommen. Durch zusätzliche Verpflichtungen im familiären Bereich kann sich möglicherweise eine Normalisierung der zirkadianen Störung bei weiblichen Pflegenden erschweren, da sie zu Hause nicht genug Zeit für Schlaf und Erholung finden.

Fragestellung

In der vorliegenden Arbeit soll explorativ untersucht werden, ob Beschäftigte in der Pflege ein höheres Risiko für Tagesschläfrigkeit haben als andere Berufsgruppen, die nicht im Schichtdienst arbeiten. Darüber hinaus soll ebenfalls explorativ analysiert werden, inwiefern das Geschlecht in Verbindung mit der Beschäftigung im Schichtdienst eine Rolle hinsichtlich der Tagesschläfrigkeit spielt.

Material und Methoden

Aus der 10.000er Baselinestichprobe der Hamburg City Health Study (HCHS) wurden alle Proband:innen selektiert, die beruflich in der Pflege tätig waren. Anhand des Alters, des Geschlechts und des Chronotyps wurden aus dem HCHS-Datensatz aktiv Beschäftigte im Verhältnis 1:3 gezogen, die aus Branchen mit vorwiegend keiner Schichtarbeit stammen (Kontrollen). Die Tagesschläfrigkeit wurde anhand des Epworth-Sleepiness-Scale-Fragebogens (ESS) erhoben.

Ergebnisse

In der Gesamtstichprobe der HCHS waren 4646 Personen aktiv beschäftigt. Unter diesen befanden sich 134 Personen, die angaben, in der Pflege zu arbeiten. Anhand des Matchings von 1:3 wurde ein Datensatz von 536 Personen erzeugt. Insgesamt konnte für 19 % der Stichprobe eine exzessive Tagesschläfrigkeit beobachtet werden, davon betroffen waren 25 % der Pflegenden und 17 % der Beschäftigten anderer Branchen. Weibliche Beschäftigte in der Pflege hatten im Vergleich zu Männern aus anderen Branchen ein statistisch signifikant erhöhtes Risiko für exzessive Tagesschläfrigkeit (OR 3,5; 95 % KI 1,32–9,23).

Diskussion

Anhand der Ergebnisse der bevölkerungsbezogenen Untersuchung zeigt sich, dass Pflegepersonal im Vergleich zu Branchen ohne Schichtarbeit öfter von Tagesschläfrigkeit betroffen ist. Inwieweit Frauen, die in der Pflege arbeiten ein noch höheres Risiko für Tagesschläfrigkeit besitzen, sollte in weiteren Studien anhand zusätzlicher Merkmale präziser untersucht werden.

A human factors approach to evaluate predicators of acute care nurse occupational fatigue

Nurses function at the point of care and assume a significant role in intercepting errors. They work in a mentally and physically demanding profession that is comprised of shift-work, subjecting nurses to considerable fatigue. Yet, few studies constructed a comprehensive model that integrates personal and occupational factors to explore their relationship with various types of fatigue (acute, chronic, physical, mental, and total). Here, we examine this type of comprehensive fatigue-model, in a report that represents one aim of a larger, mixed-methods study. The study sample comprised of 1137 registered nurses working in eight hospitals in a Midwestern state. Nurses reported higher levels of acute and total fatigue than chronic and physical fatigue. Staffing and resource adequacy, exercise, and sleep were among the strongest predictors. Since fatigue is a multi-faceted construct, a comprehensive fatigue-management strategy that targets both day and night-shift nurses is the optimal way to manage nurse fatigue.

Profiling resilience: A latent profile analysis of German nurses' coping and resilience

Introduction

Because of the shortage of nurses, it becomes crucial for organizations and health systems to keep nurses in their workforce. As individual resilience is positively associated with organizational commitment and negatively with mental disorders, it may reduce nurses' intention to leave the profession. Thus, individual resilience gained attention in research. Nevertheless, there is no common conceptualization of individual resilience in the literature. Rather, three prevalent understandings exist. Due to these multiple understandings, the role of coping in the context of resilience remains unclear. Against this background, the aim of this study is to analyze the relationship between nurses' resilience and coping based on a person-centered approach.

Methods

This study presents a latent profile analysis based on a survey of 210 German nurses. The profiles were generated based on the Brief Resilience Scale and Brief COPE. The Perceived Workload of Nurses' Scale and sociodemographic data were considered as explanatory factors using nominal logistic regression. Further, the relation with possible consequences was tested by χ²-test using the Irritation Scale and KUT Commitment Measure.

Results

The study identifies four different profiles of coping and resilience. The profiles "resistant" and "social-active" show rather low irritations and high organizational commitment. The "passive" profile has lower irritation scores than the "solitary" profile does, but the "passive" profile is associated with more irritation than the "resistant" or the "social-active" profile. Whereas the other profiles include characteristics of resilience, the "solitary" profile has a vulnerable nature. The analysis shows that more coordination and information problems, higher age, and not being in a leadership role are associated with a higher probability of belonging to the "solitary" profile. The chance of belonging to the "solitary" profile is significantly higher for women than for men, whereas women have a significantly lower chance of belonging to the "resistant" profile, compared to men.

Conclusion

The analysis shows that the three prevalent understandings of resilience are appropriate but it also indicates that future scientific debate requires more precision in defining individual resilience. The study contributes to sharpening the definition of resilience as well as to understanding the link between coping and resilience.

Evaluating the physical, psychosocial and ergonomic burden of lead aprons among Jordanian interventionists: a nationwide study

Objectives. This study assessed the physical and psychological burden of lead apron use on Jordanian interventionists and investigated the attitudes and knowledge of interventional personnel toward ergonomic guidelines and practices. Methods. A cross-sectional investigation of a randomly sampled Jordanian cohort of interventional personnel was conducted using a self-administered questionnaire.

Results. A nationwide sample of 130 practitioners with a mean 9.3 ± 8.1 years of experience in interventional procedures participated. Practitioners were aware of their apron's weight but not of its lead equivalence (71.5%). More than 60% of respondents complained of back pain. While 66.9% did not develop musculoskeletal pathologies, 64.3% of those with already established musculoskeletal pathologies experienced worse pain due to apron usage. Despite believing in the effect of lead aprons on muscular strain and work performance, 78.5% adhere to its usage. In terms of ergonomics, only 39.2% were aware of ergonomic guidelines; however, 90.0% believe that ergonomic practices are essential as 49.2% have experienced discomfort due to bad ergonomics. In terms of psychological burden, anxiety and depression were suggested in 16.4 and 21.6% of the sample.

Conclusion. Jordanian interventionists portray positive attitudes toward lead aprons; nevertheless, their awareness of ergonomic practices warrants the implementation of evidenced-based interventions.

Work schedule characteristics and occupational fatigue/recovery among rotating-shift nurses: A cross-sectional study

AIMS

To determine the effects of work schedule characteristics on occupational fatigue and recovery among rotating-shift nurses in South Korea.

BACKGROUND

Understanding the effects of work schedule characteristics on occupational fatigue is important to prevent adverse nurse outcomes and to ensure patient safety.

METHODS

This study used secondary data analysis with a cross-sectional design. Data were collected on 436 rotating-shift nurses in 2018. Nurses' occupational fatigue and recovery were measured using the Occupational Fatigue Exhaustion/Recovery Scale. We used quantile regression models.

RESULTS

The scores for acute and chronic fatigue and intershift recovery were 70.40, 73.39, and 29.82, respectively. Overtime hours, number of night shifts, number of consecutive days off, and breaks were significant influential factors in some quantiles of acute fatigue, chronic fatigue, and intershift recovery, while total working hours was only associated with chronic fatigue in the 25th quantile.

CONCLUSIONS

The quantile and linear regression models revealed different results for work schedule factors that affect occupational fatigue and intershift recovery among rotating-shift nurses.

IMPLICATION FOR NURSING MANAGEMENT

These findings have important implications for developing targeted strategies and policies to reduce occupational fatigue and improve intershift recovery for rotating-shift nurses with different levels of occupational fatigue and recovery.

Why Victimized Employees Become Less Engaged at Work: An Integrated Model for Testing the Mediating Role of Sleep Quality

Recent studies have shown that workplace victimization is negatively related to work engagement. The explanations for the underlying mechanisms, however, are still in a nascent stage. Drawing on the limited resource theory of self-regulation and research on workplace aggression and sleep, we develop and test an integrated model, which explains that victimized employees may have impaired sleep quality and thus have less energy and be less likely to be engaged in their work. The results of logistic regression and structural equation modeling analyses of large-scale survey data collected from 90,272 employees across the years 2010, 2011, 2014, and 2017, indicate that workplace victimization is negatively related to sleep quality and subsequent workplace engagement, even controlling for alternative explanations-job insecurity and basic psychological needs for competence, autonomy, and relatedness. Our findings advance our knowledge on the detrimental consequences of workplace victimization and suggest that, while unmet basic psychological needs matter, impaired sleep quality is one reason why victimized employees find it difficult to engage at work.

Reducing stress, anxiety and depression in undergraduate nursing students: Systematic review

OBJECTIVE

Undergraduate nursing students may experience high levels of stress, anxiety or depression. This can not only influence their personal wellbeing and academic performance, but also communication with patients during clinical placement and the quality and safety of the healthcare delivered. The objective of the review was to identify interventions that target stress, anxiety or depressed mood in undergraduate nursing students during their undergraduate course.

REVIEW METHOD

A quantitative systematic review, guided by the Joanna Briggs Institute methodology, was conducted. The review considered studies that included undergraduate nurses, and which evaluated interventions targeting stress, anxiety and depressed mood. The review included experimental studies published in English from 2008 to 2018. A tabulated and narrative summary was utilised to present the results.

RESULTS

A total of 1579 studies were identified following a systematic search and 931 studies were screened by title and abstract. A total of 44 studies were critically appraised resulting in 22 studies for inclusion in the systematic review. The studies focused on stress (10 studies), anxiety (14 studies) and depression (7 studies). The majority of the studies (18 of 22) reported a statistically significant reduction in the stress, anxiety or depression experienced by nursing students who participated in interventions targeting these symptoms. Interventions that sought to improve coping management skills, such as mindfulness-based interventions, were most reported.

CONCLUSION

There are a range of effective interventions that target stress, anxiety or depressed mood among nursing students. The quality of the studies reporting these interventions was found to be variable and generally samples were small with limited follow-up. Studies of mindfulness interventions comprised the largest sample sizes, displayed the highest levels of evidence, and transcended stress, anxiety and depressed mood. Future research would benefit from a co-ordinated approach to build the strength of the body of evidence.

The effect of work-related psychosocial stressors on musculoskeletal disorder symptoms in hospital attendants

BACKGROUND

Psychosocial stress at work is an important issue among hospital attendants.

OBJECTIVE

This study aimed to examine psychosocial stressors in the work environment and assess their impacts on WMSD symptoms among hospital attendants in Shiraz, southern Iran.

METHODS

This cross-sectional study was conducted on 198 hospital attendants from Shiraz. The study data were collected using a basic demographic questionnaire, Nordic Musculoskeletal Questionnaire (NMQ), the Persian version of Effort-Reward Imbalance Questionnaire (F-ERIQ), and an individual risk assessment (Evaluación del Riesgo Individual [ERIN]). The data were entered into SPSS version 16 and analyzed using Mann-Whitney U, Chi-square, and Spearman's correlation tests.

RESULTS

The prevalence of WMSD symptoms was 29.8% in the lower back, 25.3% in knees, and 20.7% in ankles/feet. Posture analysis by the ERIN technique demonstrated that 95.5% of the postures were high risk for WMSDs. F-ERIQ identified that 83.4% of the hospital attendants belonged to the "1 < ER-ratio" category. Besides, the "effort" subscale of the F-ERIQ was significantly associated with reporting of MSD symptoms in the neck, shoulders, wrists/hands, and lower back. In addition, a significant correlation was observed between effort (r = 0.367, p = 0.028), esteem (r = -0.273, p = 0.041), security (r = -0.253, p = 0.045), and over-commitment (r = 0.301, p = 0.019) and the total score of the ERIN technique.

CONCLUSION

Intervention programs and coping strategies for reduction of work-related stress and, subsequently, prevention of WMSD symptoms are recommended among hospital attendants.

Influence of Demographic Characteristics and Muscle Strength on the Occupational Fatigue Exhaustion Recovery Scale in Career Firefighters

OBJECTIVE

Little is known regarding how individual characteristics and changes in muscle strength across a shift cycle are associated with the Occupational Fatigue Exhaustion Recovery scale in career firefighters.

METHODS

Thirty-two career firefighters completed lower body maximal strength testing prior to and following three 24-hour on-off shifts. Demographic data were collected prior to the first shift and the OFER15 questionnaire was completed following the last shift.

RESULTS

Increased age was associated with greater acute and chronic fatigue and poorer recovery. A positive percent change in strength following a shift cycle was related to better recovery. Age was the only significant predictor of acute and chronic fatigue, while age and the change in strength were significant predictors of inter-shift recovery.

CONCLUSIONS

Increased age influences all dimensions of work-related fatigue, with changes in muscle strength influencing inter-shift recovery in career firefighters.

When workload predicts exposure to bullying behaviours in nurses: The protective role of social support and job recognition

AIMS

This study examined the moderating role of two resources (social support and recognition) in the longitudinal relationship between workload and bullying behaviours in nurses.

DESIGN

A two-wave (12-month) longitudinal study was conducted.

METHOD

French-Canadian nurses (n = 279) completed an online survey (October 2014 and October 2015) assessing their perceptions of job characteristics within the work environment (workload, social support, job recognition) as well as exposure to negative behaviours at work.

RESULTS

Workload positively predicted exposure to bullying behaviours over time, but only when job recognition and social support were low. Workload was unrelated to bullying when social support was high and was negatively related to bullying when job recognition was high.

CONCLUSION

This study aligns with the work environment hypothesis, showing that poorly designed and stressful job environments provide fertile ground for bullying behaviours.

IMPACT

Bullying is a growing concern in the nursing profession that not only undermines nurses' well-being but also compromises patient safety and care. It is thus important to identify work-related factors that can contribute to the presence of bullying behaviours in nurses in the hopes of reducing their occurrence and repercussions. This study contributes to this endeavour and identifies two key social coping resources that can help manage the stress associated with workload, resulting in less perceived bullying behaviour among nurses.

Prevalence of Poor Sleep Quality in Nursing Staff: A Meta-Analysis of Observational Studies

Objective: Poor sleep quality is common in nursing staff. This meta-analysis aimed to examine the pooled prevalence of poor sleep quality in nursing staff. Methods: A systematic search in PubMed, EMBASE, PsycINFO, and Web of Science databases was performed. Studies that reported sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) were synthesized using a random-effects model. Results: Fifty-three studies were analyzed. The pooled prevalence of poor sleep quality was 61.0% (95% CI: 55.8-66.1%). The pooled total PSQI score was 7.13 ± 0.18 (95% CI: 6.78-7.50). The pooled component scores were 1.47 ± 0.20 (95% CI of mean score: 1.08-1.85) in sleep latency, 0.91 ± 0.15 (95% CI of mean score: 0.61-1.21) in sleep duration, 1.59 ± 0.13 (95% CI of mean score: 1.35-1.84) in overall sleep disturbances, 0.33 ± 0.18 (95% CI of mean score: 0-0.67) in sleeping medication, 1.21 ± 1.20 (95% CI of mean score: 0.83-1.60) in daytime dysfunction, 1.39 ± 0.14 (95% CI of mean score: 1.11-1.67) in subjective sleep quality, and 0.66 ± 0.11 (95% CI of mean score: 0.44-0.87) in habitual sleep efficiency. Subgroup and meta-regression analyses found that PSQI cutoff values, mean age, body mass index (BMI), sample size, study quality, and work experience moderated the prevalence of poor sleep quality. Conclusions: Poor sleep quality appears to be common in nursing staff. Considering its negative impact on health, effective measures should be taken to improve poor sleep quality in this population. Longitudinal studies should be conducted to examine the contributing factors of nurses' poor sleep quality.

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

OBJECTIVES

This paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.

DESIGN

Cross-sectional.

SETTING

Seven core clinical disciplines from seven tertiary public hospitals in Malaysia.

PARTICIPANTS

Study was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).

RESULTS

The mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=-0.704 and r=-0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=-3.316, 95% CI=-4.516 to -2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.

CONCLUSIONS

Work-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

Measuring sleep duration in adolescence: Comparing subjective and objective daily methods

OBJECTIVES

This study provides the first investigation into the correspondence between self-reported and actigraph-measured nighttime sleep duration in adolescents that disambiguates between- versus within-person associations. Moderators were evaluated to determine if between- and within-person correspondence vary by participant characteristics.

METHODS

One hundred fifty adolescents (14-21 years) reported sleep time for 1 week, while wearing an actigraph, and reported on moderators, including demographics (i.e., sex, age, ethnicity, and socioeconomic status), depressive symptoms, and perceived stress. Mixed effects models evaluated within- and between-person associations between self-reported and actigraph-measured sleep, and examined whether these associations differed by possible moderators.

RESULTS

Results indicated significant between- (b = 0.77, SE = 0.08, P < .001) and within-person (b = 0.51, SE = 0.04, P < .001) associations between self-reported and actigraph-measured sleep duration, with no significant moderation effects.

CONCLUSIONS

Our results support the use of either self-reports or actigraphs to examine within-person nighttime sleep duration in adolescent community samples.

Chronic and acute fatigue and intershift recovery in undergraduate nursing students working 12 or 6-hour faculty-supervised clinical shifts

BACKGROUND

Nursing student fatigue and recovery time are important considerations.

PURPOSE

This descriptive research compared chronic/acute fatigue and recovery time between one 12-hour shift or two 6-hour faculty-supervised clinical shifts per week.

METHODS

The Occupational Fatigue and Exhaustion Recovery (OFER) scale was completed by undergraduate students in pediatric and obstetrical courses.

RESULTS

The student (N = 106) mean score on OFER was 37.57 for chronic fatigue, 56.57 for acute fatigue, and intershift recovery was 56.57. No differences in chronic fatigue (P = .40), acute fatigue (P = .14), or intershift recovery (P = .35) were found between groups. Nursing students (79%) preferred 12-hour clinical shifts as compared to 21% who chose two 6-hour clinical.

CONCLUSIONS

No differences in chronic/acute fatigue or intershift recovery between a 12-hour clinical shift or two 6-hour clinical shifts were found. Nursing students preferred the one 12-hour clinical shift.

Work stress and sleep disturbances among internship nursing students

Abstract

Background

Nurses are one of the most vulnerable professional groups to occupational stress and sleep problem. A relation between occupational stress and sleep problem is suggested and needs to be investigated. The aim of this descriptive study is designed to assess work stress and sleep disturbances among internship nursing students and the relation between them.

Results

A total of 95 nursing internship students were subjected to Pittsburgh Sleep Quality Index (PSQI) and Expanded Nursing Stress Scale (ENSS). The greater the number of patients a nurse cares for, the greater the nursing stress. Greater number and duration of shifts worsen sleep. Problems related to peers worsen sleep quality. Demanding patients and their families lessen the actual sleep duration of nurses. Demanding patients and their families, work load, discrimination, and uncertainty regarding treatment lessen the habitual sleep efficiency of nurses.

Conclusion

Nurses with higher workload experience more sleep disturbances.

Cancer-work management during active treatment: towards a conceptual framework

PURPOSE

Forward progress in cancer treatment has resulted in fewer adverse consequences of cancer during and after treatment, offering employed cancer patients the possibility of continuing to work during treatment, returning to work after treatment, or implementing a combination of strategies to manage the cancer-work interface. Yet, much of the research on cancer and employment examines return to work as the primary outcome, neglecting to consider the circumstances of survivors who maintain employment while engaged in active treatment. We introduce the Cancer-Work Management Framework (CWMF), a conceptual framework for understanding the cancer and job demands survivors who continue to work during active treatment experience and how cancer and job resources and strategies could promote cancer-work fit and ultimately optimize employment and health outcomes.

METHODS

We provide an overview of the research describing the cancer-work management experiences of survivors who maintain employment during active treatment and summarize the theories that informed the CWMF including ecological systems, boundary-spanning, and job demands and resources theories.

RESULTS

The paper presents a description of the components of the CWMF which include cancer demands, cancer care resources and strategies, work demands, and workplace resources. We also describe a process-cancer-work fit-that reflects the interplay between demands and resources influence employment and health outcomes.

CONCLUSIONS

Future research directions for developing knowledge about the cancer-work management process are proposed with suggestions for study of how cancer and job demands influence cancer treatment and employment decisions.

Perceived Stress among Different Occupational Groups and the Interaction with Sedentary Behaviour

Sedentary lifestyle and low physical activity are associated with health issues, including both physical and mental health, non-communicable diseases, overweight, obesity and reduced quality of life. This study investigated differences in physical activity and other individual factors among different occupational groups, highlighting the impact of sedentary behaviour on perceived stress by occupation. Cross-sectional study included 571 full-time workers of Kaunas city, Lithuania. The outcome of this study was assessment of perceived stress. Time spent sedentary per day, occupation and other individual characteristics were self-reported using questionnaires. Two main occupational groups were analysed: white-collar and blue-collar workers. Multivariate logistic regression was used to assess the impact of sedentary behaviour on perceived stress among different occupational groups. The prevalence of high sedentary behaviour was 21.7 and 16.8 % among white-collar and blue-collar workers, respectively. Blue-collar workers had a higher risk of high perceived stress (OR 1.55, 95% CI 1.05-2.29) compared to white-collar workers; however, sedentary time did not have any impact on high perceived stress level. Meanwhile, white-collar male (OR 4.34, 95% CI 1.46-12.95) and white-collar female (OR 3.26, 95% CI 1.23-8.65) workers who spend more than three hours per day sedentary had a greater risk of high levels of perceived stress. These findings indicate sedentary behaviour effect on perceived stress among two occupational groups-white-collar and blue-collar workers-and other important factors associated with perceived stress.

Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study

BACKGROUND

Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs).

PURPOSE

This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being.

METHODS

A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout.

RESULTS

The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout.

IMPLICATIONS FOR PRACTICE

The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.

Psychosocial Aspects at work and the Quality of Sleep of Professors in Higher Education

The present study aims to investigate the association between psychosocial aspects at work and the quality of sleep of professors in a public university in Feira de Santana, Bahia, Brazil. A cross-sectional study was conducted, with descriptive, bivariate and multivariate analysis, including a random sample of 423 professors. The psychosocial aspects work aspects were associated to a perception of poor sleep quality. In analysis of effect modifiers, the variable "practice of physical activity" modified the main association under test. Among professors that did not practice physical activity, the following variables kept statistically associated to the perception of poor sleep quality: having children (PR = 1.33, CI 95% 1.02-1.74), poor self-rated health (PR = 1.49; CI 95% 1.24-1.79) and quality of life self-evaluation (PR = 1.60, CI 95% 1.45-2.00), insufficient time for regular leisure activities (PR = 1.52, CI 95% 1.23-1.86) and high psychological demand (PR = 1.40, CI 95% 1.14-1.72). In final analysis, high strain and passive work were experiences associated to the perception of a poor sleep quality among professors that did not practice physical activity. The results confirmed that the adverse psychosocial aspects at work are associated to negative impacts on the professor's quality of sleep.

Work schedule characteristics and fatigue among rotating shift nurses in hospital setting: An integrative review

AIM

To systematically evaluate the effect of work schedule characteristics on fatigue among shift nurses in hospital settings.

BACKGROUND

The complexity and multidimensional nature of nursing work may lead to fatigue. This review mainly focused on work schedule characteristics that may mitigate the fatigue in nurses.

EVALUATION

Six databases were searched, and eight relevant research articles published between 2000 and 2018 were identified.

KEY ISSUES

The reviewed articles provided evidence supporting the association of work schedule characteristics such as total working hours, overtime, shift length and number of monthly night and evening shifts with fatigue. In addition, studies provided evidence for the positive association between insufficient rest period between shifts and fatigue among shift nurses in hospital settings.

CONCLUSION

The reviewed studies provided mixed results regarding the associations between work schedule characteristics and nurse fatigue. However, quick returns and days called to work on days off were consistent factors contributing to nurse fatigue. More evidence is needed to arrive at a definitive conclusion about such relationships.

IMPLICATION FOR NURSING MANAGEMENT

Nursing managers and administrators need to carefully review current rotating shift system and examine its impact on nurse fatigue as well as ensure enough resting time when developing nurse schedules.

Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.

Time pressure and sleep problems due to thoughts about work as risk factors for future sickness absence

Purpose

This study investigated whether time pressure or sleep problems due to thoughts about work are associated with future sickness absence (SA) among women and men employed in different sectors, also when adjusting for confounders including familial factors (genetics and shared environment).

Methods

The study sample included 16,127 twin individuals (52% women), aged 19–47 years who in 2005 participated in an online survey including questions regarding time pressure, sleep, work and health. Register data on SA (> 14 days) were obtained from the National Social Insurance Agency and individuals were followed from date of survey response until 12/31/2013. Associations between time pressure, sleep problems due to thoughts about work and future SA were investigated using logistic regression analyses to assess odds ratios (OR) with 95% confidence intervals (CI).

Results

In total 5723 (35%) individuals had an incident SA spell during follow-up. Sleep problems due to thoughts about work were associated with SA in the fully adjusted model (OR 1.22, CI 1.10–1.36). Stratified by sector, the highest estimate was found for state employees (OR 1.54, CI 1.11–2.13). Familial factors did not seem to influence the associations. We found no statistically significant associations between time pressure and SA. No sex differences were found.

Conclusions

Results indicated that sleep problems due to thoughts about work is a risk factor for future SA. This follows previous research showing that sleep length and sleep disturbances, regardless of reason, are associated with SA. But, experiences of work-related time pressure seem to have no effect on SA.

Stress in nurses: The 100 top-cited papers published in nursing journals

AIM

To identify and analyse the 100 most cited papers on stress in nurses published in nursing journals.

BACKGROUND

The number of citations an article receives is an index of its impact on the scientific community. An analysis of the most cited articles on stress in nursing would allow us to identify the most important articles and to obtain information about this area of knowledge.

DESIGN

A retrospective bibliometric analysis.

DATA SOURCES

In 2016, 111 journals belonging to the "nursing" category were identified in the Science and Social Science Citation Index. A search was performed of the Science Core Collection Website for articles on stress published in these journals.

REVIEW METHODS

The topic, type of article, publishing journal, countries and institutions of origin and year of publication were extracted from the articles. The impact factor, immediacy index, journal country and publisher and h index were collected from the Institute for Scientific Information. The citation density, citation tendency and Bradford's law were calculated.

RESULTS

They identified articles were mostly empirical quantitative studies with a transversal design, published from 1975 - 2011 in 23 journals. They were signed by 233 authors, most of whom are English-speaking from the USA and UK. The core distribution of the publications comprises a single journal, the Journal of Advanced Nursing.

CONCLUSION

The study of stress in nursing has shown increased visibility and recognition each decade. The most recent articles have the highest number of citations, are the highest in rank and have the higher citation densities.

Patterns and correlates of benzodiazepine use in nurses: A nationwide, population-based study

In the present study, we examined patterns of benzodiazepine (BZD) use in nurses, and compared the characteristics of frequent users with those of infrequent users. Data on all nurses enrolled in the study were derived from the reimbursement claim records in Taiwan's National Health Insurance Research Database for the period 2004-2008. The case group comprised 33 588 nurses with BZD use, and the control group was exactly matched to each case according to age and sex. The patterns of occasional, frequent, and daily BZD use demonstrated an increasing trend from 2004 to 2008. This trend was observed for most of the BZD with a short or intermediate half-life. Older nurses (>45 years) and those with greater experience (≥5 years) were more likely to use BZD frequently. Moreover, the risk of frequent BZD use increased significantly when nurses exhibited comorbid depression (adjusted odds ratio (aOR): 2.58), anxiety (aOR: 1.78), or sleep disorders (aOR: 2.29) compared with infrequent BZD use. The results indicated that nurses with BZD use had comorbidities of anxiety, depression, and sleep disorders. The increasing trend of patterns of BZD use and its association with sleep disorders, depression, and anxiety can be used as references for stress and sleep management in nurses.

Chronotype, Sleep Characteristics, and Musculoskeletal Disorders Among Hospital Nurses

Work-related musculoskeletal disorders (WMSDs) persist as the leading occupational injury, accounting for nearly half of nurses' total occupational injuries. Musculoskeletal pain is a known cause of sleep disruption, and individuals with WMSDs that interfere with sleep often report more pain. Evening chronotype has been associated with poor sleep among nurses. However, the associations among chronotype, sleep, and WMSDs are still unclear, and were explored in the present study. A cross-sectional survey was administered to 397 nurses, with 47.4% reporting WMSDs. Robust Poisson regression modeling suggested that evening type (PR = 1.32, p < .05), prolonged sleep onset latency (PR = 1.37, p < .05), and using sleep-promoting substances (PR = 1.35, p < .01) were associated with increased risk of WMSDs among nurses, after adjusting for shift work, regular exercise, body mass index, and other covariates. This study suggests that well-designed evidence-based nonpharmacological interventions to improve sleep may reduce the risk of WMSDs among nurses.

Coping strategies and social support needs of experienced and inexperienced nurses performing shiftwork

AIM

The aim of this investigation was to compare perceptions of nurses exposed to short or longer term shift work and their experiences working under this type of scheduling.

BACKGROUND

Shift work is a crucial component of nurses' working lives, ensuring continuous care for patients. This study fills a research gap around the personal experiences of shift working nurses and the strategies used to manage the impacts of shift work.

DESIGN

Qualitative case study design.

METHODS

Constructivist methodology, including in-depth semi-structured interviews conducted in 2015, was used for the study. Iterative review and inductive analysis of transcripts from nine recently graduated nurses and twelve experienced nurses enabled identification and verification of key themes.

FINDINGS

Three main areas of difference between new and experienced nurses relating to shift work challenges in a nursing environment emerged: perceptions about the utility of working in shifts, coping strategies and social support at home and work. Most experienced nurses found shift work advantageous, especially those with dependents. Coping strategies included flexible shift arrangements in both groups. Experienced nurses detailed the importance of support from family and friends while inexperienced nurses described feeling disconnected from social supports. Experienced nurses cited a lack of support from nursing managers as problematic.

CONCLUSIONS

Findings suggest shift selection mitigated challenges of shift work for both inexperienced and experienced nurses, indicating autonomous roster selection is critical. Similarly, social support at work from senior nurses and management and at home played an important role in nurses' coping.

Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses

Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses’ practice that should be monitored by nursing management.

Influencing Genomic Change and Cancer Disparities through Neighborhood Chronic Toxic Stress Exposure: A Research Framework

Black Americans have disproportionately higher incidence and mortality rates for many cancers. These disparities may be related to genomic changes that occur from exposure to chronic toxic stress and may result from conditions associated with living in racially segregated neighborhoods with high rates of concentrated poverty. The purpose of this article is to present a nursing research framework for developing and testing neighborhood-level interventions that have the potential to mitigate exposure to neighborhood-associated chronic toxic stress, improve individual-level genomic sequelae and cancer outcomes, and reduce cancer health disparities of Black Americans. Public health nursing researchers should collaborate with local officials to determine ways to reduce neighborhood-level stress. Intermediate outcomes can be measured using genomic or other stress biomarkers, and long-term outcomes can be measured by evaluating population-level cancer incidence and mortality.

Demographic, health-related, and work-related factors associated with body mass index and body fat percentage among workers at six Connecticut manufacturing companies across different age groups: a cohort study

BACKGROUND

Effective workplace interventions that consider the multifactorial nature of obesity are needed to reduce and prevent obesity among adults. Furthermore, the factors associated with obesity may differ for workers across age groups. Therefore, the objective of this study was to identify demographic, health-related, and work-related factors associated with baseline and changes in body mass index (BMI) and body fat percentage (BFP) and among Connecticut manufacturing workers acrossage groups.

METHODS

BMI and BFPof 758 workers from six Connecticut manufacturing companies were objectively measuredat two time points approximately 36 months apart. Demographic, health-related, and work-related factors wereassessed via questionnaire. All variables were included in linear regression models to identify factors associated with baseline and changes in BMI and BFP for workers in 3 age groups: <45 years (35 %), 45-55 years (37 %), >55 years (28 %).

RESULTS

There were differences in baseline and changes in BMI and BFP among manufacturing workers across age groups. Being interested in changing weight was significantly (p < 0.01) associated with higher baseline BMI and BFP across all age categories. Other factors associated with higher baseline BMI and BFP differed by age group and included: male gender (BMI p = 0.04), female gender (BFP p < 0.01), not having a college education (BMI p = 0.01, BFP p = 0.04), having childcare responsibilities (BMI p = 0.04), and working less overtime (p = 0.02) among workers in the <45 year age category, male gender (BMI p = 0.02), female gender (BFP p < 0.01) and reporting higher stress in general (BMI p = 0.04) among workers in the 45-55 year age category, and female gender (BFP p < 0.01) and job tenure (BFP p = 0.03) among workers in the >55 year age category. Few factors were associated with change in BMI or BFP across any age category.

CONCLUSIONS

Among manufacturing workers, we identified associations between individual, health-related, and work-related factors and baseline BMIand BFP that differed by age. Such results support the use of strategies tailored to the challenges faced by workers in specific age groups rather than adopting a one size fits all approach. Effective interventions should consider a full range of individual, health-related, and work-related factors. More work must be done to identify factors or strategies associated with changes in obesity over time.

Job Strain and Self-Reported Insomnia Symptoms among Nurses: What about the Influence of Emotional Demands and Social Support?

Job strain, derived from high psychological demands and low job control, is associated with insomnia, but information on the role of emotional demands and social support in this relationship is scarce. The aims of this study were (i) to test the association between job strain and self-reported insomnia symptoms, (ii) to evaluate the combination of emotional demands and job control regarding insomnia symptoms, and (iii) to analyze the influence of social support in these relationships. This cross-sectional study refers to a sample of nurses (N = 3,013 and N = 3,035 for Job Strain and Emotional demand-control model, resp.) working at public hospitals in Rio de Janeiro, Brazil. Data were collected through a self-report questionnaire. The prevalence of insomnia symptoms was 34.3%. Job strain was associated with increased odds for insomnia symptoms (OR: 2.20); the same result was observed with the combination of emotional demands and low job control (OR: 1.99). In both models, the inclusion of low social support combined with high demands and low job control led to increased odds for insomnia symptoms, compared to groups with high social support from coworkers and supervisors. Besides job strain, the study of emotional demands and social support are promising with regards to insomnia symptoms, particularly among nurses.

Evaluation of the Relationship Between Musculoskeletal Discomforts and Occupational Stressors Among Nurses

BACKGROUND

Stress in nurses may increase the prevalence of musculoskeletal discomforts.

AIM

The aim of this study was to determine the prevalence of musculoskeletal discomforts and job stress among nurses and to investigate the association between musculoskeletal discomforts and occupational stressors.

MATERIALS AND METHODS

In this cross-sectional study, 144 nurses in one of the main referral hospitals of Tehran-Iran were randomly selected and studied. Data were collected by HSE job stress questionnaire and The Cornell Musculoskeletal Discomfort Questionnaire through interviews with nurses in their workplace.

RESULTS

Most reported musculoskeletal discomforts localized in the neck, back, knee and shoulder and the minimal discomforts were in wrist and elbow. On the other hand, stressors such as demand, changes in workplace, control and responsibilities had significant effect on increasing musculoskeletal discomforts of organs such as neck, shoulders and back (P < 0.001).

CONCLUSION

There was a significant association between stressors such as demand, control, responsibilities and changes in workplace and reported musculoskeletal disorders, especially in neck, shoulders and back. It is suggested to use defined programs for management and control of stressors to control occupational stress in nurses. Moreover, prevention of musculoskeletal discomforts due to their high prevalence in the study population is important.

The Orientation Period

The purpose of this research study was to explore adaptation in new registered nurses using the Roy adaptation model as the guiding conceptual framework. This quantitative study employed a random sampling of new nurses in the state of North Carolina. Personal attributes of the new registered nurses and characteristics of their work setting were modeled with four measures considered suitable proxies for adaptation. Being in a formal orientation period significantly supported the new nurses’ overall adaptation. This may represent the benefit of social support, including education, which seems to facilitate adaptation.

An integrative review: fatigue among nurses in acute care settings

OBJECTIVE

The aim of this study was to examine current research related to nurse fatigue and identify effective prevention strategies.

BACKGROUND

Work-related fatigue negatively affects patient safety and nurses' well-being and increases employer costs. Preventing fatigue and minimizing its negative consequences require knowledge of the contributing factors if effective interventions are to be designed and implemented.

METHODS

This review targeted original research (2002-2013) examining fatigue among nurses working in acute care settings.

RESULTS

Nurses experience high rates of fatigue. Shifts longer than 12 hours contribute to increased fatigue and errors, but the evidence was inconsistent with regard to age and fatigue level. Individual lifestyle, unit culture, and organization policies influence the prevalence and intensity of work-related fatigue.

CONCLUSIONS

Preventing work-related fatigue requires multifaceted approaches involving the organization, the clinical unit, and the individual.

The mediating role of demand and control in the relationship between leadership behaviour and employee distress: a cross-sectional study

BACKGROUND

The relationship between leadership and employee distress is well established, however, the processes involved in this relationship remain largely unclear. For a stretched nursing workforce, understanding in what ways leadership may influence employee distress is particularly important.

OBJECTIVES

To examine possible mediating effects of the work environment factors demand and control in the relationship between leadership behaviour in change, production, and employee orientation and employee distress.

DESIGN

Cross-sectional study design.

SETTINGS

The study was conducted at a large county council in Sweden providing both institutional and non-institutional care.

PARTICIPANTS

A random sample of 1249 employees (primarily nurses, but also a wide range of other healthcare professionals and administrative staff), who had a healthcare manager that was about to enter a leadership development programme (n=171), responded to a web-based questionnaire. The response rate was 62%.

METHODS

The employees rated their healthcare managers' behaviour in change, production, and employee orientation, as well as their own perceptions of level of demand, control (subdivided into decision authority and skill discretion), and five distress outcomes. Multilevel analysis was performed.

RESULTS

The mediators demand, decision authority, and skill discretion were significant predictors of all five distress outcomes for all three leadership orientations. In eight of 15 regressions, the mediators fully explained the relationships between leadership orientations and outcomes. Four of five relationships with distress outcomes were fully mediated for change-oriented leadership, whereas two of five outcomes were fully mediated for production- and employee-oriented leadership. In all three leadership orientations, the relationship between the mediator skill discretion and the distress measure disengagement were particularly strong, with B-coefficients (-.44, p<.001) twice as high as for any of the other relationships.

CONCLUSIONS

It seems that the way that employees perceive healthcare managers' change-oriented behaviour, and how that aspect is related to employee distress, is primarily explained by perception of demand and control. Furthermore, regardless of leadership behaviour orientation, how employees perceive their opportunity to use specific job skills plays an important role in the interplay between perception of healthcare managers' behaviour and disengagement.

Factors associated with work-related fatigue and recovery in hospital nurses working 12-hour shifts

Nurse fatigue threatens both nurse and patient safety; fatigue affects nurses' neurocognitive functioning and hinders their work performance. The authors assessed the association of work and non-work factors with acute and chronic fatigue and intershift recovery among hospital nurses working 12-hour shifts. This study used survey data from 80 nurses who provided full-time direct patient care on medical-surgical and critical care units in a large teaching hospital. Psychological job demands (e.g., work load and social support from supervisor or coworker) were significantly associated with acute and chronic fatigue and intershift recovery. Rotating shifts were significantly related to acute fatigue. Findings suggest the need for a comprehensive approach to fatigue management, including organizational support to provide healthful work schedules and favorable nursing work environments, fewer psychological and physical demands, and assistance to improve nurses' sleep quality and quantity. [Workplace Health Saf 2014;62(10):409-414.].

The relationship between shift work and sleep patterns in nurses

The scope of this study was to evaluate the sleep/wake cycle in shift work nurses, as well as their sleep quality and chronotype. The sleep/wake cycle was evaluated by keeping a sleep diary for a total of 60 nurses with a mean age of 31.76 years. The Horne & Östberg Questionnaire (1976) for the chronotype and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality were applied. The results revealed a predominance of indifferent chronotypes (65.0%), followed by moderately evening persons (18.3%), decidedly evening persons (8.3%), moderately morning persons (6.6%) and decidedly morning persons (1.8%). The sleep quality perception was analyzed by the visual analogical scale, showing a mean score of 5.85 points for nighttime sleep and 4.70 points for daytime sleep, which represented a statistically significant difference. The sleep/wake schedule was also statistically different when considering weekdays and weekends. The PSQI showed a mean of 7.0 points, characterizing poor sleep quality. The results showed poor sleep quality in shift work nurses, possibly due to the lack of sport and shift work habits.