When does nursing burnout begin? An investigation of the fatigue experience of Australian nursing students

Is the fire even bigger? Burnout in 800 medical and nursing students in a low middle income country

BACKGROUND

Burnout, characterized by emotional exhaustion (EX), depersonalization (DP), and a reduced sense of personal efficacy (PF) among medical and nursing students can lead to suicidal ideation, lack of empathy, and dropouts. Previous studies have used over-simplified definitions of burnout that fail to capture its complexity. We describe the prevalence of burnout profiles and its risk factors among medical and nursing students.

METHODS

A cross sectional study was conducted at a tertiary care University Hospital in Pakistan. The Maslach Burnout Inventory (MBI) survey was disseminated via SurveyMonkey over a period of 4 months (November 2019 to February 2020) to 482 Medical and 441 nursing students. The MBI tool measures the dimensions of EX, DP, and PF to describe seven burnout profiles. Multivariable regression was used to identify predictors of burnout.

RESULTS

The response rate was 92% in nursing and 87.3% in medical students. The prevalence of burnout in medical and nursing students was 16.9% and 6.7% respectively (p<0.001), with 55.7% (n = 427) suffering from at least one burnout profile. Only 32.5% (n = 250) students felt engaged, (42.3% medical, 22.7% nursing students, p<0.001). The most common profile was ineffective (32.5%, n = 250), characterized by a reduced sense of personal efficacy (35.6% medical, 29.4% nursing students; p = 0.065). Medical students were at higher risk of burnout compared to nursing students (OR = 2.49 [1.42, 4.38]; p<0.001) with highest risk observed in year 4 (OR = 2.47 [1.02, 5.99]; p = 0.046). Other risk factors for burnout included occasional drug use (OR = 1.83 [1.21, 8.49]; p = 0.017) and living in a hostel (OR = 1.64 [1.01,2.67]; p = 0.233).

CONCLUSION AND RELEVANCE

Two-thirds of our participants experienced at least one dimension of burnout with the highest prevalence of a reduced sense of PF. Drivers of burnout unique to a lower-middle-income country need to be understood for effective interventions. Faculty training on principles of student evaluation and feedback may be beneficial.

Long-Term Impact of Childhood Adversity on the Gut Microbiome of Nursing Students

Adverse childhood experiences (ACEs) encompass negative, stressful, and potentially traumatic events during childhood, impacting physical and mental health outcomes in adulthood. Limited studies suggest ACEs can have short-term effects on children's gut microbiomes and adult cognitive performance under stress. Nevertheless, the long-term effects of ACEs experienced during adulthood remain unexplored. Thus, this study aimed to assess the long-term effects of ACEs on the gut microbiota of adult nursing students. We employed a multidimensional approach, combining 16S rRNA sequencing, bioinformatics tools, and machine learning to predict functional capabilities. High-ACE individuals had an increased abundance of Butyricimonas spp. and Prevotella spp. and decreased levels of Clostridiales, and Lachnospira spp. Prevotella abundance correlated negatively with L-glutamate and L-glutamine biosynthesis, potentially impacting intestinal tissue integrity. While nursing students with high ACE reported increased depression, evidence for a direct gut microbiota-depression relationship was inconclusive. High-ACE individuals also experienced a higher prevalence of diarrhea. These findings highlight the long-lasting impact of ACEs on the gut microbiota and its functions in adulthood, particularly among nursing students. Further research is warranted to develop targeted interventions and strategies for healthcare professionals, optimizing overall health outcomes.

It's a hard process - Nursing students' lived experiences leading to dropping out of their education; a qualitative study

BACKGROUND

Dropout from nursing education is a serious problem worldwide. Student nurse attrition has a profound effect not only on the nursing profession and patient care, but also on the students themselves. Dropout is recognized as a complex phenomenon that has multiple causes. A more detailed and nuanced understanding of the complexity behind dropout is needed if we are to retain more nursing students.

AIM

To explore the students' experiences and considerations before dropping out and their reflections after dropping out to gain a deeper understanding of the factors that prompted them to leave their nursing education.

DESIGN/METHOD

A qualitative explorative design inspired by Gadamer's philosophical hermeneutics was used to explore the students' lived experiences and considerations concerning dropping out. Qualitative telephone interviews were conducted on 15 nursing students.

RESULTS

The analysis revealed three main themes that disclosed and elucidated the nursing students' reasons for dropping out: (i) Resources to make a difference and help others; (ii) Clinical practice was more demanding than expected; (iii) The learning environment was important - the social environment was essential.

CONCLUSION

The students encountered a lack of support to deal with the difficult emotions that arose when witnessing serious illness and death. They expressed feeling overwhelmed by their vulnerability and called for support to develop resilience. The social environment and a sense of belonging to the nursing profession were cited by students as being essential to this support.

Health-Related Quality of Life and Undergraduate Nursing Students: A Narrative Review

Background:

Undergraduate nursing students are vulnerable to stressful university learning environments and poor working conditions in clinical rotations. This can result in students leaving nursing programs or abandoning the profession following graduation. As a result, the health-related quality of life of nursing students is an important indicator to monitor student quality of life adequacy. Preventing premature student nurses' departure from the profession is necessary to reduce the nursing shortage.

Objective:

To describe the body of knowledge about the health-related quality of life for undergraduate nursing students during their qualification process.

Methods:

This was a narrative review through a six-database search, including Cochrane, CINAHL, Pubmed, Medline, PsycINFO and Livivio, from between January 1990 and June 2018, with updates in the search followed until November 2019. To assess study quality, the STROBE checklist was used.

Results:

Eight studies were included in a narrative synthesis. All studies were of cross-sectional design, and none included follow-up procedures. Most of the studies recruited participants from nursing courses and only one study recruited students from a national register. Sample sizes ranged from 110 individuals to 4,033 participants in the register-based study. Common health-related dimensions evaluated included stress, social support, mental health, fatigue, quality of life, and drug abuse. Stress, the most commonly studied dimension, was associated with clinical placements, final exams, and non-prescribed drugs. Social support networks were positively associated with coping abilities and self-esteem.

Conclusion:

There is low-quality evidence of the impact of nursing courses upon student health-related dimensions (stress, self-esteem, health-related behaviors). Nurse educators should be aware of these associations and support routine screening of students and their health-related dimensions. Interventions, such as consultation and study redesign, might increase the level of health-related dimensions. Nursing schools should further collaborate to investigate these associations and tailored interventions to positively affect health-related dimensions in nursing students.

Relationship among faculty fatigue, academic rank, and scholarship and service productivity

AIM

To examine the relationship among the level of fatigue, academic rank, workload (credit hours) and faculty productivity (as measured by scholarship and service activities).

DESIGN

Descriptive cross-sectional correlational design.

PARTICIPANTS

All full-time faculty in national year-round nursing college.

METHODS

An Internet survey was distributed May/June 2017 to all full-time faculty (n = 318). Responses reported are from 81 faculty members in the prelicensure baccalaureate programme. Survey items included workload, scholarship and service activities and demographic data. Fatigue was measured by the trait version of Occupational Fatigue, Exhaustion Recovery scale which has three subscales: Acute, Persistent, and Chronic.

RESULTS

Mean fatigue for all traits ranged from 45.9 to 52.48. More service activities were reported than scholarship activities. There was a significant positive correlation between chronic fatigue and credit hours. No significant differences existed in fatigue scores based on frequency of scholarship and service activities.

CONCLUSION

This first study of fatigue in nursing faculty establishes the existence of fatigue in this group. This can be serious related to the existence of chronic fatigue. Strategies to reduce fatigue are important to support the long-term employment of nursing faculty.

IMPACT

What problem did the study address? Fatigue in faculty members and its relationship to academic rank and scholarship and service productivity. What were the main findings? Fatigue in faculty members exists. Higher rank was associated with more scholarship and service activities. Chronic fatigue is less than acute or persistent fatigue. Chronic fatigue is related to workload. Where and on whom will the research have impact? Findings may impact retention of nursing faculty members and academic leaders responsible for supporting work-life balance among nursing faculty.

Impact of psychosocial factors on academic performance of nursing students in Thailand

Purpose

The purpose of this study is to investigate the psychosocial factors that impact the academic performance of nursing students.

Design/methodology/approach

A cross-sectional study was conducted with 767 nursing students from three nursing colleges in Thailand. Instruments included Counseling Center Assessment for Psychological Symptoms and Rosenberg Self-Esteem Scale. Path model analyses with the maximum likelihood method were utilized to examine the proposed model. Model fit was estimated using multiple indexes, including chi-square/df ratio (χ2/df), comparative fit index (CFI), Tucker-Lewis index (TLI) and the root mean square error of approximation (RMSEA).

Findings

Results indicated that family distress, emotional negativity, self-esteem and substance use were factors that related to nursing students' academic performance. Findings of path analyses indicated that the model demonstrated good fit: χ2 (2, N = 767) = 3.11, p = 0.48; χ2/df = 1.56; CFI = 1.00; TLI = 0.99; RMSEA = 0.027, (90% CI = [0.000, 0.082], PCLOSE = 0.68).

Originality/value

While prior research has examined some facets leading to academic success for nursing students, psychosocial factors have not received adequate attention. This study presents a model of family and individual psychosocial factors that impact academic performance of nursing students along with recommendations to help improve their well-being.

Anxiety, mental illness, learning disabilities, and learning accommodation use: A cross-sectional study

BACKGROUND

Nurse educators require a robust understanding of nursing students' attributes to meet their learning needs and support their success.

PURPOSE

This research seeks to understand the proportion of nursing students with self-reported medically diagnosed anxiety, mental illnesses (MI), learning disabilities (LD), and utilized learning accommodations (LA), and determine how these students compared to a normative sample regarding studying and test-taking anxiety.

METHOD

A secondary analysis of quantitative cross-sectional data that included the Academic Success Inventory for College Students (ASICS) tool. First-year students were surveyed (4-6 weeks after program start, and students in years 1 through 4 were surveyed at the end of both academic terms.

RESULTS

At program start, 21% were diagnosed with anxiety, 16% with MI, 2% with a LD, and 6% accessed LA. By fourth-year these proportions were 23%, 22%, 8% and 13% respectively. Alarming proportions of respondents exhibited anxiety related to test-taking compared to the ASICS normative sample with large effect sizes (Anxiety h = 0.884; MI h = 0.601; LD: h = 2.094; LA h = 0.725).

CONCLUSION

To support students, we highlight a need for early identification and tailored support, enriched faculty knowledge, faculty introspection and willingness to adapt, and time for relational and individual pedagogy.

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.

Burnout among Academic Clinicians as It Correlates with Workload and Demographic Variables

Burnout syndrome (BOS) in academic physicians is a psychological state resulting from prolonged exposure to job stressors. It leads to a decline in overall job performance, which could result in misjudgment and serious clinical errors. The current study identifies the prevalence, as well as the potential demographic and workload variables that contribute significantly to BOS in academic clinicians. We distributed a modified version of the Maslach Burnout Inventory (MBI) scale to the academic clinicians in our institution; 326/900 responded, with 56.21% male and 43.46% female. The MBI scale comprised of three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Higher scores in EE and DP and lower scores in PA were associated with a higher risk for burnout. In considering the work-life of academic clinicians, this study used a modified version of the MBI to reflect three hypothesized sources of burnout: interactions with students/trainees, interactions with patients, and interactions with administration, as reflected in these three dimensions. Along both the EE and DP dimensions of the MBI, burnout was highest for interactions with administration (51% and 44.8%), moderate for interactions with patients (26.4% and 34.5%), and lowest for interactions with students (11.7% and 9.8%). The highest scores along the personal accomplishment component was found for interactions with students and patients (33.7% and 33.4%). Regression analyses identified several factors associated with higher scores on the EE and DP scales: younger age, surgical specialty, low academic rank, academic main practice, female gender, numerous night shifts, and living alone. Furthermore, higher patient volume contributed significantly to the increasing PA. This study suggests that administrative interaction contributes significantly to burnout amongst physicians, followed by patient care and trainees. Furthermore, surgeons, females, single, early career, and younger faculty staff members are at higher risk of suffering from burnout. Further studies are needed to characterize the nature of administrative interactions that contribute to burnout and to solidify other contributing variables.

Occupational health and safety incidents at a university school of nursing: A retrospective, descriptive appraisal

Nursing is recognised internationally as a high-risk occupation for graduates and students. Developing an understanding of incident data may facilitate prevention of future adverse events. A descriptive, retrospective review of occupational health and safety incidents reported by personnel at an Australian university school of nursing was conducted, spanning a period of eight-and-a-half years. Classification of incident reports was determined using the existing electronic system with manual categorisation of data not suited to electronic analysis, such as narrative descriptions. In total, 142 incidents were reported, of which 135 were included in this study. Students reported 98 incidents on placement and 10 on campus. Frequently reported student incidents involved sharps, fainting, manual handling activities and workplace violence. Fifteen reports were hazard notifications. Reviewing data gathered over a prolonged duration provided useful patterns of information. Gaps in data and reporting system constraints were identified. Dual reporting systems may be barriers to providing an all-inclusive overview. Improving data collection methods could include recording demographic information such as year level, drop-down menus for commonly reported incidents to facilitate recording, and consideration of how best to capture events that involve multiple personnel.

Confidence and motivation to help those with a mental health problem: experiences from a study of nursing students completing mental health first aid (MHFA) training

BACKGROUND

Those studying nursing are at greater risk for developing mental health problems than other tertiary students. Mental Health First Aid (MHFA) training may assist students to support peers and build mental health literacy. Understanding motivation to participate in training can identify factors influencing uptake and completion. This paper explores motivators for university nursing students to participate in MHFA training and uses previous experience and confidence in assisting someone with a mental health problem to triangulate data.

METHOD

A randomised controlled trial was employed to measure the impact of the course for nursing students at a large Western Australian university. An online survey was administered prior to MHFA training with undergraduate nursing students (n = 140). Thematic analysis of open-ended questions explores motivators to participate and help provided to an individual. Baseline frequencies describe demographics, confidence in helping and exposure to someone with a mental health problem. A Chi Square test compared confidence in helping and exposure to someone with a mental health problem.

RESULTS

More than half of participants reported contact with individuals experiencing mental health problems (55%; n = 77); approximately a third (35.8%) reported limited confidence to assist. Those in previous contact with someone with a mental health problem (71.5%; n = 55) were significantly more likely to feel confident in helping (p = 0.044). Mental health literacy, helping others, career and experiences were described as training motivators.

CONCLUSION

Exploiting motivators, both intrinsic and extrinsic may increase MHFA training uptake and completion. Tertiary institutions would benefit from policy to embed MHFA training into nursing degrees. The training may have utility for university degrees more broadly.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry; ACTRN12614000861651. Registered 11 August 2014 (retrospectively registered).

Exploring the implications of a self-care assignment to foster undergraduate nursing student mental health: Findings from a survey research study

BACKGROUND

Nursing students experience numerous personal, academic, and practice-related stressors, impacting their mental health. Nursing programs often contribute to student stress and should incorporate strategies to support students' mental health. Self-care has the potential to enhance students' ability to manage current stressors and to build capacity for addressing future stress and burnout; however, the concept has been limitedly integrated into nursing education.

OBJECTIVES

To examine students' responses to a self-care assignment integrated into core nursing coursework.

DESIGN

Cross-sectional study using an online survey.

SETTINGS

An accelerated two-year undergraduate nursing program in Western Canada.

PARTICIPANTS

Undergraduate nursing students in first- and second-year of a two-year program.

METHODS

A 16-question survey, including closed- and open-ended response fields was developed by the research team. Survey questions were grounded in Bloom's Cognitive, Psychomotor, and Affective learning domains to comprehensively examine the impact of the assignment on students' learning and self-care capacity.

RESULTS

89 participants completed the survey (49% response rate). Participants' increase in self-care practices pre- and post-assignment was statistically significant (p = 0.023). Results further demonstrate that students' knowledge of self-care and capacity to identify and manage stressors were enhanced. Participants reported that overall the assignment supported their well-being. However, some participants described that aspects of the assignment detracted from well-being, including challenges with grading and feelings of guilt when not practicing self-care.

CONCLUSIONS

A self-care assignment is an effective strategy for nursing educators to foster students' capacity to cope with stressors.

Not Just Tools to Handle It: A Qualitative Study of Nursing Students' Experiences From Participating in a Cognitive Behavioral Stress Management Intervention

Background. Stress-related problems are an increasing challenge within nurse education since it affects learning, professional development, and mental health negatively. Despite this, knowledge is scarce regarding nursing students' experiences of being in stress management interventions. Aim. This study aimed to describe how nursing students experienced a preventive cognitive behavioral therapy-based stress management intervention. Method. Data were collected through 14 semistructured interviews with nursing students who had participated in a stress management intervention, and analyzed using inductive qualitative content analysis. Results. The analysis yielded one theme, Turning points, which consisted of four categories: (1) more in touch with reality, (2) increased self-confidence, (3) improved communication skills, and (4) a new way of reflecting. Discussion. Findings emphasize the importance of both theoretical and structural aspects when planning a stress management training intervention. A group format delivery in combination with a multicomponent cognitive behavioral intervention can be interrelated elements for positive stress-related changes. Conclusion. Our findings indicate that participants developed new and more adaptive coping strategies, which were attributed to the intervention. The participants expressed that they had increased their ability to reflect, which led to increased insight and self-reflection. The intervention constitutes an example of a contribution to stress management research and provides information for stress management training initiatives in nurse education.

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.

Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample

Stress and affective distress have previously been shown to predict sleep quality, and all the factors have been shown to predict fatigue severity. However, few prior studies have examined the likely indirect mediational relationships between stress, affective distress, and sleep quality in predicting fatigue severity, and the potential role played by ruminative thinking. A short questionnaire asked 229 participants about their recent experiences of stress, affective distress, rumination, sleep, and fatigue in a community sample. High stress, anxiety, and depression were related to more ruminative thinking, which in turn was related to poor sleep quality (composed of subjective sleep quality, daytime dysfunction, sleep latency, and sleep disturbance) and poor sleep quality predicted worse fatigue. The results suggest that rumination parsimoniously explains the tendency of stress and affective distress to contribute to poor sleep quality, and together with poor sleep, it may also contribute to worse fatigue in some individuals.

The Relationship of Childhood Adversity on Burnout and Depression Among BSN Students

BACKGROUND

Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood.

PURPOSE

To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression.

METHODS

211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout.

RESULTS

The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males.

CONCLUSION

Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services.

Persistent (Anxiety and Depression) Affected Academic Achievement and Absenteeism in Nursing Students

Background:

Anxiety and depression are common among nursing students due to different factors. When they are minimal and not persistent, they work as stimuli for good achievement. However, when they are high or persistent they have negative consequences (i.e. low academic achievement and higher absenteeism rates).

Objective:

The purpose of this study was to check the effect of persistent anxiety and depression on nursing student academic achievement and absenteeism rate.

Methods:

A prospective observational correlational design with a convenience sample of 170 students enrolled in the undergraduate and graduate programs-college of nursing at a private university in Amman, Jordan. Anxiety and depression were measured twice at the beginning of the semester and then two months later by Hospital Anxiety and Depression Scale. Data regarding grade point average, number of absenteeism and the gender of the students; were collected from the electronic system of the university.

Results:

Persistently anxious group has lower grade point average than persistently non-anxious group (mean [SD], 64.1 [13.8] vs. 73.1 [12.3], P< .001). Moreover, they have higher absenteeism rate than persistently non-anxious group (7.62 [5.7] vs. 4.0 [3.4], P< .001) and higher than transiently anxious group (7.62 [5.7] vs. 4.7 [4.6], P< .05). Persistently depressed group has lower grade point average than persistently non-depressed group (64.0 [13.8] vs. 73.2 [13.0], P< .001) and lower than transiently depressed (64.0 [13.8] vs. 71.7 [10.6], P< .01).

Conclusion:

Nursing administrators should search for the underlying causes for these negative emotions. Furthermore, setting strategies to control these negative emotions is highly recommended.

Nursing students experienced personal inadequacy, vulnerability and transformation during their patient care encounter: A qualitative meta-synthesis

OBJECTIVES

To identify, appraise and synthesize the best available evidence exploring nursing students' experiences of professional patient care encounters in a hospital unit.

DESIGN

The Joanna Briggs Institute (JBI) guidelines were followed and a meta-synthesis was conducted.

DATA SOURCES

Qualitative research articles were considered for inclusion in the review, and JBI's meta-aggregative approach to synthesizing qualitative evidence was followed. An extensive search for relevant literature was undertaken in scientific databases.

REVIEW METHODS

Data were extracted from the included research articles, and qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved categorization of findings on the basis of similarity of meaning and aggregation of these categories to produce a comprehensive set of synthesized findings.

RESULTS

A total of five research articles met the inclusion criteria and were included in the review. The review process resulted in 46 subcategories that were aggregated into 13 categories. The categories generated four synthesized findings: personal existence; personal learning and development; being a professional fellow human; and clinical learning environment.

CONCLUSIONS

We meta-synthesized that: Nursing students experienced personal inadequacy, vulnerability and a transformation during their patient care encounter.

Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses

BACKGROUND

Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life.

OBJECTIVES

To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics.

METHODS

In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction.

RESULTS

Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change.

CONCLUSIONS

Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested.

Rasch Analysis of Lebanese Nurses’ Responses to the Occupational Fatigue Exhaustion Recovery Scale

Background and Purpose: The purpose of our methodological study was to explore the psychometric properties of Occupational Fatigue Exhaustion Recovery (OFER) subscales. Methods: Rasch analyses of 366 Lebanese registered nurses’ responses to the Chronic Fatigue (CF), Acute Fatigue (AF), and Intershift Recovery (IR) subscales. Results: Disordered rating categories, response dependence, and possible differential item functioning (DIF). The data were a better fit to a 3-dimensional Rasch rating scale model; difference, χ2 = 104, df = 12, p = .01; unidimensional Akaike information criterion (AIC) = 11,925; multidimensional AIC = 11,821. Conclusion: Multidimensional analysis confirmed that the CF and AF subscales have sufficient reliability for use in exploratory studies of fatigue with English-speaking respondents in the Eastern Mediterranean region. An Arabic version of OFER subscales is required to facilitate future studies in Lebanon and the region. Norm values are reported to facilitate international comparisons.

'Sometimes your safety goes a bit by the wayside' … exploring occupational health and safety (OHS) with student nurses

Because nursing is a high risk profession in terms of occupational health and safety (OHS), the topic of OHS is an important component of student nurse education and practice. Seeking ways to enhance curricular content and foster student health, safety and wellbeing is an ongoing pursuit. This pilot study explored nursing student perspectives about OHS in the clinical setting to develop an understanding of student views that could enlighten teaching about this topic within the undergraduate nursing course. Focus groups were held with pre-registration student nurses in two discrete cohort levels (first and third year). Themes were identified from the focus group discussion about trust, knowledge and responsibility. The students demonstrated a sound grasp of clinical hazards and associated administrative controls. Strengthening student awareness of higher order controls and their evaluation would augment their knowledge of legislative requirements. Students may benefit from learning about a risk management approach to OHS which would provide them with a structured basis for problem solving. This may assist them with clinical reasoning about health and safety issues and empower them in aspects of self-care.

Predictors of health of pre-registration nursing and midwifery students: Findings from a cross-sectional survey

BACKGROUND

Student nurses/midwives evidence less than exemplary lifestyle habits and poor emotional health, despite exposure to health education/promotion during their educational preparation. Knowledge of the factors that predict nursing/midwifery students' health could inform strategies to enhance their health and increase their credibility as future health promoters/educators.

OBJECTIVE

To establish the predictors of nursing/midwifery student emotional health.

DESIGN

Cross-sectional survey.

SETTING

The research took place at a university in Ireland.

PARTICIPANTS

We involved a total sample (n=473) student nurses/midwives.

METHODS

Participants completed the General Health Questionnaire, Lifestyle Behaviour Questionnaire and Ways of Coping Questionnaire to determine their self-reported emotional health, lifestyle behaviour and coping processes. Multivariate regression was performed to identify the predictors of student emotional health (dependent variable). The independent variables were demographics, coping, lifestyle behaviour and students' perceptions of determinants of their health.

RESULTS

Many respondents reported significant emotional distress (48.71%) and unhealthy lifestyle behaviours including smoking (27.94%), physical inactivity (34.29%), alcohol consumption (91.7%) and unhealthy diet (28.05%). Multivariate regressions indicated that the predictors of emotional distress included gender, year of study, smoking, passive coping and beliefs that their student life was stressful or/and that worry stress and boredom adversely impacted their diet.

CONCLUSIONS

Targeting student's beliefs regarding influences upon their health, promotion of positive lifestyles and adaptive coping is necessary to facilitate health gain of future health professionals.

Mental health first aid training for Australian medical and nursing students: an evaluation study

BACKGROUND

The role and demands of studying nursing and medicine involve specific stressors that may contribute to an increased risk for mental health problems. Stigma is a barrier to help-seeking for mental health problems in nursing and medical students, making these students vulnerable to negative outcomes including higher failure rates and discontinuation of study. Mental Health First Aid (MHFA) is a potential intervention to increase the likelihood that medical and nursing students will support their peers to seek help for mental health problems. This study aimed to evaluate the effectiveness of a tailored MHFA course for nursing and medical students.

METHODS

Nursing and medical students self-selected into either a face-to-face or online tailored MHFA course. Four hundred and thirty-four nursing and medical students completed pre- and post-course surveys measuring mental health first aid intentions, mental health literacy, confidence in providing help, stigmatising attitudes and satisfaction with the course.

RESULTS

The results of the study showed that both the online and face-to-face courses improved the quality of first aid intentions towards a person experiencing depression, and increased mental health literacy and confidence in providing help. The training also decreased stigmatizing attitudes and desire for social distance from a person with depression.

CONCLUSION

Both online and face-to-face tailored MHFA courses have the potential to improve outcomes for students with mental health problems, and may benefit the students in their future professional careers.

Psychological distress and coping amongst higher education students: a mixed method enquiry

Background

Psychological distress among higher education students is of global concern. Students on programmes with practicum components such as nursing and teacher education are exposed to additional stressors which may further increase their risk for psychological distress. The ways in which these students cope with distress has potential consequences for their health and academic performance. An in-depth understanding of how nursing/midwifery and teacher education students experience psychological distress and coping is necessary to enable higher education providers to adequately support these students.

Methods

This mixed method study was employed to establish self-reported psychological distress (General Health Questionnaire), coping processes (Ways of Coping Questionnaire) and lifestyle behaviour (Lifestyle Behaviour Questionnaire) of a total sample (n = 1557) of undergraduate nursing/midwifery and teacher education students in one university in Ireland. Individual interviews (n = 59) provided an in-depth understanding of students experiences of psychological distress and coping.

Results

A significant percentage (41.9%) of respondents was psychologically distressed. The factors which contributed to their distress, included study, financial, living and social pressures. Students used varied coping strategies including seeking social support, problem solving and escape avoidance. The positive relationship between elevated psychological distress and escape avoidance behaviours including substance use (alcohol, tobacco and cannabis) and unhealthy diet is of particular concern. Statistically significant relationships were identified between “escape-avoidance” and gender, age, marital status, place of residence, programme/year of study and lifestyle behaviours such as diet, substance use and physical inactivity.

Conclusion

The paper adds to existing research by illuminating the psychological distress experienced by undergraduate nursing/midwifery and teacher education students. It also identifies their distress, maladaptive coping and the relationship to their lifestyle behaviours. The findings can inform strategies to minimise student distress and maladaptive coping during college and in future professional years.

Effects of incivility in clinical practice settings on nursing student burnout

AIMS

To examine the relationship between nursing students' exposure to various forms of incivility in acute care practice settings and their experience of burnout.

BACKGROUND

Given that staff nurses and new nurse graduates are experiencing incivility and burnout in the workplace, it is plausible that nursing students share similar experiences in professional practice settings.

DESIGN AND SAMPLE

A cross-sectional survey design was used to assess Year 4 nursing students' (n=126) perceptions of their experiences of incivility and burnout in the clinical learning environment.

METHODS

Students completed instruments to assess frequency of uncivil behaviors experienced during the past six months from nursing staff, clinical instructors, and other health professionals in the acute care practice setting and to measure student burnout.

RESULTS

Reported incidences of incivility in the practice setting were related to burnout. Higher rates of incivility, particularly from staff nurses, were associated with higher levels of both components of burnout (emotional exhaustion and cynicism).

The influence of empowerment and incivility on the mental health of new graduate nurses

AIM

To test a model based on Kanter's theory of structural empowerment, which examines the relationships between new graduate nurses' perceptions of structural empowerment, workplace incivility and mental health symptoms.

BACKGROUND

The initial years of practice can be particularly stressful for new graduate nurses, who may be particularly vulnerable to uncivil behaviour as a result of their status in the work environment. Disempowerment and incivility in the workplace may compound the mental health symptoms experienced by new graduate nurses.

METHOD

A predictive, non-experimental design was used to examine the relationship between structural empowerment, workplace incivility and mental health symptoms in a sample of new graduate nurses working in hospital settings in Ontario (n = 394).

RESULT

High levels of structural empowerment were significantly associated with fewer negative mental health symptoms in new graduates. However, co-worker incivility and supervisor incivility partially mediated the effect of structural empowerment on new graduate nurses' mental health symptoms.

CONCLUSION

The findings suggest that empowering workplaces contribute to lower mental health symptoms in new graduate nurses, an effect that is diminished by incivility.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies that foster empowering work conditions and reduce uncivil behaviour are needed to promote positive mental health in new graduate nurses.

N2E: Envisioning a process to support transition from nurse to educator

Abstract Rising health inequities, continuing nursing shortages, and overlooked professional development needs of nurse educators are three important issues facing nursing in Australia. This paper argues for an innovative and proactive strategy that could transform the nurse education workforce into one that is repopulated, reinvigorated and refocused. The problem facing nurse educators, and subsequently affecting nurses' preparation for practice and longevity in the profession, was identified by drawing on findings from the literature, extensive educational experience, and an exploratory study of nurse educators working in universities, colleges and health services. A solution has been devised by drawing together the tenets of critical social theory, transformative learning, communities of practice and social media. Nursing educators, refocused around a social justice agenda, may be the remedy that the Australian Health Care System requires to embark on effective action that can benefit everyone, from the health service staff to our most vulnerable groups in society. This refocusing can be achieved in a structured and strategic process that builds confidence and professional capabilities.

Mental health of muslim nursing students in Thailand

The purpose of this research was to explore the mental health and well-being of Muslim nursing students in Thailand. Specifically, the study investigated the factors that impact anxiety and depression among Muslim nursing students. This cross-sectional research was conducted with a half sampling method of Muslim undergraduate students who were studying at a public nursing college in Thailand. From the 220 self-identified Muslim nursing students, 110 were sampled for this study, representing 14% of the total nursing students at this college. Results indicated a moderate prevalence of anxiety and high prevalence of depression among Muslim nursing students. Stress (β = .42) was positively associated with anxiety, while self-esteem (β = -.42) was negatively associated with anxiety; together this model accounted for 46% of the variance in anxiety. Self-esteem (β = -.41) and social support (β = -.17) were negatively associated with depression, while stress (β = .37) was positively correlated with depression; together this model accounted for 57% of the variance in depression. Recommendations were given to help train Muslim nursing students to be competent nurses with good mental health and well-being who will succeed and contribute to the nursing profession.

Interventions following a critical incident: developing a critical incident stress management team

This article describes the development and implementation of a stress management model for assisting hospital staff after critical incidents using an adaptation of Mitchell's model (J. Mitchell, 1983). A survey was conducted following the first major incident using M. Horowitz, N. Wilner, and W. Alvarez's (1979) Impact of Event Scale 10 days after and again 6 weeks following the incident to measure its emotional impact on staff. Outcomes included being symptom-free of critical incident stress after a 3-month period. The interventions were intended to help staff at a large metropolitan multispecialty hospital in Queensland in the immediate period following critical incidents. The implications of this program indicated the importance of emotional support at critical times for health professionals.

Psychological well-being of Thai nursing students

BACKGROUND

The psychological well-being of nursing students is a very important component in the training and development of future nurses. While previous studies have explored different aspects of nursing students' mental and psychological health in various countries, they have given little attention to comparing nursing students with their non-nursing student peers. The present study investigated the differences between nursing students and non-nursing students in Thailand with regard to their psychological well-being. The gender effect was also examined.

METHOD

Four hundred students were included in this study (200 nursing students and 200 non-nursing students). Participants completed a demographic questionnaire and four psychological instruments that examined their self-esteem, life satisfaction, depression, and social difficulties.

RESULTS

Overall, compared to their non-nursing counterparts, nursing students were found to score significantly higher on self-esteem and life satisfaction and reported lower levels of depression and social difficulties. Gender was also found to have a significant main effect on participants' social difficulties. Several recommendations for improving the mental health and psychological well-being of nursing students are discussed.

The role of faculty and clinical practice in predicting why nurses graduate in Hungary

AIMS

to estimate the proportion of nursing students in Hungary who intend to graduate from a nursing program and intend to work as a nurse after graduation.

METHODS

a cross-sectional, mail survey was implemented. A total of 381, purposively selected, final year students returned the survey instrument developed by the researchers. The survey was conducted in 3 of the total 7 nationwide nursing schools.

RESULTS

the rate of estimated student attrition ranged between 7 and 20%. Students were most satisfied with the mentoring and support received from faculty, and were least satisfied with their future career as a nurse. The most important factors that predicted intent to graduate and work after graduation were satisfaction with faculty support and clinical experiences, influence from family/peers to leave nursing, and intent to work abroad.

CONCLUSIONS

self-reported student attrition was prevalent in the sample studied. Students ranked faculty support as the top influence to graduate and work as a nurse after graduation. The finding that family/peers had negative influence on students' intent to graduate requires further exploration. Provision of strong, continuous support to faculty members by the school administration seems the best, but not the only counter attack against student attrition.

Safeguarding student well-being: establishing a respectful learning environment in undergraduate psychiatric/mental health education

The emotional well-being of psychiatric/mental health student nurses is critical to learners, the educational process and ultimately prospective patients. However, with a focus on client care, the psychological disposition and needs of psychiatric/mental health student nurses can be inadvertently marginalized or overlooked. To augment the extant literature, this paper examines how a respectful learning environment can be instrumental in safeguarding the emotional well-being of learners. Towards this end, this paper synthesizes and consolidates the literature regarding undergraduate psychiatric/mental health student nurse well-being, offers suggestions towards the establishment of a respectful learning environment, and invites further dialogue regarding this salient issue.