Risk factors for burnout among caregivers working in nursing homes

Resident Aggression and Staff Burnout in Nursing Homes in Hong Kong

This study examined the effects of exposure to resident aggression, self-efficacy, neuroticism, and attitudes toward dementia on burnout among direct care workers (DCWs) in nursing homes. A convenience sample of 800 DCWs from 70 randomly selected nursing homes in Hong Kong were recruited and individually interviewed. DCWs reported past-month experiences of resident aggression, levels of burnout, self-efficacy, neuroticism, attitudes toward dementia, and other personal and facility characteristics. Hierarchical multiple regression analysis revealed that, while physical environment of the facilities, and demographic background and self-efficacy of DCWs were not significant contributing factors, DCWs' exposure to resident aggression, insufficient experience and training in dementia care, negative attitudes toward dementia, and neurotic personality were associated with higher levels of staff burnout. Findings point to the importance of mitigating resident aggression and adequately screen and train staff to optimize their empathy and competence in minimizing the risk of burnout.

Association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities

BACKGROUND

As the number of older people requiring care continues to increase across the globe, maintaining care workers' mental health is an important task for all countries. This study examines the association between interpersonal relationships at work and psychological distress among care workers at elder care facilities in Japan.

METHODS

This study was a secondary data analysis of cross-sectional data. There were 406 participants who were analyzed. Questions consisted of demographic variables, psychological distress, interpersonal problems in the workplace, and intention to improve interpersonal relationships. Psychological distress was evaluated using the Japanese version of the K6 scale. Factors related to psychological distress were identified by logistic regression analysis.

RESULTS

Prevalence of psychological distress was 53.2%. Care workers experiencing interpersonal problems in the workplace were 5.95 (95% CI: 3.82-9.43) times more likely to experience psychological distress than care workers without such problems. Moreover, those who displayed an intention to improve their interpersonal relationships were 0.33 times (95% CI: 0.15-0.71) less likely to experience psychological distress than those who did not.

CONCLUSIONS

This study found there is a strong association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities. Therefore, experiencing interpersonal problems in the workplace may be a risk factor for psychological distress, and displaying an intention to improve one's interpersonal relationships may attenuate psychological distress.

Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.

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.

Stress and burnout in nursing home and égida workers during COVID-19

AIMS

Finding out whether there are differences in the levels of stress and burnout between workers providing care to dependent adults and those caring for independent older adults would provide comparative information about two different models of care. During the COVID-19 pandemic, workers caring for older adults were subjected to maladaptive situations that produced stress and burnout.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

A total of 900 nursing home and égidas workers were assessed for stress and burnout. Data were collected online from October 2020 to February 2021, when Puerto Rico was experiencing the peak of the third wave of COVID-19. MANOVAs were performed to study the interactions between the workplace and having had COVID, the workplace and the size of institution and the workplace and position held.

DATA SOURCES

October 2020 to February 2021.

RESULTS

All interactions were significant. Nursing homes showed higher levels of stress and burnout when workers had undergone COVID, when the size of the institution was larger and for technical staff other services; in égidas, having undergone COVID did not influence stress or burnout, which increased when the institution was smaller and for executive staff.

CONCLUSIONS

This study showed that the effects of the COVID-19 pandemic affected nursing home workers more significantly than those working in other types of residential models with independent older adults.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Applying preventive interventions aimed at reducing stress and burnout would facilitate the adaptation of workers caring for older adults and help to improve the quality of care.

IMPACT

This study analysed the impact of COVID-19 on the stress and burnout of workers providing services to older adults. Nursing home workers who have had COVID-19 have higher stress and burnout. The size of the institution has a different effect depending on whether older adults are dependent or independent. Workers in institutions dedicated to the care of the older adults.

REPORTING METHOD

This study has adhered to the relevant EQUATOR guidelines: STROBE.

PATIENT OR PUBLIC CONTRIBUTION

During the different waves of the COVID-19 pandemic, it was difficult to establish direct contact with workers providing care to older adults; this reason made it necessary to apply online systems to obtain information. The workers appreciated the fact that the implications for stress and burnout of the situation experienced during this difficult process were investigated.

"I haven't really gone through things like this": Young long-term care workers' experiences of working during the COVID-19 pandemic

BACKGROUND

Long-term care (LTC) facilities were hard hit by the COVID-19 pandemic in Canada. Using life course theory concepts, we looked for conditions that led to worker moral distress -i.e. pain or anguish over not being able to take right action - and how life stage may influence experiences.

OBJECTIVE

To illuminate the experiences of adults under the age of 30 who stepped into, and/or persevered in, working in LTC during the pandemic, recognizing that this emerging workforce represents the future of LTC in Canada.

METHODS

This secondary analysis uses interview data from a sub-sample of 16 young workers between 18 and 29 years of age who had been working in Canadian LTC facilities for between 8 months and 7 years.

RESULTS

Young workers expressed feeling guilt about mourning the loss of socially significant milestones as these milestones paled by comparison to the loss of life and consequences of resident isolation they witnessed at work. To manage feelings of moral distress, young workers attempted to maintain high standards of care for LTC residents and engaged in self-care activities. For some workers, this was insufficient and leaving the field of LTC was their strategy to respond to their mental health needs.

CONCLUSION

The life stage of young LTC workers influenced their experiences of working during the COVID-19 pandemic. Interventions are needed to support young workers' wellbeing and job retention.

Factors associated with satisfaction and depressed mood among nursing home workers during the covid-19 pandemic

AIMS AND OBJECTIVES

This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood.

BACKGROUND

Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction.

RESULTS

Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction.

CONCLUSIONS

Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers.

RELEVANCE TO CLINICAL PRACTICE

Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed.

NO PATIENT OR PUBLIC CONTRIBUTION

The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'.

Determinants of psychological injury among health and social care workers in community settings: A systematic review

BACKGROUND

Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings.

OBJECTIVE

To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings.

METHODS

Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist.

RESULTS

Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors.

CONCLUSION

Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.

From 65 to 103, Older Adults Experience Virtual Reality Differently Depending on Their Age: Evidence from a Large-Scale Field Study in Nursing Homes and Assisted Living Facilities

There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing studies examining the experiences and challenges facing those who facilitate VR for older adults (e.g., caregiving staff). We address these limitations through two studies. In study 1, we explore variation within older adults' experiences with VR through a field study of VR use among a large (N = 245) and age-diverse (Mage = 83.6 years, SDage = 7.9, range = 65-103 years) sample of nursing home and assisted living facility residents across 10 U.S. states. Age was negatively associated with the extent to which older adults enjoyed VR experiences. However, the negative relationship between age and older adults' attitudes toward VR was significantly less negative than the relationship between age and their attitudes toward other technologies (cell phones and voice assistants). In study 2, we surveyed caregiving staff (N = 39) who facilitated the VR experiences for older adult residents and found that the caregiving staff generally enjoyed the activity relative to other activities and felt it to be beneficial to their relationship with residents.

Factors related to the appearance and development of burnout in nursing students: a systematic review and meta-analysis

Introduction

Burnout may be suffered not only by experienced nurses, but also by those in training. The university environment can be highly stressful for student nurses, who are exposed to various stress-producing situations.

Aim

The aim of this study is to identify and analyse the main risk factors for burnout among nursing students.

Methods

A systematic review with meta-analysis was performed. The search equation used was "Burnout AND Nursing students". Quantitative primary studies on burnout in nursing students, and related risk factors published in English or Spanish and with no restriction by year of publication were included.

Results

A sample of n = 33 studies were included. Three variables are identified can influence burnout in nursing students: academic, interpersonal, environmental and/or social factors. The meta-analyses, with the higher sample of n = 418 nursing students, show that some personality factors, empathy, and resilience are correlated with emotional exhaustion, depersonalization and personal accomplishment.

Conclusion

The personality factors that can influence the development of burnout in nursing students, such as resilience and empathy, among others, must be taken into account when preventing the appearance and treating burnout. Professors should teach nursing students to prevent and recognize the most frequent symptoms of burnout syndrome.

The influence of Alzheimer's disease stigma on pain assessment in older persons

INTRODUCTION

Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored.

RESEARCH QUESTION

The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes.

METHODS

Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage).

RESULTS

Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions.

CONCLUSION

These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.

Costs of Persons with Dementia Living in Nursing Homes in The Netherlands

Background: Disease modifying treatments (DMTs) currently under development for Alzheimer’s disease, have the potential to prevent or postpone institutionalization and more expensive care and might delay institutionalization of persons with dementia. Objective: The current study estimates costs of living in a nursing home for persons with dementia in the Netherlands to help inform economic evaluations of future DMTs. Methods: Data were collected during semi-structured interviews with healthcare professionals and from the financial administration of a healthcare organization with several nursing homes. Personnel costs were calculated using a bottom-up approach by valuing the time estimates. Non-personnel costs were calculated using information from the financial administration of the healthcare organization. Results: Total personnel costs of a person with dementia per 24 hours, including both care staff and other healthcare providers, were € 151 for small-scale living wards and € 147 for independent living wards. Non-personnel costs were € 37 per day. Conclusion: This study provides Dutch estimates for total healthcare costs per day for institutionalized persons with dementia. These cost estimates can be used in cost-effectiveness analyses for future DMTs in dementia.

Postgraduate oncology educational shifts during the COVID-19 pandemic: results of faculty and medical student surveys

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice, research and teaching. During peaks, virtual courses were implemented but these changes are poorly described, especially for oncology postgraduate students and faculty teachers.

PATIENTS AND METHODS

We administered two surveys from June 2021 to October 2021 to students and faculty teachers (250 and 80 responses, respectively) who registered at Gustave Roussy School of Cancer Sciences (Université Paris-Saclay) during 3 consecutive university years (October 2018 to October 2021), where a major shift to e-learning was associated with COVID-19 pandemic.

RESULTS

Most students were female (53%), attending physicians (50%), aged 30-39 years (54%) and 2020-2021 (66.4%) was the main year of training. Most faculty teachers were male (58%), aged 40-50 years (44%) and had participated in training for at least 3 years (83%). More than half of the students received 100% virtual training [55% versus 45% face-to-face/mixed teaching modalities; online (84%) versus remote teaching (16%)]. Only 34% of students declared >80% 'active listening' and only 16% of teachers considered e-learning to be more suitable (compared with face-to-face) for postgraduate education. Virtual teaching decreased student-teacher interactions as compared with mixed/face-to-face (lessons were sufficiently interactive for 54% students if virtual only teaching versus for 71% if other teaching modalities; P = 0.009). Teachers stated that virtual learning did not lead to any improvements in terms of attendance (68%), interaction (74%) and quality of teaching (68%). However, most faculty (76%) acknowledged that partial e-learning training should be maintained outside the pandemic, if it represents ≤50% of the whole teaching (teachers: 79% versus student: 66%; P = 0.04).

CONCLUSIONS

COVID-19 accelerated the transition toward novel practices. Students and faculty teachers agreed on the need for future mixed (≤50% e-learning) teaching modalities. Adequate formation and the use of codified best newer virtual practices are required.

Pragmatic Trial of Personalized Music for Agitation and Antipsychotic Use in Nursing Home Residents With Dementia

OBJECTIVE

To test the effect of a personalized music intervention on agitated behaviors and medication use among long-stay nursing home residents with dementia.

DESIGN

Pragmatic, cluster-randomized controlled trial of a personalized music intervention. Staff in intervention facilities identified residents' early music preferences and offered music at early signs of agitation or when disruptive behaviors typically occur. Usual care in control facilities may include ambient or group music.

SETTING AND PARTICIPANTS

The study was conducted between June 2019 and February 2020 at 54 nursing homes (27 intervention and 27 control) in 10 states owned by 4 corporations.

METHODS

Four-month outcomes were measured for each resident. The primary outcome was frequency of agitated behaviors using the Cohen-Mansfield Agitation Inventory. Secondary outcomes included frequency of agitated behaviors reported in the Minimum Data Set and the proportion of residents using antipsychotic, antidepressant, or antianxiety medications.

RESULTS

The study included 976 residents with dementia [483 treatment and 493 control; mean age = 80.3 years (SD 12.3), 69% female, 25% African American]. CMAI scores were not significantly different (treatment: 50.67, SE 1.94; control: 49.34, SE 1.68) [average marginal effect (AME) 1.33, SE 1.38, 95% CI -1.37 to 4.03]. Minimum Data Set-based behavior scores were also not significantly different (treatment: 0.35, SE 0.13; control: 0.46, SE 0.11) (AME -0.11, SE 0.10, 95% CI -0.30 to 0.08). Fewer residents in intervention facilities used antipsychotics in the past week compared with controls (treatment: 26.2, SE 1.4; control: 29.6, SE 1.3) (AME -3.61, SE 1.85, 95% CI -7.22 to 0.00), but neither this nor other measures of psychotropic drug use were statistically significant.

CONCLUSIONS AND IMPLICATIONS

Personalized music was not significantly effective in reducing agitated behaviors or psychotropic drug use among long-stay residents with dementia. Barriers to full implementation included engaging frontline nursing staff and identifying resident's preferred music.

Sense of coherence and burnout in nursing home workers during the COVID-19 pandemic in Spain

Care staff in nursing homes work in a challenging environment, and the COVID-19 pandemic has exacerbated those challenges in an unprecedented way. On the other hand, the sense of coherence (SOC) is a competence that could help these professionals perceive the situation as understandable, manageable and meaningful. This study aims to analyse the extent to which potential risk and protective factors against burnout have affected nursing home workers during the COVID-19 pandemic and to assess the contribution of these factors to their burnout. Three hundred forty professionals who worked in nursing homes in Spain completed a survey and reported on their sociodemographic characteristics and their organisational characteristics of the job related to COVID-19, SOC and burnout. Multiple linear regression analyses were performed. The results showed that the SOC is highly related to the dimensions of burnout and is a protective factor against this. In addition, the increase in hours has a negative effect, facilitating inadequate responses to stressful situations; and whereas perceived social support and availability of resources have a protective effect, the deterioration in mental and physical health is the most important risk factor. This study could help better understand the psychological consequences of the effort that nursing home workers and can also help design mental health prevention and care interventions for workers that provide them with resources and supports that foster their coping skills.

Measuring the effects of a personalized music intervention on agitated behaviors among nursing home residents with dementia: design features for cluster-randomized adaptive trial

Background

Agitated and aggressive behaviors (behaviors) are common in nursing home (NH) residents with dementia. Medications commonly used to manage behaviors have dangerous side effects. NHs are adopting non-pharmacological interventions to manage behaviors, despite a lack of effectiveness evidence and an understanding of optimal implementation strategies. We are conducting an adaptive trial to evaluate the effects of personalized music on behaviors. Adaptive trials may increase efficiency and reduce costs associated with traditional RCTs by learning and making modifications to the trial while it is ongoing.

Methods

We are conducting two consecutive parallel cluster-randomized trials with 54 NHs in each trial (27 treatment, 27 control). Participating NHs were recruited from 4 corporations which differ in size, ownership structure, geography, and residents’ racial composition. After randomization, there were no significant differences between the NHs randomized to each trial with respect to baseline behaviors, number of eligible residents, degree of cognitive impairment, or antipsychotic use. Agitated behavior frequency is assessed via staff interviews (primary outcome), required nursing staff conducted resident assessments (secondary outcome), and direct observations of residents (secondary outcome). Between the two parallel trials, the adaptive design will be used to test alternative implementation strategies, increasingly enroll residents who are likely to benefit from the intervention, and seamlessly conduct a stage III/IV trial.

Discussion

This adaptive trial allows investigators to estimate the impact of a popular non-pharmaceutical intervention (personalized music) on residents’ behaviors, under pragmatic, real-world conditions testing two implementation strategies. This design has the potential to reduce the research timeline by improving the likelihood of powered results, increasingly enrolling residents most likely to benefit from intervention, sequentially assessing the effectiveness of implementation strategies in the same trial, and creating a statistical model to reduce the future need for onsite data collection. The design may also increase research equity by enrolling and tailoring the intervention to populations otherwise excluded from research. Our design will inform pragmatic testing of other interventions with limited efficacy evidence but widespread stakeholder adoption because of the real-world need for non-pharmaceutical approaches.

{2a} Trial registration

ClinicalTrials.govNCT03821844. Registered on January 30, 2019. This trial registration meets the World Health Organization (WHO) minimum standard.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05620-y.

Explanatory Factors of Burnout in a Sample of Workers with Disabilities from the Special Employment Centres (SEC) of the Amica Association, Spain

BACKGROUND

we have based our study on the fact that the labour market is progressively becoming more accessible for people with disabilities. This investigation aims to identify the factors that contribute to high levels of work-related stress in a group of disabled individuals in order to develop policies to prevent it and promote the health of the workforce.

METHODS

131 workers from two Special Employment Centres (SECs) of the Amica Association in Cantabria (Spain) participated in the study. Sociodemographic and job-related variables were collected using a questionnaire. Work-related stress was evaluated using the Maslach Burnout Inventory General Survey (MBI-GS), which analyzes emotional exhaustion, cynicism and personal efficacy.

RESULTS

the main explanatory factors for higher levels of emotional exhaustion were more than 5 years of service in the company (OR 3.235-IC 95% 1.392-7.519; p = 0.006) and bad job satisfaction (OR 7.615-IC 95% 2.467-23.503; p = 0.0001); higher levels of cynicism were also explained by bad job satisfaction (OR 8.599-IC 95% 2.481-29.799; p = 0.001).

CONCLUSIONS

future research is needed to facilitate the design of company policies and promote the well-being of the disabled population in the workplace, to avoid pathological conditions such as burnout syndrome.

The psychometric properties, confirmatory factor analysis, and cut-off value for the Fraboni scale of ageism (FSA) in a sampling of healthcare workers

PURPOSE

The Fraboni scale of ageism (FSA) is one of the scales used to determine ageism, which is the expression of prejudice toward the elderly because of their age through attitudes and behaviors. The purpose of this study is to determine the psychometric properties, factor analysis, and cut-off value for the FSA in a sampling of healthcare workers.

DESIGN AND METHODS

The sampling of this study was conducted methodologically in a descriptive and relationship-seeking type of research and comprised 814 healthcare workers employed at a university and state hospital.

FINDINGS

As a result of the exploratory and confirmatory factor analyses, it was found that the FSA comprised 29 items and three subdimensions, that these three factors explain approximately 30.23% of the total variance, and that the cut-off value is 78.

PRACTICE IMPLICATIONS

This study determined that the Turkish adaptation of the FSA is a suitable tool to measure the ageism of healthcare workers.

Burnout Syndrome in Paediatric Oncology Nurses: A Systematic Review and Meta-Analysis

Purpose: To determine levels of burnout among paediatric oncology nurses, and the risk factors that may influence its development. Method: A literature review with meta-analysis was conducted, via a search in the PubMed, CINHAL, Scopus, ProQuest (Health and Medical Complete), Scielo and PsycINFO databases, using the search equation: "Nurs* AND burnout AND oncology AND pediatric". Results: The final sample of selected studies was of eight articles. All were quantitative studies of paediatric oncology nurses, using the Maslach Burnout Inventory, written in English or Spanish. No search restrictions were established on the year of publication. The eight studies reported moderate-high levels of burnout in each of its three dimensions. These dimensions were all related to the characteristics of the profession, in terms of complexity, shifts and workload, and to sociodemographic variables such as marital status, work experience, age and gender. The prevalence meta-analytical estimation for a sample of n = 361 nurses were 37% for high emotional exhaustion, 16% for high depersonalisation and 27% for low personal fulfilment. Conclusions: Most paediatric oncology nurses present moderate-high levels of burnout. Therefore, strategies and interventions should be identified and implemented to protect these workers from the syndrome.

Staff nurses' evaluation of care process quality and patient outcomes in long-term care hospitals: A cross-sectional questionnaire survey

AIM

Despite the large and growing body of research on quality care evaluation and improvements in long-term care facilities, issues regarding the quality of care provided prevail worldwide. Further and more diverse research related to this topic is urgently required. To that end, this study examines the association between the subjective care process evaluations of nurses and selected patient outcomes in Japanese long-term care hospitals.

METHOD

To conduct a cross-sectional survey, we approached 2,000 long-term care hospitals in Japan, of which 263 (13.2%) completed and returned the questionnaires. We recruited ward managers and all full/part-time nurses in one ward from each hospital. We questioned managers about six patient outcome indicators: prevalence of physical restraint, urinary tract infections, indwelling catheter use, monthly incidence of new pressure ulcers, falls and recreational activities. We examined the nurses' care process evaluations using nine questions pertaining to daily caregiving activities developed from previous qualitative research. We examined the association between the ward averages of the nurses' evaluations and selected patient outcomes using the generalised linear model with a negative binomial distribution, with the exception of recreational activities for which we used a Poisson distribution, controlling for ward size and patient case mix.

RESULTS

We analysed the responses with complete data for outcome indicators from 199 (10.0%) managers and 2,508 nurses. Some patient outcome indicators were significantly associated with the nurses' care process evaluations, namely, urinary tract infections (B = -1.28, p < .001), indwelling catheter use (B = -0.57, p < .049), pressure ulcers (B = -1.20, p < .001) and recreational activities (B = 1.48, p < .001). These results suggest that better patient outcomes were associated with higher care process evaluations.

CONCLUSION

The nurses' evaluations and certain patient outcome indicators were associated. When considering potential quality improvement programmes, focusing on these evaluations will be beneficial.

Effects of a practical training programme on burnout among professional caregivers in a care home for older adults with dementia: a pilot study

AIM

As the number of persons with dementia has increased so has the need for both specialized care and long-term care centres. Professional caregivers working in these centres encounter specific problems, including stress, burnout, and feelings of dissatisfaction, each which can affect the quality of care. Due to the nature of their work, they are more likely to experience stress, which may lead to burnout syndrome. Therefore, the aim of this work was to assess the results of a practical training programme with regard to burnout among direct care professionals in a nursing home for people with dementia.

METHODS

A practical training programme was conducted for caregivers at the Sagrado Corazón de Jesús Nursing Home in Cuenca, Spain. The programme used a dynamic, interactive methodology to provide training related to concepts and strategies for dementia care. Weekly 2-h sessions were held over 9 months, from April 2016 to January 2017, with the post-test administered in February. Pretest and post-test measures were taken for a sample of 36 caregivers. An anova was used to analyze the differences in means before and after training. An ancova was also performed to determine the effects of the intervention.

RESULTS

The results revealed a significant difference between pre- and post-intervention emotional exhaustion and depersonalization scores. Personal accomplishment scores improved, but the changes were not significant.

CONCLUSION

A practical training programme for direct care professionals working with dementia patients can decrease burnout levels.

Analysis of the Mediating Role of Self-Efficacy and Self-Esteem on the Effect of Workload on Burnout's Influence on Nurses' Plans to Work Longer

At the present time, we know that there is a positive relationship between self-efficacy and self-esteem in which positive beliefs about one’s own efficacy increase one’s sense of self-worth as stressful situations of a heavy workload are coped with successfully, and this, in turn, affects the nurses’ plans to work longer. Analyze the mediating role of self-efficacy and self-esteem in the effect of workload, measured as the number of users attended to during a workday, on burnout in nursing professionals. A sample of 1307 nurses aged 22 to 60 years who were administered the Brief Burnout Questionnaire, the General Self-Efficacy Scale, and the Rosenberg Self-Esteem Scale, and workload, measured as the number of users attended to during the workday. The results show that professionals with high levels of self-efficacy also scored higher on global self-esteem. Burnout correlated negatively with both variables (self-efficacy and self-esteem). Three clusters were found with the variables (self-efficacy, self-esteem, and workload) showing significant differences in burnout scores among clusters. Self-efficacy and self-esteem function as buffers of the negative effects of workload on burnout. Organizations should design interventions for promoting the personal resources of their workers through training activities and organizational resources (e.g., redesigning job positions) to promote satisfaction and wellbeing of employees, making their stay at work greater.

Nurses' and Care Workers' Perception of Care Quality in Japanese Long-Term Care Wards: A Qualitative Descriptive Study

Despite the growing importance of long-term care for older adults, there has been limited attention to its quality assurance issues in Japan. To start planning the initiation of continuous quality improvement in long-term care hospitals, we explored how nurses and care workers themselves perceived current approaches to quality assurance and improvement on their ward. We interviewed 16 licensed nurses and nine care workers, transcribed and analyzed data using qualitative content analysis techniques, and derived six categories: keeping clients alive is barely possible, the absence of a long-term care practice model, the lack of quality indicators, long-term care hospitals as places for castaways, client quality of life as a source of satisfaction, and conflict between staff and client well-being. To develop continuous quality improvement in Japanese long-term care hospitals, it may be first necessary to introduce a practice model of long-term care and mechanisms to evaluate quality.

Opportunities for Occupational Therapy to Serve as a Catalyst for Culture Change in Nursing Facilities

Ensuring that older adults are receiving quality and effective rehabilitation and skilled nursing services must be a priority to society and to the health care system, but health care policies and systems driving reimbursement continue to challenge the delivery of services. A review of the literature indicates significant problems among residents of skilled nursing facilities (SNFs) that could be alleviated by meaningful occupational therapy. Research and practice in the occupational therapy community should focus on this large area of practice. Advocacy by individual practitioners-challenging themselves and others to provide more patient-centered care-can lead to changes that benefit clients, facilities, and payment systems as well as contribute to career satisfaction of occupational therapy practitioners. Occupational therapy can and should serve as catalyst for culture change in SNFs by providing meaningful interventions and opportunities that support engagement and health.

Burnout Risk and Protection Factors in Certified Nursing Aides

Studies have found a higher risk of burnout among employees in the healthcare sector. As such, this study focused on Certified Nursing Aides (CNAs) who have shown a high prevalence of burnout and are therefore considered an especially vulnerable group. The objective of this study was to identify the relationships between some organizational, personal, and sociodemographic factors and burnout. The final study sample included 278 working CNAs with a mean age of 40.88 (SD = 9.41). To compile the data, an ad hoc questionnaire was used to collect sociodemographic information. To collect professional and employment information, we used the Brief Emotional Intelligence Inventory for Adults, the Brief Questionnaire on Perceived Social Support, and the General Self-Efficacy Scale. The results showed that Burnout Syndrome is significantly and negatively related to all the emotional intelligence factors, self-efficacy, and perceived social support. The risk of burnout is higher in younger persons and in permanently employed professionals. General self-efficacy and stress management act as protective factors against the likelihood of burnout. This study suggests that organizations should urge coaching and transformational leadership training programs to promote the wellbeing and organizational commitment of workers.