How a critical care environment influences nurses' health and working capacity: a scoping review

BACKGROUND

Internationally, the nursing workforce is ageing. Chronic conditions are becoming more prevalent amongst the ageing nursing workforce. With an increase in chronic conditions and an ageing nursing workforce, understanding environmental influences on nurses' health and work capacity is vital to supporting this workforce.

AIM

A scoping review was conducted to explore the influence of a critical care environment on nurses' health and work capacity.

DESIGN

A scoping review was conducted according to PRISMA-ScR guidelines.

METHODS

Database extraction occurred in June 2023 and included MEDLINE Complete, PubMed, Scopus, CINAHL, and Embase.

RESULTS

Eight studies met the inclusion criteria. Studies were conducted internationally with sample sizes from 20 to 500 critical care nurses (CCNs).

CONCLUSIONS

Findings identified the critical care environment had an impact on nurses' health and working capacity. Many CCNs self-reported having a chronic condition that influenced their nursing practice. Further research is needed to explore how to mitigate the influence of a chronic condition to support this valuable workforce.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.

Slip-resistant footwear to reduce slips among health-care workers: the SSHeW RCT

Background

In Great Britain, 100,000 injuries due to slips, trips and falls on the level (as opposed to falls from a height, e.g. a ladder) occur in the workplace each year. They are the most common cause of non-fatal injury in the workplace, accounting for 30% of all those injuries reported to the Health and Safety Executive. Nearly 1 million working days are lost because of slips, trips and falls each year.

Objectives

To assess the clinical effectiveness and cost-effectiveness of 5-star, GRIP-rated, slip-resistant footwear in preventing slips in the workplace compared with usual footwear.

Design

A two-arm, multicentre, randomised controlled trial with an economic evaluation and qualitative study.

Setting

Seven NHS trusts in England.

Participants

NHS staff aged ≥ 18 years, working at least 22.5 hours per week in clinical, general or catering areas who owned a mobile phone. Staff required to wear protective footwear were excluded.

Interventions

Intervention participants were offered 5-star, GRIP-rated, slip-resistant footwear. The waiting list control group were asked to wear their usual work shoes for the duration of the study and were offered the trial footwear at the end of their participation.

Main outcome measures

The primary outcome was the incidence rate of self-reported slips in the workplace over 14 weeks. Secondary outcomes included the incidence rate of falls either resulting from a slip or not resulting from a slip, proportion of participants reporting a slip, fall or fracture, time to first slip and fall, health-related quality of life and cost-effectiveness.

Results

A total of 4553 eligible NHS staff were randomised (2275 to the intervention arm and 2278 to the control arm). In total, 6743 slips were reported [2633 in the intervention group (mean 1.16 per participant, range 0–36 per participant) and 4110 in the control group (mean 1.80 per participant, range 0–83 per participant)]. There was a statistically significant reduction in the slip rate in the intervention group relative to the control group (incidence rate ratio 0.63, 95% confidence interval 0.57 to 0.70; p < 0.001). Statistically significant reductions were observed in falls from a slip (incidence rate ratio 0.51, 95% confidence interval 0.28 to 0.92; p = 0.03), the proportion of participants who reported a slip (odds ratio 0.58, 95% confidence interval 0.50 to 0.66; p < 0.001) or fall (odds ratio 0.73, 95% confidence interval 0.54 to 0.99; p = 0.04) and the time to first slip (hazard ratio 0.73, 95% confidence interval 0.67 to 0.80; p < 0.001). Half of the intervention participants wore the shoes all the time at work. Incremental cost per quality-adjusted life-year in the base case was £38,900 from the NHS perspective and –£60,400 (i.e. cost saving) from the societal perspective.

Limitations

This was an unblinded trial in which outcome data were participant self-reported, which may have led to inaccuracies in the reported slip data. Exposure to the trial footwear was lower than hoped.

Conclusions

The offer and provision of 5-star, GRIP-rated footwear reduced slips in the workplace, was acceptable to participants and could be cost-effective.

Future work

Replication of the study within other settings may be required to evaluate the clinical effectiveness and cost-effectiveness in other environments settings, such as catering and factories.

Trial registration

Current Controlled Trials ISRCTN33051393.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 3. See the NIHR Public Journals Library website for further project information. The Health and Safety Executive provided some research costs.

Considerations for an aging nurse anesthetists workforce

The Certified Registered Nurse Anesthetists (CRNA) workforce is aging. It is estimated that nearly half (49.7%) of the CRNA workforce is age 50 or greater, with those practicing in management positions and as educators having the oldest mean ages. Older CRNAs face workplace challenges that can lead to decreased productivity and overall job satisfaction. Common injuries to older practitioners result from repetitive motion, slips and falls, needle sticks, fatigue, and emotional or mental health related illness. Because of the high acuity environment in which CRNAs practice they are at an elevated risk for these injuries. Creating a healthy and supportive work environment has been shown to improve the retention of aging healthcare workers, and succession planning is essential in preparing for their retirement.

The impact of moving to a 12h shift pattern on employee wellbeing: A qualitative study in an acute mental health setting

Background

Against a backdrop of increasing demand for mental health services, and difficulties in recruitment and retention of mental health staff, employers may consider implementation of 12 h shifts to reduce wage costs. Mixed evidence regarding the impact of 12 h shifts may arise because research is conducted in divergent contexts. Much existing research is cross sectional in design and evaluates impact during the honeymoon phase of implementation. Previous research has not examined the impact of 12 h shifts in mental health service settings.

Objective

To evaluate how employees in acute mental health settings adapt and respond to a new 12 h shift system from a wellbeing perspective.

Design

A qualitative approach was adopted to enable analysis of subjective employee experiences of changes to organisation contextual features arising from the shift pattern change, and to explore how this shapes wellbeing.

Setting(s)

Six acute mental health wards in the same geographical area of a large mental health care provider within the National Health Service in England.

Participants

70 participants including modern matrons, ward managers, clinical leads, staff nurses and healthcare assistants.

Methods

Semi-structured interviews with 35 participants at 6 months post-implementation of a new 12 h shift pattern, with a further 35 interviewed at 12 months post-implementation.

Results

Thematic analysis identified unintended consequences of 12 h shifts as these patterns changed roles and the delivery of care, diminishing perceptions of quality of patient care, opportunities for social support, with reports of pacing work to preserve emotional and physical stamina. These features were moderated by older age, commitment to the public healthcare sector, and fit to individual circumstances in the non-work domain leading to divergent work-life balance outcomes.

Conclusions

Findings indicate potential exists for differential wellbeing outcomes of a 12 h shift pattern and negative effects are exacerbated in a stressful and dynamic acute mental health ward context. In a tight labour market with an ageing workforce, employee flexibility and choice are key to retention and wellbeing. Compulsory 12 h shift patterns should be avoided in this setting.

Misreading Injectable Medications-Causes and Solutions: An Integrative Literature Review

BACKGROUND

This integrative review examines research identifying the misreading of injectable medications as a cause of medication error in hospitals, factors affecting injectable medication visibility leading to medication errors, and interventions to increase the readability of injectable medications. Signal detection theory (SDT) is applied to explain why visual enhancement of injectable medications may improve accuracy of administration.

METHODS

Academic health databases were searched for articles published between 2000 and 2019. An integrative review methodology permitted exploration and critique of both theoretical and empirical literature.

RESULTS

Fifteen studies reported that misreading injectable medications contributed to medication errors. Five studies investigated interventions to improve visualization of injectable medications. SDT suggested three factors may contribute to misreading injectable medications: (1) environmental light levels, (2) medication labels, and (3) clinician factors.

CONCLUSION

Although the literature on this topic was limited and not definitive, results of this review indicated possible ways to improve practice and targets for future research to reduce medication errors due to misreading injectable medication labels.

Menopause and the NHS: caring for and retaining the older workforce

Menopause is a natural transition affecting most women between the ages of 45 and 55. Three-quarters of women will experience mild to moderate menopausal symptoms and a further quarter will report them as severe. Symptoms can include night sweats, hot flushes, poor concentration, tiredness, poor memory and lowered confidence. The workplace can exacerbate these symptoms and for some women can influence their decision to stop working earlier than previously intended. The need for support and understanding from managers is crucial and can make a major difference to how a woman deals with her menopause. Many women enter the menopause at the peak of their productive lives. These women have valuable skills, knowledge and experience that employers need to retain, so they should be developing resources to help navigate this normal and natural stage of the ageing process.

Organization of Work Factors Associated with Work Ability among Aging Nurses

The United States (U.S.) workforce is aging. There is a paucity of literature exploring aging nurses' work ability. This study explored the work-related barriers and facilitators influencing work ability in older nurses. We conducted a qualitative descriptive study of aging nurses working in direct patient care (N = 17). Participants completed phone or in-person semi-structured interviews. We used a content analysis approach to analyzing the data. The overarching theme influencing the work ability of aging nurses was intrinsically motivated. This was tied to the desire to remain connected with patients at bedside. We identified factors at the individual, unit-based work level and the organizational level associated with work ability. Individual factors that were protective included teamwork, and feeling healthy and capable of doing their job. Unit-based level work factors included having a schedule that accommodated work-life balance, and one's chronotype promoted work ability. Organizational factors included management that valued worker's voice supported work ability.

Visual Performance and Occupational Safety Among Aging Workers

With the rapid growth of the aging workforce, age-related conditions may negatively influence overall workplace safety and health among these workers and their employers. In this summary, we have outlined details about visual acuity, glare sensitivity, and contrast sensitivity, which are common age-related vision changes that can potentially affect their occupational safety. The occupational health nurse is well positioned to address these concerns by instructing aging workers about potential development of vision change and ensuring they receive the appropriate vision screening. By assisting employers to modify work environments to accommodate this population, the occupational health nurse can reduce the risk of injury, as well as positively impact the health of their aging workforce.

Current access and recruitment practices in nursing education institutions in KwaZulu-Natal: A case study of student nurses with disabilities

Background

While institutions of higher education may have increased access and accommodation for students with disabilities, institutions primarily providing nurse training in South Africa do not mirror the same practice.

Objectives

Notwithstanding the integration of disability policies enacted in South Africa in 2010, a majority of people with disabilities are still excluded from the activities of society equally applicable to nursing education. This article describes the current access and recruitment practices for student nurses with disabilities (SNWDs) in nursing education institutions in KwaZulu-Natal to provide baseline data, which is largely absent in nursing institutions.

Method

A concurrent mixed-method design using a multiple embedded case study approach was employed. This article presented phase 1 of the study, a quantitative survey of all private nursing education institutions (n = 27), complemented by individual, in-depth interviews with SNWDs (n = 10). Quantitative data were analysed using SPSS version 24, with a response rate of 78% (n = 21), whereas qualitative data were analysed using content analysis.

Results

The findings revealed that the majority of private NEIs lack policy guidelines for recruiting SNWDs; however, other means of guidance is sought, for example, using the technical assistance. While NEIs were willing to recruit SNWDs, access to clinical sites, lectures, support systems and reasonable accommodation was challenging.

Conclusion

Private NEIs are providing an inclusive education to all students including those with disabilities; however, they still have a long way to go in meeting the needs of SNWDs with regards to support and accommodation.

Integration experiences of student and qualified nurses with disabilities who graduated from selected KwaZulu-Natal nursing education institutions: An exploratory case study

BACKGROUND

 Despite the introduction of the Disability Policy Guidelines in South Africa (SA), student nurses who have disabilities (SNWDs) are still habitually and effectively excluded from nurse training programmes, and hence from the nursing profession. Yet SNWD may be able to offer a unique perspective.

OBJECTIVES

 To explore and describe the integration experiences of both student and qualified nurses with disabilities who graduated from selected KwaZulu-Natal nursing education institutions (NEIs).

METHOD

 A concurrent mixed-method design based on multiple embedded case studies served as the primary data collection instrument in this paper. The researcher initially conducted a survey of all the private NEIs to determine which had experienced training SNWDs; 3 cases and 10 embedded cases were selected, using non-probability purposive sampling. Individual interviews were conducted with students and qualified nurses with who have a disability (n = 10) who had graduated from NEIs.

RESULTS

 The findings of the study indicated that, largely, private NEIs are paving the way for integrating SNWDs; however, there are still some gaps in meeting the needs of these students. Despite strong legislative policies, an inclusive and enabling teaching and learning environment for SNWDs in nurse training remains largely absent.

CONCLUSION

 The study recommends that NEIs develop policy guidelines for integrating SNWDs in nursing education programmes promoting an inclusive nursing education for SNWDs. The introduction of a disability liaison to assist SNWDs by liaising between key stakeholders and, perhaps, addressing many of the challenges that SNWDs experience in the clinical facilities where nursing personnel are unaware of their disability.

The relationship between organizational policies and practices and work limitations among hospital patient care workers

OBJECTIVE

We examined relationships between organizational policies and practices (OPPs) (safety practices, ergonomic practices, and people-oriented culture) and work limitations in a sample of hospital workers.

METHODS

We used the 6-item Work Limitations Questionnaire (WLQ) to assess workers' perceptions of health-related work limitations. Self-reported OPPs and the WLQ were collected from workers in Boston, Massachusetts (n = 1277). We conducted random-intercept multi-level logistic regression models for each OPP using stepwise selection of covariates.

RESULTS

As the unit-average ergonomic practice score increased by one, the odds of a worker reporting work limitations decreased by approximately 39% (P-value = 0.018), adjusted for job title, age, and body mass index. A similar relationship existed for people-oriented culture (P-value = 0.038). The association between safety practices and work limitations was similar, but not statistically significant.

CONCLUSIONS

This study demonstrated the importance of workplace OPPs. OPPs that promote positive and supportive environments and that foster improvements in ergonomics may help reduce work limitations.

Human errors and occupational injuries of older female workers in residential healthcare facilities for the elderly

This study aimed to describe the characteristics of occupational injuries of female workers in residential healthcare facilities for the elderly, and to analyze human errors as causes of accidents. From the national industrial accident compensation data, 506 female injuries were analyzed by age and occupation. The results showed that medical service worker was the most prevalent (54.1%), followed by social welfare worker (20.4%). Among injuries, 55.7% had <1 year of work experience and 37.9% were aged ≥60 years. Slips/falls were the most common type of accident (42.7%), and the proportion injured by slips/falls increases with age. Among human errors, action errors were the primary reasons, followed by perception errors and cognition errors. In addition, the ratios of injuries by perception errors and action errors increase with age. The findings of this study suggest that there is a need to design workplaces that accommodate the characteristics of older female workers.

Occupational therapists' experience of workplace fatigue: Issues and action

BACKGROUND

Occupational therapists (OTs) work in all areas of health and wellbeing. The work is physically and psychologically demanding, but OTs are often not diligent about recognizing and attending to the workplace health and safety issue of fatigue in their own work settings.

OBJECTIVE

The purpose of this paper is to determine current issues and the evidence-base as presented in the literature so as to develop awareness and best practice interventions for fatigue reduction and management in occupational therapists' workplace.

METHODS

A comprehensive search strategy was carried out by the medical librarian on the study team and themes were extracted from the relevant literature by the study team.

RESULTS

The literature revealed little research directly addressing occupational therapy workplace fatigue and we expanded our review of the evidence-base across all healthcare workers to identify publications of particular relevance to occupational therapists.

CONCLUSION

This background paper is an important first step to raising awareness among OTs, guide key stakeholders regarding contributing factors to, and consequences of, OTs' workplace fatigue, and set research direction. Knowing which factors influencing workplace fatigue are shared across healthcare professionals and which are unique to OTs can also help organizations develop more tailored workplace fatigue risk reduction programs. This review concludes with a list of existing guidelines and tools for developing workplace fatigue risk assessment and management programs relevant to occupational therapists.

Relating Older Workers' Injuries to the Mismatch Between Physical Ability and Job Demands

OBJECTIVE

We examined the association between job demand and occupational injury among older workers.

METHODS

Participants were workers aged 50+ enrolled in the Health and Retirement Study, 2010 to 2014. Participants reported physical ability within three domains: physical effort, stooping/kneeling/crouching, and lifting. To measure subjective job demand, participants rated their job's demands within domains. We generated objective job demand measures through the Occupational Information Network (ONET). Using Poisson regression, we modeled the association between physical ability, job demand, and self-reported occupational injury. A second model explored interaction between job demand and physical ability.

RESULTS

The injury rate was 22/1000 worker-years. Higher job demand was associated with increased injury risk. Within high job demands, lower physical ability was associated with increased injury risk.

CONCLUSIONS

Older workers whose physical abilities do not meet job demands face increased injury risk.

Occupational Exposures of Home Healthcare Workers

Population demographics in the United States are rapidly changing with increased dependence on home healthcare (HHC) by an aging population, patients suffering from chronic diseases, and inability to perform activities of daily living. Despite the occupational injury rates for HHC workers (HHCW) being higher than the national average, an understanding of the occupational safety and health experiences and exposures of HHCW is limited. The purpose of this study was to understand the health and safety risk factors for HHCW. One-on-one interviews were conducted with HHCW to elicit frequency of daily occupational exposures to hazards and risk factors during visits to patients' homes. Approximately 67% of the study population was over 40 years old and mostly obese, potentially increasing risk for injury. HHCW routinely perform physical tasks with increased risk for occupational musculoskeletal injuries. Exposures to drug residue from dispensing oral medications and anticancer medications and exposure to potentially infectious agents and cleaning chemicals used for infection prevention were reported. The majority of HHCW were also exposed to secondhand smoke and occasionally experienced violence. Developing and implementing intervention strategies that address engineering controls, establish employee safety-related policies, provide training and retraining, promote a healthy lifestyle among HHCW, and providing suitable personal protective equipment may help to decrease occupational injury rates.

Effects of the Nurse Athlete Program on the Healthy Lifestyle Behaviors, Physical Health, and Mental Well-being of New Graduate Nurses

Recognizing that transition from nursing student to point-of-care nurse can be a stressful time period in one's career. A pilot study at a large Midwestern medical center tested the preliminary effects of a health-oriented workshop, the Nurse Athlete, on new graduate nurses' healthy lifestyle beliefs, healthy lifestyle behaviors, depressive and anxiety symptoms, as well as health outcomes. The Nurse Athlete workshop, provided in partnership with Johnson & Johnson's Human Performance Institute (HPI), used materials from HPI's Corporate Athlete program. The 2-day workshop focuses on energy management through a comprehensive examination of goals and values in relation to one's spiritual, mental, emotional, and physical development and provides practical strategies to improve self-care. Eighty-eight new graduate nurses hired at the university's medical center were offered the opportunity to participate in the Nurse Athlete program and associated study. Sixty-nine percent of these new graduate nurses (n = 61) consented and participated in the program. There was a statistically significant decrease in the participants' weight and body mass index from baseline to the 6-month follow-up assessment, which resulted in small to medium positive effects for the Nurse Athlete program. There was also a significant decrease in body fat percentage across time, resulting in a large positive intervention effect. Statistically significant reductions in depressive symptoms were measured between baseline and 6 months.

Complexity of occupational exposures for home health-care workers: nurses vs. home health aides

AIM

To identify occupational exposures for home health-care nurses and aides.

BACKGROUND

Home health-care workers' occupational injury rates in the USA are higher than the national average, yet research on causative exposures and hazards is limited.

METHODS

Participants were interviewed about annual frequency of occupational exposures and hazards. Exposure and hazard means were compared between home health-care nurses and aides using a Wilcoxon two-sample test.

RESULTS

A majority of the sample was over 40 years old and obese, potentially increasing injury risks. Home health-care nurses performed more clinical tasks, increasing exposure to blood-borne pathogens. Home health-care aides performed more physical tasks with risk for occupational musculoskeletal injuries. They also dispensed oral medications and anti-cancer medications, and were exposed to drug residue at a frequency comparable to home health-care nurses. Both groups were exposed to occupational second-hand smoke.

CONCLUSIONS

Establishing employee safety-related policies, promoting healthy lifestyle among staff, and making engineered tools readily available to staff can assist in decreasing exposures and hazards.

IMPLICATIONS FOR NURSING MANAGEMENT

Implications for nursing management include implementation of health-promotion programmes, strategies to reduce exposure to second-hand smoke, ensuring access to and education on assistive and safety devices, and education for all staff on protection against drug residue.

Changes in the expression of calcitonin gene-related peptide after exposure to injurious stretch-shortening contractions

One of the factors that can result in musculoskeletal injuries, and time off work, is exposure to repetitive motion. The goal of this study was to determine if skeletal muscle injury induced by exposure to injurious stretch-shortening cycles (iSSCs), resulted in hyperalgesia in the hind limb and changes in calcitonin-gene related peptide (CGRP) immunolabeling in the dorsal root ganglia (DRG) in young and old male rats.

METHODS

Young (3months) and old (30months) male Fisher 344×BN F1 rats were anesthetized with isoflurane and the left hind limbs were exposed to 15 sets of 10 SSCs. Control animals were exposed to a single bout of SSCs of equal intensity. Sensitivity to mechanical stimulation was assessed using von Frey filaments prior to beginning the experiment, and on days 2 and 9 following exposure to iSSCs. Rats were euthanized one, 3 or 10days after the exposure. The ipsilateral DRG were dissected from the L4-5 region of the spine, along with the left tibialis anterior (LTA) muscle.

RESULTS

Rats exposed to iSSCs were more sensitive to mechanical stimulation than control rats 2days after the exposure, and showed a reduction in peak force 3days after exposure. Changes in sensitivity to pressure were not associated with increases in CGRP labeling in the DRG at 3days. However, 9days after exposure to iSSCs, old rats still displayed an increased sensitivity to mechanical stimulation, and this hyperalgesia was associated with an increase in CGRP immunolabeling in the DRG. Young rats exposed to iSSC did not display a change in CGRP immunolabeling and sensitivity to mechanical stimulation returned to control levels at 10days.

CONCLUSIONS

These findings suggest that hyperalgesia seen shortly after exposure to iSSC is not influenced by CGRP levels. However, in cases where recovery from injury may be slower, as it is in older rats, CGRP may contribute to the maintenance of hyperalgesia.