Exploring Resilience in Care Home Nurses: An Online Survey

Resilience is considered a core capability for nurses in managing workplace challenges and adversity. The COVID-19 pandemic has brought care homes into the public consciousness; yet, little is known about the resilience of care home nurses and the attributes required to positively adapt in a job where pressure lies with individuals to affect whole systems. To address this gap, an online survey was undertaken to explore the levels of resilience and potential influencing factors in a sample of care home nurses in Northern Ireland between January and April 2022. The survey included the Connor-Davidson Resilience Scale, demographic questions and items relating to nursing practice and care home characteristics. Mean differences and key predictors of higher resilience were explored through statistical analysis. A moderate level of resilience was reported among the participants (n = 56). The key predictors of increased resilience were older age and higher levels of education. The pandemic has exposed systemic weakness but also the strengths and untapped potential of the care home sector. By linking the individual, family, community and organisation, care home nurses may have developed unique attributes, which could be explored and nurtured. With tailored support, which capitalises on assets, they can influence a much needed culture change, which ensures the contribution of this sector to society is recognised and valued.

Association between Resilience, Professional Quality of Life, and Caring Behavior in Oncology Nurses: A Cross-Sectional Study

PURPOSE

The degree of caring behavior of oncology nurses is a crucial factor in the care provided to patients with cancer. In this study, we aimed to investigate factors related to oncology nurses' caring behavior, including their resilience and professional quality of life.

METHODS

A cross-sectional descriptive study was conducted with 107 oncology nurses at an urban tertiary hospital from May 18 to 24, 2015. We used a self-report questionnaire to measure resilience, professional quality of life, and degree of caring behavior. Data analysis included descriptive statistics, correlations, and multiple regression analysis using SPSS/WIN 20.0.

RESULTS

Oncology nurses presented with low levels of resilience and caring behavior, and high levels of compassion satisfaction, burnout, and secondary traumatic stress. There was a statistically significant relationship between the degree of caring behavior, resilience (r = .43, p < .001), compassion satisfaction (r = .51, p < .001), and burnout (r = -.42, p < .001), as well as between secondary traumatic stress and burnout (r = .34, p < .001). Factors associated with oncology nurses' degree of caring behavior were compassion satisfaction (t = 6.00, p < .001) and educational level (t = 3.45, p = .001).

CONCLUSION

This study demonstrates that oncology nurses' degree of caring behavior is related to their professional quality of life and education. These findings suggest that enhancing oncology nurses' healthy coping strategies at both the individual and organizational levels can further develop holistic nursing care. Additionally, it is necessary to examine the factors affecting nurses' compassion satisfaction and to try to promote this aspect.

A rapid review of evaluated interventions to inform the development of a resource to support the resilience of care home nurses

BACKGOUND

Nurses working in care homes face significant challenges that are unique to that context. The importance of effective resilience building interventions as a strategy to enable recovery and growth in these times of uncertainty have been advocated. The aim of this rapid review was to inform the development of a resource to support the resilience of care home nurses. We explored existing empirical evidence as to the efficacy of resilience building interventions. undertaken with nurses.

METHODS

We undertook a rapid review using quantitative studies published in peer reviewed journals that reported resilience scores using a valid and reliable scale before and after an intervention aimed at supporting nurse resilience. The databases; Cumulative Index to Nursing and Allied Health Literature, Medline and PsychInfo. and the Cochrane Library were searched. The searches were restricted to studies published between January 2011 and October 2021 in the English language. Only studies that reported using a validated tool to measure resilience before and after the interventions were included.

RESULTS

Fifteen studies were included in this rapid review with over half of the studies taking place in the USA. No studies reported on an intervention to support resilience with care home nurses. The interventions focused primarily on hospital-based nurses in general and specialist contexts. The interventions varied in duration content and mode of delivery, with interventions incorporating mindfulness techniques, cognitive reframing and holistic approaches to building and sustaining resilience. Thirteen of the fifteen studies selected demonstrated an increase in resilience scores as measured by validated and reliable scales. Those studies incorporating 'on the job,' easily accessible practices that promote self-awareness and increase sense of control reported significant differences in pre and post intervention resilience scores.

CONCLUSION

Nurses continue to face significant challenges, their capacity to face these challenges can be nurtured through interventions focused on strengthening individual resources. The content, duration, and mode of delivery of interventions to support resilience should be tailored through co-design processes to ensure they are both meaningful and responsive to differing contexts and populations.

Resilience amongst Ontario registered practical nurses in long-term care homes during COVID-19: A grounded theory study

AIMS

This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long-term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic.

BACKGROUND

Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID-19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID-19-related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings.

METHODS

Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in-depth one-on-one interviews and analyses completed between April to September 2021.

RESULTS

Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'.

CONCLUSION

Resilience was largely drawn from themselves as individuals. Resources to support self-care and work-life balance are needed. Additionally, workplace supports to build capacity for team-based care practices, collegial support in problem-solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC.

PATIENT OR PUBLIC CONTRIBUTION

Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long-term care during the COVID-19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation.

Resilience Among Direct Care Staff in Nursing Homes: Validation of the CD-RISC2

OBJECTIVES

Caring for older adults is a demanding task. Some professionals may find themselves in complex situations for which they may not be prepared. However, the repercussions of these difficult experiences will depend on personal factors. Resilience acts as a buffer against difficulties and experiences. However, its study with first-line caregivers in nursing homes is limited. This study aimed to validate the Connor-Davidson Resilience Scale-2 (CD-RISC2), examine its psychometric properties, and analyze the variables associated with resilience (sociodemographic and professionals´ variables).

METHODS

312 nursing home professionals participated in the study. Besides the Connor-Davidson Resilience Scale-2, they answered questionnaires about good care, burnout, quality of life, person-centered care, and well-being.

RESULTS

The CD-RISC2 showed adequate reliability and test-retest reliability. Good support was found for convergent validity with perceived health, person-directed care, personal growth, life purpose, quality of life and good care, and for discriminant validity with burnout. Conclusions: To our knowledge, this is the first study that validates the CD-RISC2 Spanish version with front-line workers in nursing homes showing adequate psychometric properties.

CLINICAL IMPLICATIONS

An abbreviated, simpler, self-assessed version may be more useful than longer versions, especially with professionals with a heavy workload, such as direct care staff in nursing homes.

A communication model for nursing staff working in dementia care: Results of a scoping review

BACKGROUND

Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking.

OBJECTIVES

To identify and visualize factors associated with communication between nursing staff and people with dementia.

DESIGN

A scoping review of scientific literature.

DATA SOURCES

Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO.

REVIEW METHODS

The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model.

RESULTS

The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed.

CONCLUSIONS

The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.

The Effect of Practice toward Do-Not-Resuscitate among Taiwanese Nursing Staff Using Path Modeling

This study aimed to elucidate the predictors and the effects of path modeling on the knowledge, attitude, and practice toward do-not-resuscitate (DNR) among the Taiwanese nursing staff. This study was a cross-sectional, descriptive design using stratified cluster sampling. We collected data on demographics, knowledge, attitude, and practice as measured by the DNR inventory (KAP-DNR), Mindful Attention Awareness Scale, General Self-Efficacy Scale, and Dispositional Resilience Scale. Participants were 194 nursing staff from a medical center in northern Taiwan in 2019. The results showed that participation in DNR signature and education related to palliative care were significant positive predictors of knowledge toward DNR. The DNR predictors toward attitude included DNR knowledge, mindfulness, self-efficacy, dispositional resilience, and religious belief of nurses. Generally, the critical predictors of DNR practice were DNR attitude, dispositional resilience, and male nurses. In path modeling, we identified that self-efficacy, dispositional resilience, master’s degree, and religious belief directly influenced practice constituting DNR. Based on the findings of this study, we propose that nurses should improve their self-efficacy and dispositional resilience through training programs. Encouraging staff to undertake further education and have religious beliefs can enhance the practice of DNR and provide better end-of-life care.

A Tailored Motivational Messages Library for a Mobile Health Sleep Behavior Change Support System to Promote Continuous Positive Airway Pressure Use Among Patients With Obstructive Sleep Apnea: Development, Content Validation, and Testing

BACKGROUND

Continuous positive airway pressure (CPAP) therapy is the most effective treatment for obstructive sleep apnea (OSA). Despite the reported benefits of CPAP therapy in treating OSA, its effectiveness is reduced by less-than-optimal adherence or use. Up to 50% of patients who accept CPAP therapy fail to adhere to it. As a lack of commitment to CPAP therapy is one of the most significant factors that hinder OSA treatment effectiveness, patient motivation and education are critical to help alleviate the problem of poor CPAP adherence or use.

OBJECTIVE

This study aims to support the development of mobile health interventions or information systems solutions to promote CPAP adherence and use among patients with OSA through development, content validation, and testing of tailored motivational messages.

METHODS

In phase 1, an initial library of 60 messages was developed to promote CPAP use among patients with OSA. In phase 2, draft messages were evaluated for content validation testing for relevance and clarity by research and clinical experts. In phase 3, patients with OSA (N=24) were recruited through a Qualtrics panel to rate the perceived persuasiveness of the messages in terms of threat and efficacy perceptions, as per their computed extended parallel process model (EPPM) response states. The average score of the ratings was calculated for each message. The messages were sorted according to their average (from highest to lowest) to select the best 12 messages for each tailored set based on the potential responses from the EPPM.

RESULTS

In phase 1, 60 messages were developed based on the existing literature and a review of existing materials. In phase 2, the enumerated content validity of the messages was established through the use of the content validity index for items. A total of 57 messages were found to have acceptable content relevance and clarity. In phase 3, patients with OSA perceived the final library of 48 messages to be persuasive.

CONCLUSIONS

After the process of content validation and testing, the final library of messages met the criteria for clarity, relevance, and perceived persuasiveness. This study emphasizes the importance of developing and validating the content of motivational messages, grounded in EPPM theory, across the 4 possible response states in terms of high or low efficacy and threat perceptions.

Nurse resilience: A concept analysis

Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.

Factors Affecting Mistreatment of the Elderly in Long-Term Care Facilities

In long-term care facilities, elderly mistreatment occurs routinely and frequently. However, few studies have empirically explored the multifaceted risk factor of mistreatment. The purpose of this paper was to explore the factors affecting elderly mistreatment by care workers in Japanese long-term care facilities and to examine the relationship between these factors and mistreatment. This analysis was based on a sample of 1473 care workers from long-term care facilities and used multiple regression analyses. The results revealed that the nursing care level, work period, resilience, and attitude towards mistreatment among residents and staff were factors significantly associated with the degree of mistreatment. Facility size, an institutional environment that does not limit the behavior of residents, and family and community support for the elderly were among the institutional environment factors that had significant relationships with mistreatment. Staff gender, care-related qualifications, and workload were not associated with mistreatment. These findings suggest that strengthening the staff’s attitude and coping skills to prevent mistreatment, as well as interventions for changes in the institutional environment, are needed to prevent and reduce the prevalence of mistreatment in Japan. In addition, raising staff resilience to stress situations and building a resident-centered facility care environment is an important measure to reduce mistreatment.

They Care for Others, But What About Themselves? Understanding Self-Care Among DSPs' and Its Relationship to Professional Quality of Life

Direct support professionals (DSPs) are instrumental to the daily operations of organizations that support people with intellectual and developmental disabilities (IDD). With extensive responsibilities, DSPs often experience high levels of stress and burnout that can result in turnover and vacant positions. Self-care is the practice of behaviors that promote well-being, counter work-related stress, and foster resilience. The current study explored self-care and resilience, and their relationship with professional quality of life (i.e., satisfaction, burnout, and secondary traumatic stress) among DSPs. Using a convenient sample, 153 DSPs (71% female) completed an online survey comprised of multiple measures. Results indicated that DSPs often engaged in self-care behaviors across physical, psychological, emotional, spiritual, relational, and workplace domains, however, less than 40% engaged in self-care behaviors directly related to work. On average, DSPs reported high levels of resilience. Collectively, self-care and resilience accounted for 12% to 28% of variance in DSPs' professional quality of life. Given the contribution of self-care to resilience and professional quality of life, an active approach by IDD organizations to foster self-care among DSPs may help promote their longevity and retention.

Psychometric Evaluation of the Korean Version of the Personhood in Dementia Questionnaire Using Rasch Analysis

There is an increasing awareness of the need to promote behaviors consistent with the understanding that individuals with dementia deserve adequate respect. Person-centered attitudes on the part of a care facility’s staff can affect care practices and relationships with residents. This study examined the psychometric properties of the Korean version of the Personhood in Dementia Questionnaire (KPDQ), which measures staff’s person-centered attitudes toward individuals with dementia. The KPDQ was translated and adapted based on commonly used guidelines from the World Health Organization. For psychometric testing, the data obtained from a total of 269 participants in 13 long-term care facilities were analyzed. Factor analysis, item fit, convergent validity, and known-group validity were examined. Reliability and differential item functioning (DIF) based on Rasch analysis were also assessed. The KPDQ consists of 20 items with three subscales (“agency”, “respect for personhood” and “psychosocial engagement”). Item fit statistics indicated that each item fits well with the underlying construct. The KPDQ demonstrated satisfactory convergent validity, known-group validity and internal consistency reliability. There was no DIF by subgroup according to age or educational status. Results indicated that the KPDQ is a reliable and valid tool for measuring long-term care staff’s beliefs about personhood.

Age differences in attitudes about older adults with dementia

Dementia, a term that describes a variety of brain conditions marked by gradual, persistent and progressive cognitive decline, affects a significant proportion of older adults. Older adults with dementia are sometimes perceived less favourably than those without dementia. Furthermore, compared to persons without dementia, those with dementia are often perceived by others as having reduced personhood. This study was aimed at investigating whether differences in attitudes towards dementia and personhood perceptions vary as a function of age group, care-giver status, attitudes towards ageing, dementia knowledge, gender and education. In total 196 younger, middle-aged and older adults were recruited. Findings revealed that being a care-giver as well as having less ageist attitudes were predictive of being more comfortable around persons with dementia, having more knowledge about dementia and ascribing greater personhood to people with dementia. Those with more dementia knowledge (prior to the study) were less comfortable around people with dementia. Finally, when controlling this prior dementia knowledge, older adults were more comfortable around people with dementia compared to younger and middle-aged adults. Gender and education were not associated with any of the variables under study. Findings contribute to a better understanding of the role of age- and care-giver-related factors in the determination of attitudes towards dementia.

Validation of the resilience scale for nurses (RSN)

AIM

The purpose of this study was to verify the validity and reliability of the resilience scale for nurses (RSN).

METHODS

27 preliminary items were extracted from previous research. The subjects were 339 nurses who worked at 2 hospitals in South Korea in 2016. Collected data were analyzed using explanatory factor analysis (EFA). EFA was performed with principal axis factoring with oblimin rotation and confirmatory factor analysis (CFA) with SPSS 25.0 and AMOS 25.0 version program. Also, data were examined by construct, discriminant, and convergent validity, and internal consistency reliability.

RESULTS

Resilience scale for nurses showed CFA supported the four-factor structure (Philosophical pattern, Relational pattern, Dispositional pattern, and Situational pattern) of the measure. The 19 items for 4 factors identified that explained 67.329% of the total variance in RSN. A total the internal consistency reliability (Cronbach's α = 0.938) was stable.

CONCLUSION

Psychometric properties of RSN show that it is a useful and reliable scale to assess Resilience in Korean nurses. Based on these results, effective resilience intervention programs for nurses can be developed.

"Who would want to die like that?" Perspectives on dying alone in a long-term care setting

The discourse of dying alone is negatively weighted and models of a good death identify not dying alone as a key outcome. Understanding why dying alone is viewed negatively and its effects on care is a priority. In separate focus groups with long-term care residents, family caregivers, and staff, we identified evidence for four different perspectives on the importance of presence at the time of death. However, while each individual had their own unique perspective on dying alone, the predominant view expressed across respondent groups was that having human connection near the end of one's life was important.

Identification of factors associated with resilience in medical students through a cross-sectional census

OBJECTIVES

Research on resilience has been gaining momentum, and it has already been shown that increased resilience creates positive changes at the individual and collective levels. Understanding of the factors associated with resilience may guide specific actions directed towards different populations. The objective of this study was to investigate these associated factors within a population of medical students.

DESIGN

Cross-sectional census.

SETTING

A public medical school in the state of Rio de Janeiro, Brazil.

PARTICIPANTS

Out of a total of 551 medical students, five students were excluded due to inactive registrations, and four transferred students were also excluded, resulting in a total of 542 remaining participants.

MEASURES

Adopting an anonymous questionnaire that included the Resilience Scale, in addition to questions related to sociodemographic, behavioural health-related and academic variables, the association between these variables and resilience was investigated.

RESULTS

The high rate of answers to each item constitutes a indication of students' interest in participating, whereas the lowest percentile was 97.1%. The mean resilience score obtained was considered moderate. Factors such as gender, race, previous schools attended, financial independence, living situation, parents' education level, religion, quota-based admission, smoking, alcohol abuse and use of illegal drugs were not associated with resilience. In a multivariate analysis using ordinal logistic regression, associations were maintained only between the highest resilience score and the non-use of habit-forming prescription drugs (OR: 0.58; 95% CI 0.41 to 0.80), having a better perception of one's own health (OR: 0.57; 95% CI 0.41 to 0.81) and being older (OR: 1.37; 95% CI 1.12 to 1.67).

CONCLUSION

The census performed with the medical students showed, with the multivariate analysis, that besides age, the variables most closely tied with resilience were health and medicalisation, and the variables connected with income and religion showed no association.

Pain in Dementia: Use of Observational Pain Assessment Tools by People Who Are Not Health Professionals

Objective

Pain is prevalent among older adults but is often underestimated and undertreated, especially in people with severe dementia who have limited ability to self-report pain. Pain in patients with moderate to severe dementia can be assessed using observational tools. Informal caregivers (relatives of seniors with dementia) are an untapped assessor group who often bear the responsibility of care for their loved ones. Our objective was to evaluate the ability of laypeople to assess pain using observational measures originally developed for use by health care professionals.

Design

We employed a quasi-experimental design and presented videos depicting patients with dementia (portrayed by actors) displaying pain behaviors or during a calm relaxed state (no pain) to long-term care nurses and laypeople. Participants rated the pain behaviors observed in each video by completing two standardized observational measures that had been previously developed for use by long-term care staff.

Results

As expected, both laypeople and nurses were able to effectively differentiate painful from nonpainful situations using the standardized tools. Both groups were also able to discriminate among gradations of pain (i.e., no pain, mild, moderate, severe) and required comparable amounts of time to complete the assessments.

Conclusions

We conclude that, as hypothesized, the instruments under study can be used for the assessment of pain by laypeople. This is the first study to validate these instruments for use by laypeople. The use of these tools by laypeople (under the guidance of health professionals) has the potential of facilitating earlier detection and treatment of pain in older adults with dementia who live in community settings.