The Mediating Effect of Professional Values on the Relationship Between Self-Leadership and Compassion Competence of Community Mental Health Nurses

BACKGROUND

Compassion competence is a core nursing skill that is significant in understanding and alleviating the physical and mental distress of individuals. Self-leadership and nursing professional values are also reported as important factors in improving the clinical care practices of nurses and may have a positive effect on improving the compassion competence of nurses. However, there are few studies examining the relationship between these variables in community mental health nurses.

AIM

This study investigated the mediating effect of professional values on the relationship between self-leadership and compassion competence of community mental health nurses.

METHODS

A cross-sectional correlational study was conducted with 121 community mental health nurses from 30 mental health welfare centers in South Korea. Participants completed self-report scales on self-leadership, nursing professional values, and compassion competence. Baron and Kenny's regression method and the Sobel test revealed significant mediating effects of nursing professional values on the relationship between self-leadership and compassion competence.

FINDINGS

Participants' mean compassion competence scores were 3.57 (SD = 0.45) on a 5-point scale. Compassion competence positively correlated with self-leadership (r = 0.67, P < .001) and nursing professional values (r = 0.60, P < .001). Nursing professional values played a partial mediating role in the relationship between self-leadership and compassion competence (Z = 3.23, P = .001).

CONCLUSION

Compassion competence of community mental health nurses can be improved by promoting self-leadership and nursing professional values.

Factors influencing the job embeddedness of new graduate nurses: A multicentre cross-sectional study

AIM

To identify factors associated with job embeddedness from the perspective of retaining new graduate nurses.

DESIGN

The study was cross-sectional in design.

METHODS

Convenience and stratified sampling were used to recruit 415 newly graduated nurses from 12 tertiary hospitals in China. Anonymized data were collected through self-designed sociodemographic questionnaires, job embeddedness scale, feedback-seeking behaviour scale, authentic leadership perception scale and decent work scale. Appropriate indicators were used for descriptive statistics and t-tests, ANOVA, Pearson correlation analysis and multiple linear regression to examine the influencing factors.

RESULTS

The study showed that monthly income level, decent labour, authentic leadership and feedback-seeking behaviour were significant predictors of job embeddedness among new graduate nurses.

CONCLUSION

The job embeddedness of new graduate nurses is moderate. Nursing managers need to construct reasonable and fair compensation incentives, adopt positive leadership styles and encourage proactive feedback-seeking behaviours to improve the job embeddedness of new graduate nurses and alleviate the nursing talent shortage.

IMPACT

Exploring the factors influencing the job embeddedness of new graduate nurses provides a reference for establishing new graduate nurse retention strategies to help promote the career development of new graduate nurses and alleviate the nursing brain drain.

REPORTING METHOD

We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Association of self-leadership and epidemic risk perception on quality of life in post-pandemic mainland of China: a cross-sectional study

Background

Self-leadership has proven to adjust individual psychological states and promote active behaviors to mitigate stress perception and negative lifestyle. This study aims to investigate the relationship between self-leadership, epidemic risk perception, and quality of life among the general public in post-pandemic mainland of China.

Methods

Two online self-reported questionnaire surveys were carried out with 3,098 and 469 people in the Chinese mainland in February 2021 and December 2022, respectively. The univariate analysis, structural equation modeling, and fuzzy-set qualitative comparative analysis were used to analyze the data which was collected by Revised Self-Leadership Questionnaire, Perceived Risk of COVID-19 Pandemic Scale and World Health Organization Quality of Life Brief Scale.

Results

The Self-leadership was directly, moderately, and positively correlated with quality of life (Standardized path coefficients: 0.383 and 0.491, respectively; p < 0.05), and epidemic risk perception was negatively correlated with quality of life (Standardized path: 0.068 and 0.120, respectively; p < 0.05). The structural equation model for self-leadership, epidemic risk perception, and quality of life had a good fit (CFI = 0.957, 0.939 > 0.9; RSMEA = 0.058, 0.064 < 0.08, respectively) and was consistent across genders, educational levels, and types of occupations (Delata-CFI < 0.01). The core condition for achieving a high quality of life lies in maintaining a low level of self-punishment and a high level of self-cueing or a high level of self-punishment and a low level of self-cueing.

Conclusion

In the post-epidemic era, the public can adjust their attitude toward stress by enhancing their self-leadership skills. Among various self-leadership skills, self-punishment or self-cueing may have the most significant impact on the quality of life.

Job satisfaction, professional competence, and self-efficacy: a multicenter cross-sectional study among registered nurses in Sweden and Norway

BACKGROUND

Healthcare organizations worldwide face persistent challenges relating to turnover and intention to leave the nursing profession among registered nurses. Factors contributing to their retention and well-being at work include high job satisfaction, professional competence, and self-efficacy. Few multicenter studies have investigated these factors in relation to work experience in a Nordic context. Therefore, this study aimed to investigate job satisfaction, professional competence, and self-efficacy among registered nurses.

METHODS

This multicenter cross-sectional study survey was part of a larger overarching Swedish-Norwegian project, and was conducted among registered nurses (n = 1137) in September 2021. The participants worked in a variety of health care units, e.g., hospital units, primary health care, and home care. Data was subjected to descriptive and comparative statistical analysis; chi-square test, one-way between-groups analysis of variance (ANOVA) and Kruskal-Wallis test.

RESULTS

The findings show that job satisfaction is reported as lowest in registered nurses with medium-term work experience as compared to newly qualified and long-term work-experienced registered nurses. Professional competence and self-efficacy are reported as higher among registered nurses with long-term work experience as compared to those with medium-term work experience and newly qualified registered nurses. However, the participants reported their professional competence as highest in relation to the same factor - "Value-based nursing care" - regardless of their work experience.

CONCLUSIONS AND IMPLICATIONS

This study underscores the need for continuous support and professional development for registered nurses throughout their careers. Proactive support for newly qualified nurses may improve job satisfaction as they progress to being registered nurses with medium-term work experience. Tailored interventions to address the distinct needs of both newly qualified and medium-term work-experienced registered nurses are crucial for nurturing a sustainable nursing workforce.

Moral distress, moral resilience, and job embeddedness among pediatric nurses

BACKGROUND

Nurses often face ethical issues in their daily work that can have an impact on their level of job embeddedness. And positive job embeddedness is essential to reduce burnout among nurses and improve professional retention in the medical industry. However, few studies have focused on the relationship between moral distress, moral resilience, and job embeddedness.

OBJECTIVES

To investigate the relationship between moral distress, moral resilience, and job embeddedness, and explore the mediating role of moral resilience between moral distress and job embeddedness among nurses.

DESIGN

A quantitative, cross-sectional study.

METHODS

Nurses from a number of tertiary general hospitals in central China were surveyed and assessed using the Moral Distress Scale, the Nurse Moral Resilience Scale, and the nurse job embeddedness Scale from February to March 2023. The study was conducted in line with the 1964 Declaration of Helsinki.

ETHICAL CONSIDERATION

All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-313).

FINDINGS

Moral distress was positively correlated with moral resilience (β = 0.525, p < 0.01) and negatively correlated job embeddedness (β = -0.470, p < 0.01). Moral resilience partially mediated the relationship between moral distress with job embeddedness (β = -0.087, p < 0.01).

DISCUSSION

The findings reveal a relationship between moral distress, job embeddedness, and moral resilience among nurses.

CONCLUSION

Moral distress and moral resilience are important correlates of job embeddedness in nurses. Interventions to reduce moral distress and increase moral resilience may have potential benefits for improving nurses' job embeddedness. It is recommended that clinical nursing administrators create a favorable ethical atmosphere, educate nurses about ethics, and increase nurses' moral resilience.

Implementation of an Enculturation Toolkit for New Nurses During Unit Onboarding

OBJECTIVE

This quality improvement project targeted an enculturation gap among new nurses by assembling and piloting an Enculturation Toolkit.

BACKGROUND

Enculturation of new nurses contributes to engagement, performance, sense of belonging, and retention. During the COVID-19 pandemic, orientation was shortened, virtual, and asynchronous, creating a gap in enculturation.

METHODS

New nurses and their preceptors were surveyed at baseline, 2 to 3 months, and 4 to 5 months to measure engagement and enculturation using the Meaning and Joy in Work Questionnaire (MJWQ) and questions about the history and values of the organization.

RESULTS

Initial MJWQ responses were high and sustained throughout the study period. Participants demonstrated increased knowledge of the organization's mission statement and logo. New nurses rated the toolkit activities favorably, with an average score of 4.6 out of 5.

CONCLUSIONS

An Enculturation Toolkit was effective in improving knowledge about the organization and sustaining engagement and belonging.

The relationship between nursing students' readiness and attitudes for E-learning: The mediating role of self leadership: An online survey (comparative study)

BACKGROUND

To meet the learning demands of new generation students, higher education institutions should apply relevant breakthroughs in science, technology, and education to update their educational policies or teaching techniques. Aim To investigate the relationship between nursing students' readiness and attitudes toward e-learning, as well as the role of self‑leadership in mediating this relationship.

METHODS

This is a descriptive comparative research. A total of 410 students consented to participate after being recruited from two nursing colleges at Alexandria and Damanhur Universities in Egypt and completing self-administered, online surveys.

RESULTS

The majority of the participants (83.3 % and 76.9 %, respectively) were female from Alexandria and Damanhur University, and their mean self‑leadership scores were 3.89.49 at Alexandria and 3.65.40 at Damanhur University. According to the SEM, self‑leadership accounted for 74 % of the variance in students' attitudes and 87 % of the variance in students' readiness for e-learning.

CONCLUSION

Self‑leadership is an important predictor of students' attitudes and readiness for e-learning. The study's implications: Self‑leadership allows students to accept responsibility for themselves, and the idea that one can be accountable for guiding oneself through life is thrilling, especially in today's environment.

How Does Servant Leadership Nurture Nurses’ Job Embeddedness? Uncovering Sequential Mediation of Psychological Contract Fulfillment and Psychological Ownership

Aim. This research aimed to explore how servant leadership nurtures nurses’ job embeddedness by uncovering the sequential mediation of psychological contract fulfillment and psychological ownership. Background. The healthcare of Pakistan is undergoing an acute shortage of 1.3 million nurses. The gap is widening due to unprecedented natural uncertainties (floods, earthquakes, COVID-19, dengue, polio, and monkeypox) and the large-scale brain drain of nurses. Therefore, exploring the underlying factors that could facilitate nurses’ job embeddedness is imperative. Methods. A cross-sectional research design was employed, wherein data were gathered in three rounds, two months apart, from 587 nurses employed in public hospitals in Pakistan, and analysis was performed with Smart-PLS. Results. Servant leadership positively influences nurses’ job embeddedness and psychological contract fulfillment. Besides, psychological contract fulfillment positively affects psychological ownership, and psychological ownership enhances nurses’ job embeddedness. Finally, psychological contract fulfillment and psychological ownership sequentially mediate the relationship between servant leadership and job embeddedness. Conclusions. This research emphasized the vitality of servant leadership in nurturing nurses’ job embeddedness. Implications for Nursing Management. Healthcare authorities should keenly focus on promoting servant leadership that shapes the positive perception of nurses about their psychological contract fulfillment and psychological ownership, which are essential resources to cherish nurses’ job embeddedness.

Strategies for the Facilitation of Self-Leadership Among Ward Nurses in a Nurse-Led Critical Care Outreach Service

Introduction

Nurses are responsible for monitoring and providing nursing care to patients. The early detection of a patient who is starting to deteriorate - and the activation of critical care outreach services (CCOS) - can improve patient outcomes. However, the literature indicates that CCOS are underutilised. Self-leadership is a process whereby persons influence their own behaviour.

Objective

The purpose of this study was to develop strategies for the facilitation of self-leadership in ward nurses that will enable them to act proactively and promptly in utilising CCOS at a private hospital group in South Africa.

Methods

A sequential exploratory mixed-method research approach was followed to develop strategies for the facilitation of self-leadership in nurses that will enable them to utilise CCOS proactively when a patient starts to deteriorate. An adapted version of Neck and Milliman's self-leadership strategic framework was used as the methodological steps of the study.

Results

The quantitative analysis extracted eight factors, which were used as the departure point to develop strategies for the facilitation of self-leadership among nurses in a CCOS. Five strategies were developed that related to self-motivation, role models, patient outcome, assistance and guidance from CCOS, and the power of self-confirmation; these strategies aligned with the themes and categories extracted from the qualitative data analysis.

Conclusion

There is a need for self-leadership among nurses in a CCOS.

Effects of the areas of worklife on job embeddedness: a national cross-sectional study among Egyptian nurses

AIM

This study aimed to examine the effects of a person-job match in the six areas of worklife on Egyptian nurses' job embeddedness.

BACKGROUND

Healthcare organizations struggle to embed nurses in their job. However, the antecedents of nurses' job embeddedness are not fully known, especially those related to organizational factors. This study is an initiative to contribute in this field.

METHODS

A national cross-sectional study that enrolled 1003 Egyptian licensed nurses was conducted. Data were collected using an online-based version of the Areas of Worklife Scale and the Global Job Embeddedness Scale and analyzed using the descriptive statistics, Pearson correlation, and regression analysis.

RESULTS

Nurses reported a moderate level of job embeddedness with a person-job match in control, reward, and community. Regression analysis showed four of six areas of worklife (value, fairness, community, and control) contributing to nurses' job embeddedness.

CONCLUSION

Nurses who experience a person-job match in the value, fairness, community, and control areas of worklife are more likely to embed in their job. A match in the value area has the great potentials for nurses to embed in their job.

IMPLICATIONS FOR NURSING MANAGEMENT

Actions aimed at embedding nurses should prioritize on optimizing a person-job match in value, fairness, community, and control.

Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies

To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.

Mediating effect of circadian rhythm between work stress and sleep quality in Chinese shift-working nurses: A cross-sectional survey

AIM

This study examined the mediating effect of circadian rhythm amplitude (LV) and stability (FR) between work stress and sleep quality among Chinese shift-working nurses (SWNs).

DESIGN

A cross-sectional study.

METHODS

Three-hundred and seventy-nine nurses working in shifts were investigated by convenient sampling from six hospitals in Shanghai, China. The mediating effect was analysed using the structural equation model with bootstrapping procedures.

RESULTS

Work stress could directly affect shift nurses' sleep quality and indirectly affect sleep quality through circadian rhythm amplitude and stability. The total indirect effects of work stress on sleep quality accounted for 36.7% of the total effect. The study revealed that poor sleep quality is very common among SWNs, which deserves attention. The mediating effect of the circadian rhythm provides new insights to improve sleep quality, not only by lightening the work stress but also by improving circadian rhythm in SWNs.

Translation, cross-cultural adaptation, and validation of the Chinese version of self-efficacy and attitudes for providing Mouth Care scale

Background

In recent years, oral care for older people has received extensive attention in long-term care facilities. The Self-Efficacy for Providing Mouth Care (SE-PMC) and Attitudes for Providing Mouth Care (A-PMC) scale evaluated the self-efficacy and attitude of nursing staff while providing oral care. However, whether this scale is valid and reliable for Chinese nursing staff in China remains unverified. This study aims to translate the English version of SE-PMC and A-PMC into Chinese and determine their reliability and validity.

Methods

After obtaining the author’s consent, the procedure for a double-back translation and cross-cultural adaptation was conducted to develop the Chinese version of SE-PMC and A-PMC. The validity and reliability of the Chinese version of SE-PMC and A-PMC were evaluated in a cross-sectional observational study with 852 nurses from 42 Geriatric Care Facilities (GCFs). Exploratory factor analysis (EFA) (n = 427) and confirmatory factor analysis (CFA) (n = 425) were conducted to test the construct validity and quality of the factor structures. We applied the item discrimination test and homogeneity test for item analysis. Cronbach’s alpha coefficient and split-half coefficient were adopted to evaluate internal consistency.

Results

The Chinese version of SE-PMC (11 items, 3 factors) and A-PMC (11 items, 2 factors) included 22 items, reflecting adequate construct validity and reliability. In addition, test-retest reliability was 0.809 for SE-PMC and 0.811 for A-PMC, evincing good stability. The Cronbach’s α coefficient of SE-PMC was 0.831, with each factor ranging from 0.793~0.906. The Cronbach’s α coefficient of the A-PMC was 0.768, with each factor ranging from 0.814~0.824. Item-Content Validity Index (I-CVI) of SE-PMC and A-PMC ranged from 0.84 ~1.00 and 0.82~1.00, respectively.

Conclusion

The Chinese version of SE-PMC and A-PMC was validated as a reliable assessment tool to evaluate the self-efficacy and attitude of nursing staff in GCFs for providing oral care in China.

Implementation and evaluation of a preceptor educational development programme involving the health cluster colleges at Qatar University

BACKGROUND

'The Practice Educators' Academy Programme' is an innovative educational intervention developed following a preceptor-focussed needs assessment. The primary aim of this study was to evaluate the programme's effect on self-efficacy and knowledge amongst multi-disciplinary clinical preceptors who precept students across the Health Cluster in Qatar University. The secondary aim was to assess the preceptors' satisfaction with the programme's comprehensiveness, appropriateness, and relevance.

METHODS

This is a longitudinal study, with the same participants followed at different time points (i.e., pretest-posttest interventional design). The sample size was calculated to represent 10% of the sample expected for the main study, utilising a stratified convenience sampling technique. Preceptor self-efficacy was assessed using the Preceptor Self-Efficacy Questionnaire, a validated 21-item questionnaire. Preceptor knowledge was assessed through a 25-item multiple-choice question test. Satisfaction with programme content and delivery was assessed through a 14-item questionnaire with open comments.

RESULTS

Thirty pretest-posttest respondents for the PSEQ assessment, and 26 pretest-posttest respondents for the knowledge assessment were appropriately matched and analysed. Participation in the self-efficacy questionnaire resulted in a statistically significant increase in their posttest median score (pretest-to-posttest: 3.3-to-3.6, p = 0.001). Participation in the knowledge assessment resulted in a statistically significant increased posttest mean score (pretest-to-posttest: 10.2-to-15.7, p < 0.001). Participants indicated high levels of satisfaction with the programme (average score = 4.42/5).

CONCLUSIONS

Our findings suggest the programme is effective as demonstrated through a significant improvement in preceptors' self-efficacy and knowledge. Recommendations for future iterations include placing greater focus on active learning strategies, and inter-disciplinary interactions.

Agile Leadership and Perceived Career Success: The Mediating Role of Job Embeddedness

Agile leadership is an important managerial function in which responsiveness and innovation appear to be essential elements for the long-term development and success of any business. The world has become increasingly volatile, uncertain, complex, and ambiguous (VUCA) during and post COVID-19. Managers are required to possess agile leadership to facilitate their employees’ successful careers. Therefore, this study aims to find out the relationship between agile leadership and career success by examining the mediation of job embeddedness in healthcare organizations. The descriptive research design and survey method were employed in this study. The data were collected by using three scales from healthcare employees in healthcare organizations in Turkey. Hypotheses were tested using structural equation modelling (SEM). The data were analysed by using SPSS and AMOS programs. The findings of this study showed that agile leadership behaviours enhance career success. Moreover, the relationship between agile leadership and career success is mediated by job embeddedness. The role of agile leadership in promoting employees’ career success has rarely been studied in the literature. This is one of the first studies to examine the effect of agile leadership on career success along with the mediating role of job embeddedness. Healthcare managers have faced many critical challenges at their workplace during the COVID-19 pandemic. Through the lens of managing efficient healthcare organizations in many contexts, this research sheds some important light on the association between agile leadership, career success, and job embeddedness. Managers with high agility levels used strategies such as group decision making, problem solving, effective internal and external communication, and adaptation to uncertain environment in order to increase their career success.

Organisational and individual resources as antecedents of older nursing professionals' organisational commitment: Investigating the mediating effect of the use of selection, optimisation and compensation strategies

AIM AND OBJECTIVES

To investigate how organisational and individual resources are linked to older (50+) nursing professionals' organisational commitment, and to examine the possible mediating role of the active use of selection, optimisation and compensation (SOC) strategies.

BACKGROUND

Many healthcare organisations need to find ways to retain their older nursing professionals due to nursing shortage.

DESIGN

To test a set of hypotheses, cross-sectional survey data (n = 396) were used. Data were analysed using correlation analysis and partial least-squares structural equation modelling. STROBE Statement for cross-sectional studies has been followed in this study.

RESULTS

The results exhibited that both individual and organisational resources and the active use of SOC strategies were positively associated with older nursing professionals' organisational commitment. The active use of SOC strategies had a partially mediating role in the relationship between individual resource (career management self-efficacy) and organisational commitment. Similarly, career management self-efficacy partially mediated the association between organisational resources (perceived high-involvement work practices) and organisational commitment.

CONCLUSIONS

Regarding the retention of older nursing professionals, attention should be paid to both individual and organisational resources and the active use of SOC strategies.

RELEVANCE FOR CLINICAL PRACTICE

By providing opportunities to actively use SOC strategies and by paying attention to career management self-efficacy among older nursing professionals, nursing managers may influence the retention of the older nursing workforce. Similarly, supportive organisational practices can support older nursing professionals' career management self-efficacy and their organisational commitment.

A concept analysis of self-leadership: The "bleeding edge" in nursing leadership

AIM

To explore the concept of self-leadership in nursing. Self-leadership, while frequently referenced, has not been clearly defined in either the literature or within nursing.

DESIGN

Common language sources were reviewed, along with literature searched from 2017 to 2019 using seven electronic databases: CINAHL, EbscoHost, Sabinet, ScienceDirect, ProQuest, Nexus, and Academic Complete. Database searches yielded 10 articles. REVIEW METHODS: Walker and Avant's method of concept analysis was modified, as suggested by Risjord.

RESULTS

Reviews of the broad literature demonstrated that self-leadership is the creation of a space for the individual with self-awareness to live a better self through reflective consciousness. The multidimensionality of work and blurring of boundaries between work and living has prompted the individual to understand their own qualities or abilities. The individual has a true sense of who they are and what they think and feel. This shift in leadership refocuses on a more desirable way of living and envelopes being a master of one's own destiny.

CONCLUSION

Analytic work provides support for a middle-range explanatory theory that engenders self-awareness, taking the lead, and personal satisfaction. Explication of the concept and the relevance to professional nursing gives direction for future research.

Self-Leadership Among Healthcare Workers: A Mediator for the Effects of Job Autonomy on Work Engagement and Health

Due to the high workload, working within the healthcare industry can be quite demanding. This often results in high rates of absenteeism, unfulfilled vacancies, and voluntary turnover among healthcare workers. We expect that job autonomy is an important resource for work engagement and health of healthcare workers because it satisfies the basic need for autonomy. However, we propose that this relationship between job autonomy and work engagement and health can be explained by self-leadership. Self-leading individuals take initiative and responsibility and are assumed to use self-influencing strategies (e.g., goal setting, self-observation, creating natural rewards) as a way to improve motivation and general well-being. Employees from two healthcare organizations (N = 224 and N = 113) completed a questionnaire containing measures of job autonomy, work engagement, general health, and self-leadership. The hypothesized model was tested using a series of regressions, and the results confirmed the indirect relationships between job autonomy and work engagement and general health, respectively, through natural rewards strategies. The behavior-focused and cognitive self-leadership strategies were, as mediator, marginally significant: positively for work engagement and negatively for general health. Self-leadership behavior was not related with work engagement and general health. Implications of the findings for theory and practice on healthy healthcare workers are discussed.