Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review

Factors contributing to nurses' intent to leave during COVID-19

To examine the association between demographic characteristics (i.e., gender, race, age, and years of experience), burnout, and nurses' intent to leave their jobs during the first wave of COVID-19 in New Jersey. COVID-19 has exacerbated burnout and intent to leave among acute care nurses. Nonetheless, little is known about demographic factors contributing to nurses' desire to leave their jobs. A cross-sectional survey of actively licensed registered nurses who provided direct patient care in an acute care hospital in New Jersey during COVID-19. Among 2760 nurses, those who reported burnout were 4.78 times more likely to report intent to leave their job within 1 year as compared to nurses who did not report burnout. Black RNs were 2.06 times more likely to report intent to leave as compared to White RNs. Older nurses (aged 40-49) were 36% less likely to report intent to leave as compared to younger nurses (aged 21-29). RNs with 30 years of experience or more were 58% less likely to report intent to leave as compared to RNs with less than 5 years of experience. In addition, Black RNs with 6-12 years of experience were 2.07 times more likely to report intent to leave as compared to White RNs with less than 5 years of experience. Nurses' intent to leave during the first wave of the pandemic was influenced by burnout, race, age, and years of experience. Based on the results of the current study, Black nurses were more likely to report intent to leave their job within 1 year as compared to White RNs. Nurses' intention to leave is one of the most important global issues facing the healthcare system. Findings of the current study demonstrate that burnout, race, age, and years of experience are significant predictors of nurses' intent to leave their jobs. Therefore, organizations should prioritize strategies to reduce burnout and create diverse and inclusive work environments.

Challenges faced by human resources for health in Morocco: A scoping review

BACKGROUND

Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population.

METHODS

We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included.

RESULTS

Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns.

CONCLUSIONS

The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.

Exploring the relationship between adverse working environments and poor psychological states of Chinese workers: A comprehensive study

BACKGROUND

Employee mental health is linked with job satisfaction and productivity. However, there is a notable lack of empirical evidence regarding the adverse effects of Hazardous Work Environments (HWE) on employee mental health, indicating a significant gap in occupational health research.

METHODS

Data from the China Family Panel Studies involving 9972 participants were utilized. Mental health was assessed using the Kessler 6 Psychological Distress Scale at baseline and the 8-item Center for Epidemiologic Studies Depression scale at follow-up. Associations between HWE exposure and mental health were explored cross-sectionally at baseline plus mediation analyses for the influence of sleep duration. Cox proportional hazards regression was used to assess the longitudinal implications of HWE exposure.

FINDINGS

Participants exposed to HWE showed a higher risk of having serious psychological distress (OR (95%CI): 1.47 (1.29-1.69)) cross-sectionally at baseline, and this risk rose with increased number of HWE elements (1.30 (1.11-1.52) and 2.18 (1.75-2.72) for 1-2 and ≥ 3 elements, respectively). Longitudinally, HWE exposure was associated with an increased risk of depression (HR (95%CI): 1.10 (1.07-1.14)). Similarly, this risk risen with increased number of HWE elements (1.08 (1.06-1.09) and 1.20 (1.05-1.38) for 1-2 and ≥ 3 elements, respectively) and longer duration of exposure (1.01 (1.00-1.01)). Short sleep duration emerged as a significant mediator between HWE exposure and psychological distress.

INTERPRETATION

This study illuminates a robust association between HWE exposure and psychological distress, especially under prolonged and multiple exposures. We advocate for rigorous mental health monitoring and interventions for workers in adverse working environments.

FUNDING

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Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study

BACKGROUND

Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals.

METHODS

Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach.

RESULTS

Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader's presence, accessibility, and rapid responsiveness, fostering adaptability.

CONCLUSIONS

The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.

The "Ladder of Inference" as a Conflict Management Tool: Working with the "Difficult" Patient or Family in Healthcare Ethics Consultations

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties' respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place.

Effectiveness of intervention programs aimed at improving the nursing work environment: A systematic review

BACKGROUND

The nursing work environment can be compromised due to workload, stress and many other issues. A good nursing work environment is needed to for the health and wellbeing of nurses and therefore measures are developed to improve nursing work environment.

AIM

To determine whether measures designed to improve the work environment for nursing professionals are effective.

METHODOLOGY

Online research in the Medline, Scopus, Web of Science, ERIC, CINHAL, PsycINFO, and American Doctoral Dissertations databases, along with manual search, was carried out. Primary experimental studies made up of intervention and control groups were included, with pre-/post-measure evaluation in the nursing team, based on the effects of the interventions. Risk of bias was calculated using the Cochrane tool.

RESULTS

A total of 1997 studies were examined; 19 clinical trials met the inclusion criteria. A total of 1427 nurses participated in the selected studies. The fields of application of the interventions were personal and environmental. Out of the fields targeting individuals, three methodologies were identified: cognitive-behavioral techniques, stress management, channeling anxiety and physical well-being; and those aimed at environmental fields: aromatization and organization. The most evaluated characteristic was teamwork, and the most analyzed symptom was stress. Most of the interventions concluded with at least one significant improvement.

CONCLUSIONS

Interventions aimed at enhancing the work environment are effective ways of increasing job satisfaction. The heterogeneity of the data did not allow us to determine which intervention is the most effective. The combination, type, and duration are variables that affect efficacy.

IMPLICATION FOR NURSING AND NURSING POLICY

This systematic review provides resources for improving the work environment that affects nursing staff, other professionals, and patients. Encouraging a healthy atmosphere leads to excellence in care and improved safety.

Emotional Intelligence and Occupational Stress Among Nursing Professionals in Tertiary Care Hospitals of Bangalore: A Multicentric, Cross-Sectional Study

Background

Nursing profession requires strength and resilience not just physically, but emotionally as well which requires them to adapt in stressful situations that they are often exposed to in their work environment.

Objective

To determine the prevalence and associated factors of emotional intelligence (EI) and occupational stress (OS) among the nursing professionals from selected tertiary care hospitals in Bangalore, India.

Methods

This was a multi-centric, cross-sectional study done among nurses with more than 1year of work experience and they were randomly selected from four tertiary care hospitals in Bangalore. The EI and OS were assessed using the Emotional intelligence scale (EIS) and Occupational Stress Index (OSI). Data was collected, both online and offline, owing to the ongoing COVID-19 pandemic. The data was analyzed using SPSS v21.0 to calculate the mean, associations, and regression.

Results

Out of the total 294, the mean age of the study participants was 27±4.92years. A total of 75 (25.5%) nurses had poor EI and 245 (83.3%) had moderate OSI. None of the participants had high OSI. There was a significant association between the severity grades of EI and OSI (P = 0.010) and a binary logistic regression showed that those staff with high EI had a lesser odd (OR 0.531, 95% CI 0.282-0.999) of developing occupational stress as compared to those with low EI.

Conclusion

EI plays a significant role in reversing the effect of one's occupational stress. Thereby, the training curriculum should include skills and measures of resilience to facilitate their EI improvement.

The effects of COVID-19 event strength on job burnout among primary medical staff

BACKGROUND

As a global pandemic, The Corona Virus Disease 2019 (COVID-19) has brought significant challenges to the primary health care (PHC) system. Health professionals are constantly affected by the pandemic's harmful impact on their mental health and are at significant risk of job burnout. Therefore, it is essential to gain a comprehensive understanding of how their burnout was affected. The study aimed to examine the relationship between COVID-19 event strength and job burnout among PHC providers and to explore the single mediating effect of job stress and work engagement and the chain mediating effect of these two variables on this relationship.

METHODS

Multilevel stratified convenience sampling method was used to recruit 1148 primary medical staff from 48 PHC institutions in Jilin Province, China. All participants completed questionnaires regarding sociodemographic characteristics, COVID-19 event strength, job stress, work engagement, and job burnout. The chain mediation model was analyzed using SPSS PROCESS 3.5 Macro Model 6.

RESULTS

COVID-19 event strength not only positively predicted job burnout, but also indirectly influenced job burnout through the mediation of job stress and work engagement, thereby influencing job burnout through the "job stress → work engagement" chain.

CONCLUSIONS

This study extends the application of event systems theory and enriches the literature about how the COVID-19 pandemic impacted PHC medical staff job burnout. The findings derived from our study have critical implications for current and future emergency response and public policy in the long-term COVID-19 disease management period.

Examining moral injury in clinical practice: A narrative literature review

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included "moral injury" and "moral distress," identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs.

Using a Mediator's Toolbox: Reducing Clinical Conflict by Learning to Reconceive the "Difficult" Patient or Family

Introduction

Given the prevalence of conflict between physicians and patients and families, it is crucial that trainees build the skills to manage clinical conflict. Mediators employ an approach that can be applied to clinical encounters to prevent conflicts from escalating. This workshop introduced trainees to techniques commonly used by mediators to manage disputes.

Methods

Medical students in a virtual workshop (cohort A) and clinical fellows in an in-person workshop (cohort B) were presented with a mediator's approach to interpreting patient and family behavior viewed as challenging. Trainees were introduced to two specific techniques designed to facilitate the resolution of clinical conflict. After an interactive large-group discussion of each method, small groups practiced applying the technique to a sample clinical case. Finally, participants completed an assessment of their perception of the workshop's effectiveness.

Results

In early 2022, 15 medical students (cohort A) participated in a virtual workshop and 10 clinical fellows (cohort B) participated in an in-person workshop on clinical conflict management. Eight medical students from cohort A completed the postworkshop assessment (response rate: 53%); six clinical fellows from cohort B completed the assessment (response rate: 60%). Cohort A gave the workshop an overall evaluation of 4.6 out of 5.0; cohort B gave the workshop an overall score of 4.7 out of 5.0.

Discussion

In both the virtual platform and the traditional in-person format, this workshop introduces a set of tools for navigating bedside conflicts with patients and their families that participants believed would better prepare them for such challenging interactions.

Influence of empathy on work alienation among Chinese nurses during the COVID-19 pandemic: The mediating effect of ego depletion

Background

Nurses' work alienation has become increasingly serious due to the increase in workload and risk during the coronavirus disease 2019 (COVID-19). However, no studies have investigated the link between empathy, ego depletion, and work alienation among Chinese nurses. The present study aimed to evaluate Chinese nurses' empathy, ego depletion, and work alienation and to examine whether nurses' ego depletion mediates the relationship between empathy and work alienation.

Methods

This was a descriptive, cross-sectional study involving 353 nurses from Shaanxi. The Jefferson Scale of Empathy-Health Professionals, Self-Regulating Fatigue Scale and Work Alienation Questionnaire were used to collect data through an online survey. Structural equation modeling was conducted to analyze the mediating model.

Results

Work alienation was negatively correlated with empathy (r = -0.305, p < 0.01) and positively correlated with ego depletion (r = 0.652, p < 0.01). Empathy was negatively correlated with ego depletion (r = -0.325, p < 0.01). Empathy can directly predict work alienation (β = -0.263, p < 0.01), while ego depletion has a mediating effect between empathy and work alienation (β = -0.309, p < 0.01), and the mediating effect accounts for 54.02% of the total effect.

Conclusion

Nurses' work alienation was at a moderate-to-high level. Improving empathy can reduce work alienation through less ego depletion. Nursing managers should discover nurses' work alienation as soon as possible. Interventions to improve empathy can help replenish nurses' psychological resources, thereby reducing ego depletion and work alienation.

Nursing Leaders as Visionaries and Enablers of Action

OBJECTIVES

The engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future.

DATA SOURCES

Author experience, journal articles and organizational position papers were used.

CONCLUSION

To improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management.

IMPLICATIONS FOR NURSING PRACTICE

Nursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.

Teamwork Is Associated with Reduced Hospital Staff Burnout at Military Treatment Facilities: Findings from the 2019 Department of Defense Patient Safety Culture Survey

BACKGROUND

A National Academy of Medicine report emphasizes the importance of creating positive work environments to address the negative effects of burnout on health care workers. The purpose of this investigation was to determine the scope of burnout among military hospital personnel and explore the relationship between teamwork, burnout, and patient safety culture.

METHODS

A logistic regression analysis investigated the relationship between teamwork and burnout using the 2019 US Department of Defense Patient Safety Culture Survey data from 15,838 military hospital workers. Additional regressions investigated teamwork/burnout relationships among individual work areas and staff positions.

RESULTS

About one third of respondents (34.4%) reported experiencing burnout. Work areas most likely to report burnout included many different/other work areas (43.4%), pharmacy (41.8%), and labor and delivery/obstetrics (41.8%). Staff positions most likely to report burnout included pharmacy/pharmacists (39.7%), assistants/technicians/therapists (38.1%), and nurses/nursing (37.6%). Analysis revealed an association between lower burnout and high teamwork, both within (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.48-0.60) and across (OR 0.64, 95% CI 0.57-0.72) units. Within-unit teamwork was associated with reduced odds of burnout across almost all work areas and staff positions, with the greatest odds reduction among personnel working in emergency (OR 0.25, 95% CI 0.14-0.43), radiology (OR 0.41, 95% CI 0.20-0.83), and labor and delivery/obstetrics (OR 0.42, 95% CI 0.27-0.65); and physicians/medical staff (OR = 0.44, 95% CI: 0.28-0.69), other staff positions (OR 0.48, 95% CI 0.28-0.81), and assistants/technicians/therapists (OR 0.58, 95% CI 0.46-0.73).

CONCLUSION

Effective teamwork may reduce burnout in hospital workers. This association between teamwork (particularly teamwork within units) and burnout was found in all work areas, even in those with the highest levels of self-reported workplace chaos. Greater adoption of workplace interventions focused on improving teamwork, such as TeamSTEPPS, is warranted.

Ethical Issues in Using Behavior Contracts to Manage the "Difficult" Patient and Family

Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the "difficult" patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics meetings and conversations and idea-sharing among practitioners on HEC social media. While there are a handful of papers gesturing toward a bioethical critique of behavior contracts of various types, the use of behavior contracts in the context of interpersonal conflict has not been vetted by bioethicists to determine their ethical legitimacy or efficacy. In this paper, we highlight a set of ethical concerns that we believe must be addressed before continuing or widespread implementation of behavior contracts to manage the "difficult" patient or family.

Investigating burn-out contributors and mitigators among intensive care unit nurses during COVID-19: a focus group interview study

OBJECTIVE

Past literature establishes high prevalence of burn-out among intensive care unit (ICU) nurses, and the influence of the COVID-19 pandemic in intensifying burn-out. However, the specific pandemic-related contributors and practical approaches to address burn-out have not been thoroughly explored. To address this gap, this work focuses on investigating the effect of the COVID-19 pandemic on the burn-out experiences of ICU nurses and identifying practical approaches for burn-out mitigation.

DESIGN

Semistructured focus group interviews were conducted via convenience sampling and qualitatively analysed to identify burn-out contributors and mitigators. Maslach Burnout Inventory for Medical Personnel (MBI-MP) and Post-traumatic Stress Disorder Checklist (PCL-5) were employed to quantify the prevalence of burn-out of the participants at the time of study.

SETTING

Two ICUs designated as COVID-19 ICUs in a large metropolitan tertiary care hospital in the Greater Houston area (Texas, USA).

PARTICIPANTS

Twenty registered ICU nurses (10 from each unit).

RESULTS

Participants experienced high emotional exhaustion (MBI-MP mean score 32.35, SD 10.66), moderate depersonalisation (M 9.75, SD 7.10) and moderate personal achievement (M 32.05, SD 7.59) during the pandemic. Ten out of the 20 participants exhibited post-traumatic stress disorder symptoms (PCL-5 score >33). Regarding contributors to burn-out in nurses during the pandemic, five thematic levels emerged-personal, patient related, coworker related, organisational and societal-with each factor comprising several subthemes (eg, emotional detachment from patients, constant need to justify motives to patients' family, lack of staffing and resources, and politicisation of COVID-19 and vaccination). Participants revealed several practical interventions to help overcome burn-out, ranging from mental health coverage to educating public on the severity of the pandemic and importance of vaccination.

CONCLUSIONS

By identifying the contributors to burn-out in ICU nurses at a systems level, the study findings inform the design and implementation of effective interventions to prevent or mitigate pandemic-related burn-out among nurses.

Quality of working life of medical doctors and associated risk factors: a cross-sectional survey in public hospitals in China

OBJECTIVES

To assess the quality of working life (QWL) of medical doctors and associated risk factors.

SETTING AND PARTICIPANTS

A cross-sectional questionnaire survey of 2915 medical doctors from 48 hospitals was conducted in China.

METHODS

The QWL-7-32 scale was adopted to assess seven domains of QWL: physical health, mental health, job and career satisfaction, work passion and initiative, professional pride, professional competence, and balance between work and family.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were analysed using SPSS V.19.0. Analysis of variance tests and multivariate linear regression analyses were performed to identify the sociodemographic characteristics and job factors associated with overall QWL and its seven subdomain scores.

RESULTS

On average, the respondents reported an overall QWL score of 92.51 (SD=17.74) of a possible 160. Over 35% of respondents reported more than 60 hours of weekly working time; 59.9% experienced night sleep deprivation frequently; 16.6% encountered workplace violence frequently. The multivariate regression models revealed that the eastern region (β≤-2.887 for non-eastern regions, p<0.001), shorter working hours (β≤-2.638 for over 40 hours a week, p<0.01), less frequent night sleep deprivation (β≤-5.366 for sometimes or frequent, p<0.001), higher income (β≥2.795 for lower income, p<0.001) and less frequent encounters of workplace violence (β≤-9.267 for sometimes or frequent, p<0.001) were significant predictors of higher QWL. Night sleep deprivation and workplace violence were common predictors (p<0.05) for all seven domains of QWL.

CONCLUSION

The low QWL of medical doctors working in public hospitals in China is evident, which is associated with high workloads, low rewards and workplace violence. There are also significant regional differences in the QWL of medical doctors, with the eastern developed region featuring better QWL. Public hospitals in China are facing serious challenges in occupational health and safety, which needs to be addressed through a systems approach.

Effect of stress management based on cognitive-behavioural therapy on nurses as a universal prevention in the workplace: a systematic review and meta-analysis protocol

INTRODUCTION

The mental health status of nurses affects not only their well-being but also the organisational outcomes and the quality of patient care. Hence, stress management strategies are critical as a universal prevention measure that address an entire population and are not directed at a specific risk group to maintain nurses' mental health in the workplace. No systematic review or meta-analysis has been conducted to evaluate the effect of cognitive-behavioural therapy (CBT) that specifically focuses on universal prevention. Therefore, the aim of this study is to examine the effectiveness that is reported in published randomised controlled trial (RCT) studies.

METHODS AND ANALYSIS

This systematic review and meta-analysis will analyse published studies selected from electronic databases (ie, Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycARTICLES, Web of Science and the Japan Medical Abstracts Society). The inclusion criteria for studies are that they (1) were conducted to assess the effect of CBT on the mental health of nurses as a universal prevention, (2) used an RCT design and (3) provided sufficient results (sample sizes, means and SD) to estimate the pooled effect sizes with 95% CIs. Studies will be excluded if they only targeted nurses who had been screened as being at high risk in terms of their mental health and indicated that they required the prevention. The methodological quality of the included studies will be assessed using the Cochrane Collaboration's risk of bias tool.

ETHICS AND DISSEMINATION

Ethical approval is not required because this study is based on information obtained from previous studies. The results and findings of this study will be submitted for publication in a peer-reviewed international scientific journal. Results from this study will be helpful when implementing CBT strategies for nurses as a universal preventative measure in the workplace and for managing stress-related outcomes.

PROSPERO REGISTRATION NUMBER

CRD42020152837.

Leadership to improve nurse engagement and empowerment: evidences to improve the training of nurses

Aim

The objective of this study was to identify the key dimensions of transformational leadership that influence the promotion of engagement and structural empowerment in a population of nurses from different care settings.

Method

A cross-sectional survey study asking about engagement, leadership style and structural empowerment was used. Descriptive and correlational statistics were applied followed by hierarchical regression. 131 nurses were recruited from a Spanish health organisation using random sampling.

Results

Individualised consideration and intellectual stimulation were predictors of structural empowerment in a hierarchical regression of transformational leadership dimensions controlled by demographic variables (R2=0.467). In addition, intellectual stimulation was a predictor of engagement (R2=0.176).

Conclusion

The results are the starting point for the design of an organisationwide educational intervention to increase the engagement of nurses and staff development.

Workplace Stress in Portuguese Oncology Nurses Delivering Palliative Care: A Pilot Study

Oncology nurses often face complex end-of-life issues, underlining their need for specific training in palliative care. In this context, nurses experience several emotional and psychological dilemmas, which are often difficult to manage and result in high levels of workplace stress. This study aimed to determine the levels and work-related factors of workplace stress among oncology nurses. A descriptive baseline study was performed as part of a large four-phase study based on quantitative data collected from Portuguese oncology nurses. Of the 32 participating nurses, most were women, and the mean age was 42.69 ± 10.04 years. Overall, nurses revealed moderate levels of stress. Younger nurses with less professional experience had difficulties dealing with issues related to death and dying. This pilot study supported the development of a program of six Stress Management Training Workshops (SMTW) to reduce stress and increase adaptative strategies. Assessing workplace stress among oncology nurses should be the focus of intervention by managers and institutional leaders.

Effects of Classical Music Virtual Reality on Pediatric Healthcare Worker Compassion Fatigue

OBJECTIVE

The aim of this study was to explore the impact of classical music virtual reality (VR) on burnout, secondary traumatic stress, anxiety, and capacity for developing caring relationships with patients among healthcare workers (HCWs).

BACKGROUND

COVID-19 accentuated the importance of promoting the well-being of frontline workers. Efforts to address the mental health needs of HCWs are likely to positively impact patient outcomes.

METHODS

Healthcare workers completed 3 sessions of VR. A Wilcoxon rank-sum test was used to compare premeasure versus postmeasure on the Professional Quality of Life (ProQOL), State Trait Anxiety Inventory, and Caring Ability Inventory. Analysis of variance was performed to identify associations between the intervention and differences in scores for each ProQOL domain. Bonferroni correction adjusted for multiple comparisons. Fisher's t test was used for categorical analysis.

RESULTS

Seventy-one HCWs completed the study. There was a significant reduction in burnout after the experience, compared with baseline.

CONCLUSIONS

This study provides evidence that classical music VR may reduce burnout in HCWs.

Job Demands, Work Functioning and Mental Health in Dutch Nursing Home Staff during the COVID-19 Outbreak: A Cross-Sectional Multilevel Study

COVID-19 posed enormous challenges for nursing home staff, which may have caused stress and mental health problems. This study aimed to measure the prevalence of mental health problems among nursing home staff and investigate the differences in job demands, work functioning and mental health between staff with and without COVID contact or COVID infection and across different levels of COVID worries. In this cross-sectional study, 1669 employees from 10 nursing home organizations filled in an online questionnaire between June and September 2020. The questionnaire measured the participants’ characteristics, COVID contact, infection and worries, job demands, work functioning, depressive symptoms and burnout. Differences were investigated with multilevel models to account for clustering at the organization level. Of the participants, 19.1% had high levels of depressive symptoms and 22.2% burnout. Job demands, work functioning, depressive symptoms and burnout differed between participants who never worried and participants who often or always worried about the COVID crisis. Differences were smaller for participants with and without COVID contact or infection. Most models improved when clustering was accounted for. Nursing homes should be aware of the impact of COVID worries on job demands, work functioning and mental health, both at the individual and organizational level.

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

BACKGROUND

Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care.

METHODOLOGY

Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso's guidelines.

RESULTS

Sixteen articles met the inclusion criteria. The overarching synthesized theme was "the intricacies of developing HaH," and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development.

CONCLUSION

Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.

Oral and Subcutaneous Anticancer Therapy Training Course for Non-physician Healthcare Professionals: a Survey Evaluating the Relevance of its Content and its Implications in the Practice of Cancer Care

The creation of antitumor agents with an oral or subcutaneous route of administration has had important positive implications in the development of drugs to treat cancers, but issues such as false drug intake, uncontrolled side effects, and limited supervision may jeopardize the ability of these agents to improve treatment. A potential solution is the recruitment of non-physician healthcare professionals (i.e., nurses and physician assistants) and a special training course for them that focuses on the improvement of patient compliance. We developed and implemented three special professional training modules for non-physician healthcare professionals, which focus on the pharmacological aspects and side effects of oral and subcutaneous antitumor medications in regard to management strategies and communication issues that these non-physician healthcare professionals should address. Subsequently, we administered a questionnaire survey evaluating the course content and the implementation of the course in practice to the training participants to collect data for its implementation. Of 165 questionnaires that were administered, 44 (27%) were answered. The participants rated the course as being highly useful for their daily work. The participants reported a significant improvement in their professional expertise from the course. They emphasized the importance of medical topics and practical content to be included in the course delivery. The course encouraged 75% of the responders to start independent consultations with cancer patients that focused on questions of medication adherence for oral and subcutaneous antitumor medications, as well as the management of their side effects. Based on our results, at least a portion of the non-physician healthcare workforce is highly interested in engaging in active and autonomous co-supervision of patients who are treated with oral and subcutaneous antitumor medications. In addition to the theoretical basics of the treatment modalities, educational courses on oral and subcutaneous antitumor medications for non-physician healthcare professionals should focus on practical training and topics relevant to patient care.

The association between work-related physical and psychosocial factors and musculoskeletal disorders in healthcare workers: Moderating role of fear of movement

Objectives

Knowledge is lacking on the interaction between fear of movement (FOM) and work‐related physical and psychosocial factors in the development and persistence of musculoskeletal disorders (MSDs).

Methods

In this cross‐sectional study, 305 healthcare workers from several Belgian hospitals filled out a questionnaire including sociodemographic factors, work‐related factors (social support, autonomy at work, workload, and physical job demands), FOM, and MSDs for different body regions during the past year. Path analysis was performed to investigate (1) the association between the work‐related factors, FOM and MSDs, and (2) the moderating role of FOM on the association between the work‐related factors and MSDs among healthcare workers.

Results

Complaints were most frequently located at the neck–shoulder region (79.5%) and lower back (72.4%). Physical job demands (odds ratio [OR] 2.38 and 95% confidence interval [CI] 1.52–3.74), autonomy at work (OR 1.64 CI [1.07–2.49]) and FOM (OR 1.07 CI [1.01–1.14] and OR 1.12 CI [1.06–1.19]) were positively associated with MSDs. Healthcare workers who experienced high social support at work (OR 0.61 CI [0.39–0.94]) were less likely to have MSDs. Fear of movement interacted negatively with workload (OR 0.92 CI [0.87–0.97]) and autonomy at work (OR 0.94 CI [0.88–1.00]) on MSDs.

Conclusions

Work‐related physical and psychosocial factors as well as FOM are related to MSDs in healthcare workers. FOM is an important moderator of this relationship and should be assessed in healthcare workers in addition to work‐related physical and psychosocial factors to prevent or address MSDs.

Efficacy of a Workplace Intervention Program With Web-Based Online and Offline Modalities for Improving Workers' Mental Health

OBJECTIVE

This study aims to examine the efficacy of the Workplace Web-based blended psychoeducation mental health intervention program. Of particular interest is the short-term effect of the intervention on workplace burnout, stress, quality of life, and the mental health literacy of workers.

METHODS AND MATERIALS

The study focused on employees (n = 456) in specific industries with high levels of work-related stress, adopting a phase III wait-listed cluster randomized controlled trial. Work-related burnout was assessed by the Maslach Burnout Inventory (MBI) and stress was measured using the stress subscale of the Depression, Anxiety, and Stress scale (DASS). Quality of Life was evaluated by the European Quality of Life-5 Dimensions (EQ-5D-5L) and Mental Health Literacy was assessed using the Australian National Mental Health Literacy and Stigma Survey. Data were analyzed as a trial with intention-to-treat analysis and adjustment for the clustering effect of work sites.

RESULTS

Significant differences between intervention and control groups were found on all outcome measures except the self-rated quality of life. The intervention group displayed a significant reduction in the weighted mean score of about 1.0 units (s.e. = 0.4) on the stress scale (p = 0.015) and an increase in the weighted mean score of 1.9 units (s.e. = 0.9) in the professional accomplishment domain of the MBI (p = 0.035). Significant increases were found in the weighted mean scores in the intervention group for correct recognition of the mental problems, help-seeking, and stigmatization, in comparison to the control group who scored 0.2 (s.e. = 0.1), 0.9 (s.e. = 0.2), 1.8 (s.e. = 0.4), respectively.

CONCLUSIONS

The results obtained from a comparison of the outcome measures between the intervention and control groups were statistically significant, indicating that the intervention group performed better on most measures. The study demonstrates that, in the short term. the on-and-offline modalities of the Web-based blended psychoeducation intervention program is efficacious in reducing workplace burnout and stress and promoting mental health literacy at the workplace.

"Burnout syndrome and association with work stress in nursing staff in public hospital of the northern border of Mexico"

Currently in Mexico, there is a lack of published research assessing nursing burnout in a consistent manner. The pressure of having to provide quality care to low income patients can be a serious factor triggering work stress in the nursing professional. The aim of this study was to establish the connection between burnout, work stress and both demographic and labor factors in nursing staff. A sample of 424 nurses participated in the descriptive and cross-sectional study. Each of the participants answered a questionnaire with two validated instruments, the Maslach Burnout Inventory-Human Services Survey and the Nursing Stress Scale, both in their Spanish version, as well as a demographic and labor survey of the authors' own creation. A bivariate logistic regression analysis was used to determine any significant association between the variables. We found a prevalence of 65.09% in mid-level burnout syndrome among the female sex. Men, on the other hand, featured a high level of emotional exhaustion and depersonalization, whereas the female sex showed significantly lower levels of depersonalization. Most of the staff showed acute stress levels. Some factors found in the potential development of burnout were work shift, position, department and gender.

Correlation of Job stress and self-control through various dimensions in Beijing Hospital staff

BACKGROUND

Mental, emotional and physical exhaustion has been increasing in humans due to work related stress. Many studies have been conducted on various variables contributing to and counteracting job stress. In our study, we aimed to examine the effect of different demographic and personal variables on job stress and its correlation with self-control in a hospital setting.

METHOD

Our cross-sectional study involved 220 healthy staff members from Beijing hospital. Job stress and self-control were measured via the Chinese versions of the House and Rizzo Work Scale and the Self-Control Scale, respectively.

RESULT

Participants with male gender and those with leading positions of authority reported higher job stress and poorer self-control (P < 0.01). Smokers also showed poorer self-control (P < 0.05, Bonferroni corrected P > 0.05). Poor physical and mental health conditions were observed to be significantly related to poor self-control (Bonferroni corrected P < 0.01) and higher job stress (Bonferroni corrected P < 0.05). Moreover, negative correlation was found between job stress and self-control and its dimensions (P < 0.001). Furthermore, job stress group and leadership position could interact to influence self-control, healthy habit, and resistance to temptation.

CONCLUSION

We concluded that gender difference, leadership position, physical and mental health conditions all can affect work stress and an individual's self-control. Moreover, self-control dimensions like impulse control and attention to work correlated to job stress. Furthermore, the interaction between job stress and leadership could affect self-control and its dimensions. Future studies can be focused on using these variables to cope up with the ever increasing work related stress in the modern world.

Rationing of Nursing Care and Professional Burnout Among Nurses Working in Cardiovascular Settings

Introduction: Nursing needs close interpersonal contact with the patient and emotional involvement, therefore can contribute to professional burnout and rationing of nursing care.

Aim: Assessing the relationship between the rationing of nursing care and professional burnout in nursing staff.

Materials and Methods: The study included a group of 219 nurses working in cardiovascular facilities. This was a cross-sectional study designed to investigate the relationship between factors of the care rationing and professional burnout. The survey data was collected with standardised and research instruments such as the revised Basel Extent of Rationing of Nursing Care questionnaire (BERNCA-R) and the Maslach Burnout Inventory (MBI).

Results: The total mean BERNCA-R score was 1.38 (SD = 0.62), while the total MBI score amounted to 38.14 (SD = 22.93). The specific components of professional burnout yielded the values: emotional exhaustion (M = 44.8), job dissatisfaction (M = 40.66), and depersonalisation (M = 28.95). Multiple linear regression showed that independent predictors of BERNCA-R score were emotional exhaustion, depersonalisation, job dissatisfaction, and multi-jobs activity (p < 0.001).

Conclusion: The level of rationing of nursing care in cardiovascular facilities increases along with emotional exhaustion, depersonalisation and job dissatisfaction, and multi-jobs activity.

Workplace interventions to prevent or reduce post-traumatic stress disorder and symptoms among hospital nurses: A scoping review

OBJECTIVES

The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions.

BACKGROUND

A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted.

METHODS

We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet.

RESULTS

From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises.

CONCLUSIONS

This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations.

RELEVANCE TO CLINICAL PRACTICE

This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.

Identifying the risk features for occupational stress in medical workers: a cross-sectional study

Objective

Occupational stress is considered a worldwide epidemic experienced by a large proportion of the working population. The identification of characteristics that place people at high risk for occupational stress is the basis of managing and intervening in this condition. In this study, we aimed to identify and validate the risk features for occupational stress among medical workers using a risk model and nomogram.

Methods

This cross-sectional study included 1988 eligible participants from Henan Province in China. Occupational stress and worker-occupation fit were measured with the Depression, Anxiety and Stress Scales (DASS-21) and Worker-Occupation Fit Inventory (WOFI). The identification of risk features was achieved through constructing multiple logistic regression model, and the risk features were used to develop the risk model and nomogram. Receiver operating characteristic (ROC) curves and calibration plots were generated to assess the effectiveness and calibration of the risk model.

Results

Among 1988 participants in our study, there were 42.5% (845/1988) medical workers experienced occupational stress. The risk features for occupational stress included poor work-occupation fit (WOF score < 25, expected risk: 77.3%), nurse population (expected risk: 63.1%), male sex (expected risk: 67.2%), work experience duration of 11–19 years (expected risk: 54.5%), experience of a traumatic event (expected risk: 65.3%) and the lack of a regular exercise habit (expected risk: 60.2%). For medical workers who have these risk features, the expected risk probability of occupational stress would be 90.2%.

Conclusion

The current data can be used to identify medical workers at risk of developing occupational stress. Identifying risk features for occupational stress and the work-occupation fit can support hierarchical stress management in hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01762-3.

[Is this the parallel pandemic? : Measures to improve working conditions and stress levels among health care personnel]

Employee health and ability to perform is essential to a functioning health care system. Even before the coronavirus disease 2019 (COVID-19) pandemic, a substantial proportion of employees reported impaired mental health at work. This paper outlines the state of knowledge and evidence on interventions to promote mental health in the workplace, with particular focus on the organization of work and activities. In addition to an initial review of approaches, the factors facilitating successful and effective approaches are addressed.

Yoga complemented cognitive behavioral therapy on job burnout among teachers of children with autism spectrum disorders

BACKGROUND/OBJECTIVE

Job burnout is a syndrome of reaction to chronic job-related stress which affects overall health, limits occupational efficacy, and personal accomplishments of employees thereby thwarting organizational outcomes. Burnout symptoms are common among teachers of children with autism spectrum disorders (ASD) and affect the academic progress of the children. This study investigated the effectiveness of Yoga-based cognitive behavioral therapy (Y-CBT) in reducing occupational burnout among teachers of children with autism in Lagos States, Nigeria.

METHODS

A group-randomized control-trial with immediate intervention and waitlist control groups was design was adopted. Participants included 58 teachers of children with autism in public and private special schools in the area. Participants were randomly assigned to Y-CBT (N = 29) and waitlist control (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments Demographic variable, Single Item Stress Questionnaire (SISQ), and Maslach Burnout Inventory-Educators' Survey (MBI-ES) were used to collect data. Data were collected at baseline; post-test and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.

RESULTS

Results revealed that job-burnout reduced significantly at post-test assessment among the Y-CBT group compared to the waitlisted group. The reduction in the participant was sustained across 3months follow-up evaluation.

CONCLUSION

It was concluded that Y-CBT modalities could help to reduce the burnout symptoms among teachers of children with ASD.

Exploring factors influencing the retention of nurses in a religious hospital in Taiwan: a cross-sectional quantitative study

Background

Long-term deficits in the nursing labor force and high turnover rates are common in the Taiwanese medical industry. Little research has investigated the psychological factors associated with the retention of nursing staff. However, in practice, religious hospitals often provide nursing staff with education in medicine or the medical humanities to enhance their psychological satisfaction. The objective of this study was to explore factors influencing nursing staff retention in their work in relation to different levels of needs. A further objective was to investigate whether medical humanities education was associated with the retention of nursing staff.

Methods

This study used self-administrated questionnaires to survey nurses working in northern areas of Taiwan. The questionnaire design was based on the six levels of Maslow’s hierarchy of needs. Participation was voluntary, and the participants signed informed consent documents. Self-administrated questionnaires were distributed to a total of 759 participants, and 729 questionnaires were returned (response rate 96.04%). Logistic regression analysis was used to estimate the impact of seniority on nurses’ reported intention to stay after adjustment for nurse characteristics (gender and age).

Results

In the Pearson correlation analysis, nurses’ willingness to stay was moderately correlated with “physical needs”, “safety needs”, “love and belonging needs”, and “esteem needs” (r = 0.559, P < 0.001; r = 0.533, P < 0.001; r = 0.393, P < 0.001; and r = 0.476, P < 0.001, respectively). Furthermore, nurses’ willingness to stay was highly correlated with “self-actualization needs”, “beyond self-actualization needs” and “medical humanities education-relevant needs” (r = 0.707, P < 0.001; r = 0.728, P < 0.001; and r = 0.678, P < 0.001, respectively). We found that the odds ratios (ORs) of retention of nursing staff with less than 1 year (OR = 4.511, P = 0.002) or 1–3 years (OR = 3.248, P = 0.003) of work experience were significantly higher than that of those with 5–10 years of work experience.

Conclusions

With regard to medical humanities education, we recommend adjusting training, as the compulsory activities included in the official programs are inadequate, and adjusting the number of required hours of medical humanities education. Tailoring different educational programs to different groups (especially nurses who have worked 3–5 years or 5–10 years in the case study hospital) might improve acceptance by nursing staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00558-7.

A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic

The Covid-19 pandemic has exposed health workers to a diverse set of hazards impacting their physical, psychological and social wellbeing. This review aims to provide an overview of the categories of the psychosocial risk factors and hazards affecting HCWs during the Covid-19 pandemic and the recommendations for prevention. We used the scoping review methodology to collate categories of psychosocial risks, the related health outcomes, interventions, and data gaps. The review was conducted on global peer-reviewed academic and authoritative grey literature, published between 1. January-26. October 2020; in total, 220 articles were included into the review and the subsequent analysis. Analysis of the extracted data found PSRs related to four sources: personal protective equipment (PPE), job content, work organisation, and social context. is. Women health workers and nurses reported worst health outcomes. Majority of the research to date concerns health workers in secondary care, while data on psychosocial risks at primary and community-based settings are scarce. However, the emerging research implies that the pandemic creates psychosocial risks also to non-clinical health workers. The intervention and mitigation measures address individual and organisational levels. Preventative and mitigating measures for social and societal risks-such as staff shortages, intersecting inequalities, and financial stressors require further research.

Burnout and patient safety: A discriminant analysis of paediatric nurses by low to high managerial support

AIM

To explore how levels of managerial support discriminate paediatric nurses' burnout, quality of life, intent to leave and adverse patient events.

DESIGN

A quantitative correlational study.

METHODS

A total of 225 paediatric nurses were selected from nine major hospitals across Jordan. The main measures used were the Copenhagen Burnout Inventory and the brief version of World Health Organization-Quality of Life Instrument. The study methods were compliant with the STROBE checklist.

RESULTS

Nurse manager support was negatively associated with adverse patient events, work-related burnout, client-related burnout, and intent to leave; and positively with physical and psychological quality of life. Frequency of nosocomial infections characterized low manager support, whereas medication errors described high support. Greater nurse manager support decreased the likelihood of adverse patient outcomes.

Feasibility and efficacy of integrating resiliency training into a pilot nurse residency program

The high stress associated with the nursing profession can negatively affect the health of nurses and the quality of patient care that they provide. This quasi-experimental study aimed to 1) assess the feasibility of integrating a Stress Management and Resiliency Training (SMART) program within a nine-month pilot nurse residency program and 2) assess the effects of the program on participants' stress, anxiety, mindfulness, and resilience relative to a comparison group. A pre- and post-intervention survey design was used, with measurements taken at baseline and at 1, 3, 9, and 12 months after baseline. We enrolled 51 registered nurses (intervention group, n = 23; comparison group, n = 28) at a Midwestern US academic medical center. Nurses in the intervention group had a participation rate of 93%-100% with SMART program events. Despite the relatively limited adherence to the protocol by intervention group participants, significant improvements were noted for stress (P < .001), mindfulness (P < .001), and resilience (P < .001) in the intervention group compared with the comparison group. The SMART program can potentially be successfully integrated into a nurse residency program and positively impact nurse stress, mindfulness, and resilience. Further research is needed to determine the proper dose of the intervention and methods to enhance adherence.

Recovery Experience: A Concept for Maintaining Quality of Life and Its Mediating Effect Among Female Nurses in China

Purpose

Nurses are high-risk groups for job burnout, which affect their quality of life (QOL). Recovery experience, a conceptualization of positive psychological resources, can combat the negative impacts of job burnout on health and QOL. The aim of this study was to examine the mediating effect of recovery experience on the relationship between job burnout and QOL among female nurses in China.

Participants and Methods

QOL information was captured from 1068 female nurses from December 2017 to February 2018 in tertiary hospitals in Shenyang, Liaoning Province of China. A structural equation model was employed to examine the mediating effect of recovery experience on the relationship between job burnout and QOL.

Results

Job burnout had a significant impact on both the mental component summary and the physical component summary of a 36-item Short-Form Health Survey. However, mental component summary scores were significantly lower than physical component summary scores in female nurses. Recovery experience played a mediating role in the relationship between job burnout and QOL.

Conclusion

Job burnout could result in a reduction in QOL among Chinese female nurses. Recovery experience, as a mediating factor, could alleviate the impact of job burnout on QOL. Recovery experience should be strengthened to attenuate job burnout and enhance QOL.

Mediating effects of nursing organizational climate on the relationships between empathy and burnout among clinical nurses

AIMS AND OBJECTIVES

To investigate how nurses who worked in Guangdong province in China perceived empathy, nursing organization climate and burnout.

DESIGN

A cross-sectional quantitative research design was used. We carried out the research in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist.

METHODS

The study was carried out from August-October of 2018 using a structured electronic questionnaire. A total of 965 participants were selected with convenience sampling in Guangdong province.

RESULTS

A total of 786 valid questionnaires were collected in this study. The average burnout score of participants was 38.19 (SD 13.32) and 67.4% of them rated their burnout as more than 30 points, while 5.7% were higher than 60 points. The multi-variable linear regression model explained 9.4% of the variance in burnout related to sociodemographic variables (p < 0.001). Empathy was significantly and positively associated with nursing organizational climate and emotional exhaustion while negatively associated with reduced personal accomplishment. In addition, nursing organizational climate mediated the relationship between empathy and reduced personal accomplishment.

CONCLUSION

Our findings suggest that both empathy and nursing organizational climate are protective factors that prevent burnout in this population. Managers can alleviate nurses' burnout through developing empathy and improving the organizational climate.

IMPACT

This study demonstrates that empathy is not the cause of burnout; rather, it can prevent nurses from experiencing burnout. Nursing organizational climate is another protective factor that has a mediating effect on empathy and burnout. Improving empathy and nursing organizational climate could help reduce nurse burnout.

The effects of "Workplace Health Promotion Program" in nurses: A randomized controlled trial and one-year follow-up

In this study, the authors examined the effects of the "Workplace Health Promotion Program" (WHPP) on pain, fatigue, stress, professional quality of life (Pro-QoL), and coping skills for nurses. The authors conducted a randomized control trial in 30 nurses who agreed to participate in this study. Progressive relaxation training, posture and breath exercises, and ergonomic suggestions as a WHPP were applied to the intervention group (n = 15) during the five weeks. The intervention group showed decrease in pain (p = .001), fatigue (p = .001), and stress levels (p = .003) and increase in coping skills and Pro-QoL (p < .05). In contrast, the authors observed no improvement in the control group. The authors concluded at the end of the study that WHPP remains effective in nurses.

Adherence of Female Health Care Workers to the Use a Web-Based Tool for Improving and Modifying Lifestyle: Prospective Target Group Pilot Study

BACKGROUND

Health care professionals are exposed to the psychological and physiological effects of stress, which is a well-known risk factor for various mental and physical health problems.

OBJECTIVE

The aims of this study were to assess the adherence of female health care workers to use a web-based tool for improving and modifying lifestyle and to identify the potential factors influencing their adherence.

METHODS

A prospective, observational study was performed. A total of 80 female health care workers (physicians and gradated nurses) from 2 university medical centers and female members of a family medicine society participated. Participants completed a questionnaire that inquired about their basic demographic data and physical fitness. Physical fitness was assessed by the Rockport Fitness Walking Test. Adherence to a web-based application (24@life) was followed for 3 months and the number of log-ins into the application was counted.

RESULTS

The study was conducted from March to October 2019. Significantly high workload has been detected in all groups (P<.05), except in the general practitioner with normal workload group. The graduated nurse working in the surgery room group showed chronic stress with elevated S-cortisol levels (>690 nmol/L); activated cellular immune system with elevated concentrations of lymphocytes (reference 1.1-2.5 × 10⁹ cells/L), CD3 cells (reference 0.7-1.9 × 10⁹ cells/L), CD8 cells (reference 0.2-0.7 × 10⁹ cells/L), and HLA-DR/CD3 cells (reference 0.04-0.2 × 10⁹ cells/L); and the worst quality of sleep (mean 2.8 [SD 1.2]). Only 32 of 80 participants (40%) were adherent to the web-based application. Participants most frequently viewed web pages on areas of physical activity (497 times) and nutrition (332 times). No factors or participant's characteristics such as weight (odds ratio [OR] 1.026, 95% CI 0.977-1.078), BMI (OR 0.993, 95% CI 0.834-1.184), age (OR 0.970, 95% CI 0.910-1.034), or stress level (OR 0.997, 95% CI 0.995-1.000) were identified to affect the adherence rates.

CONCLUSIONS

Female health care workers exposed to high workload did not find the web-based application useful for improving and modifying their lifestyle. Therefore, other strategies that might help health care workers facing stress and improve their lifestyle should be identified.

Psychometric properties of the short-form Chinese Community Nurses Stress Scale: A cross-sectional study

Job-related stress had adverse effects on both patients and community nurses. To evaluate stress, an effective and reliable instrument was needed. The aim of this study was to develop a short-form Chinese Community Nurse Stress Scale and examine its psychometric properties.A cross-sectional study was conducted. A total of 969 community nurses were selected from 56 community centers/stations in Sichuan Province. The socio-demographic data and job stress assessed by the Chinese Community Nurse Stress Scale (CNSS) were collected. After randomly splitting the sample into group 1 and group 2, exploratory and confirmatory factor analysis were carried out to shorten the scale and test its reliability and construct validity.There were no significant differences in socio-demographic variables between group 1 (n = 488) and group 2 (n = 481). During exploratory factor analysis, 4 factors were selected, including management and interpersonal relationships (8 items), patient care (7 items), environment and resources of work (6 items), and career promotion (4 items), which explained 62.66% of all variance. Cronbachs α coefficient of the short-form CNSS was 0.94, and the cross-sample validity test supported the best fit model for this 25-item CNSS.The results in this study supported that the 25-item CNSS had a good reliability and validity when it was administrated to Chinese community nurses.

What is known about paediatric nurse burnout: a scoping review

Burnout in healthcare providers has impacts at the level of the individual provider, patient, and organization. While there is a substantial body of literature on burnout in healthcare providers, burnout in pediatric nurses has received less attention. This subpopulation may be unique from adult care nurses because of the specialized nature of providing care to children who are typically seen as a vulnerable population, the high potential for empathetic engagement, and the inherent complexities in the relationships with families. Thus, the aim of this scoping review was to investigate, among pediatric nurses, (i) the prevalence and/or degree of burnout, (ii) the factors related to burnout, (iii) the outcomes of burnout, and (iv) the interventions that have been applied to prevent and/or mitigate burnout. This scoping review was performed according to the PRISMA Guidelines Scoping Review Extension. CINAHL, EMBASE, MEDLINE, PsycINFO, ASSIA, and The Cochrane Library were searched on 3 November 2018 to identify relevant quantitative, qualitative, and mixed-method studies on pediatric nurse burnout. Our search identified 78 studies for inclusion in the analysis. Across the included studies, burnout was prevalent in pediatric nurses. A number of factors were identified as impacting burnout including nurse demographics, work environment, and work attitudes. Similarly, a number of outcomes of burnout were identified including nurse retention, nurse well-being, patient safety, and patient-family satisfaction. Unfortunately, there was little evidence of effective interventions to address pediatric nurse burnout. Given the prevalence and impact of burnout on a variety of important outcomes, it is imperative that nursing schools, nursing management, healthcare organizations, and nursing professional associations work to develop and test the interventions to address key attitudinal and environmental factors that are most relevant to pediatric nurses.

Burnout syndrome in Brazilian and Spanish nursing workers

Objective:

to analyze the burnout dimensions scores in Brazilian and Spanish nursing workers.

Method:

quantitative, cross-sectional and comparative study conducted with 589 Nursing workers who answered the Sociodemographic and Professional Characterization Questionnaire and the Maslach Burnout Inventory. Descriptive and analytical analysis of the data was performed.

Results:

Spanish Nursing workers presented higher averages in the Depersonalization dimension (p = 0.004) and Brazilians, higher scores in the Professional Achievement dimension (p = 0.031). In both Spain and Brazil, nursing assistants / technicians were found to have higher Emotional Exhaustion than nurses; In Brazil, Depersonalization is higher in nurses and in Spain it is higher in Nursing assistants / technicians. Statistically significant results were found in the association of burnout dimensions with sociodemographic and work characteristics: age; professional category; workplace; work regime; work shift; time of professional experience; working time in the same workplace and consider stressful work.

Conclusion:

Although Brazilian and Spanish nursing workers score low levels of Depersonalization and high Professional Achievement, there are average levels of Emotional Exhaustion, indicating an important preventive factor to be worked on, since Emotional Exhaustion is considered the first stage of burnout.

Evidence of Workplace Interventions-A Systematic Review of Systematic Reviews

Work environment factors are highly correlated with employees' health and well-being. Our aim was to sum up current evidence of health promotion interventions in the workplace, focusing on interventions for the prevention of musculoskeletal disorders, psychological and behavioral disorders as well as interventions for older employees and economic evaluations. We conducted a comprehensive literature search including systematic reviews published from April 2012 to October 2017 in electronic databases and search engines, websites of relevant organizations and institutions. It consisted of simple and specific terms and word combinations related to workplace health promotion based on the search strategy of a previous review. After full-text screening, 74 references met the eligibility criteria. Using the same search strategy, there was a higher proportion of relevant high-quality studies as compared with the earlier review. The heterogeneity of health promotion interventions regarding intervention components, settings and study populations still limits the comparability of studies. Future studies should also address the societal and insurer perspective, including costs to the worker such as lost income and lost time at work of family members due to caregiving activities. To this end, more high-quality evidence is needed.

Occupational Burnout and Its Related Factors Among Iranian Nurses: A Cross-Sectional Study in Shahroud, Northeast of Iran

BACKGROUND

Good physical and mental health of employees is one of the major characteristics of a healthy organisation.

AIM

Due to the importance of occupational burnout and its potentially negative consequences, the aim of this study was to assess occupational burnout and its related factors among Iranian nurses.

METHODS

In this cross-sectional study, 205 nurses who were working in two educational hospitals affiliated with Shahroud University of Medical Sciences were included. Forty-two of the nurses were male, and 163 were female (mean age: 31 years). Maslach Occupational Burnout Inventory, demographic and job characteristics questionnaires were completed for each nurse. Questionnaires were then collected, and data were analysed statistically by SPSS, version 22.

RESULTS

In the assessment of occupational burnout, the highest level was observed in emotional exhaustion and then in personal performance. There was a significant difference between the frequency of nurses' emotional exhaustion domain in terms of gender (P < 0.05), so that, women suffered more from emotional exhaustion. There was a significant difference between the frequencies of nurses' performance in terms of marital status (P < 0.05) so that married people had more personal performance disorder.

CONCLUSION

The results of this study showed that nurses suffered from low occupational burnout. Female gender, sleeping disorders, awakening at night and employment in stressful wards such as the emergency ward was associated with a higher level of occupational burnout in nurses.

Core Burnout and Power in Portuguese Nursing Staff: An Explanatory Model Based on Structural Empowerment

In the nursing context, structural empowerment has proved to be an organizational tool leading to the prevention of stress and burnout. Structural empowerment is defined as the perception of the presence or absence of empowering conditions in the workplace. However, few studies have explored the particular relationships between power in organizations, structural empowerment, and burnout. The aim of this study was to examine the mediator role of structural empowerment (access to opportunities, information, support, and resources) in the relationship between formal and informal power, and core burnout among Portuguese nurses. We administered a questionnaire among a convenience sample of 304 nurses employed in public hospitals. Model fit and mediation analysis were conducted using path analysis and bootstrapping methods. Formal power, informal power, access to opportunities, and access to resources were significant and negative predictors of core burnout. Opportunities, resources, and informal power had a direct influence on core burnout. Formal power and informal power showed an indirect influence, mediated by opportunities and resources, on core burnout. These findings suggest that by providing nurses with high levels of formal and informal power, as well as access to resources and opportunities, their risk of core burnout can be lowered.

Burnout Precursors in Oncology Nurses: A Preliminary Cross-Sectional Study with a Systemic Organizational Analysis

Burnout negatively affects nurses’ health and performance. Healthcare managers have an ethical duty to create healthy organizations that reduce burnout, especially within critical settings such as oncology. The aim of this study was twofold: (1) to measure the presence of nurses’ burnout to formulate organizational strategies to prevent the syndrome onset, and (2) to evaluate the effect of recent organizational changes on the burnout phenomenon. A descriptive, cross-sectional design supported by a systemic organizational analysis was conducted in a Swiss Oncology Institute in 2013. Of 103 nurses working in the Institute, 52 (51.4%) completed the Burnout Potential Inventory (BPI) questionnaire. Data were analyzed using descriptive statistics and Mann–Whitney and Kruskal–Wallis tests. Burnout risk levels were low to moderate. Only 2 nurses out of the 52 showed moderate burnout risk levels. Inpatient nurses showed a higher risk of burnout than outpatient nurses, particularly due to ambiguity and feelings of powerlessness. Nurses with post-basic education showed a higher risk when considering poor teamwork values and ambiguity in the workplace. Poor middle-management was found to negatively influence worker wellbeing. The working environment set by management resulted in low burnout risk levels. Managers must carefully select middle-management because inappropriate leadership might promote the onset of burnout.