Healthcare-Related Regret among Nurses and Physicians Is Associated with Self-Rated Insomnia Severity: A Cross-Sectional Study

Psychometric Evaluation of the Insomnia Severity Index in Nurses

OBJECTIVES

Examine psychometric properties of the Insomnia Severity Index (ISI) in a sample of nurses.

METHOD

In a sample of day shift nurses (N = 289), a confirmatory factor analysis (CFA), convergent and discriminant validity analyses, and a test-retest reliability analysis were performed.

RESULTS

CFA showed that a two-factor model provided the best fit. The ISI had moderate to poor convergent validity with sleep diary parameters, and moderate convergent validity with the Sleep Condition Indicator (r = -.66), Pittsburgh Sleep Quality Index (r = .66), and PROMIS Sleep-Related Impairment measure (r = .67). The ISI demonstrated good discriminant validity with the measures Composite Scale of Morningness (r = -.27), Nightmares Disorder Index (r = .25), PTSD Checklist for DSM-5 (sleep items removed; r = .32), and Perceived Stress Scale (r = .43). The ISI had weaker discriminant validity with the PHQ-9 (r = .69) and Generalized Anxiety Disorder Screener (r = .51). The ISI demonstrated a good test-retest reliability (ICCs = .74-.88).

CONCLUSIONS

The ISI is a psychometrically strong measure for the assessment of insomnia severity in day shift nurses. Overlap with psychological symptoms, primarily anxiety and depression, suggests caution while interpreting these constructs.

Measuring care-related regret intensity: Reliability and validation of a 10-item scale among Chinese nursing interns

AIM

The 10-item care-related regret intensity scale (RIS-10) assesses the experience and intensity of care-related regrets. The aim of this study was to validate a Chinese version of the RIS and examine its reliability and validity when applied to Chinese nursing interns.

BACKGROUND

Nursing students, the future healthcare workforce, often face clinical errors and adverse events due to limited knowledge and experience. Assessing care-related regret during their internships is crucial for their development.

METHODS

Through a process involving translation, back-translation and cross-cultural adaptation, a Chinese version of the RIS-10 was developed. A convenience sampling method was employed to survey 529 nursing interns to validate the reliability and validity of the scale.

RESULTS

The Chinese version of the scale, consisting of 10 items, demonstrated a single dimension, explaining 66.77% of the total variance according to exploratory factor analysis. Content validity for the 10 items ranged from 0.800 to 1.000, with a scale-level content validity of 0.980. Confirmatory factor analysis indicated a well-fitting model (CFI = 0.968, GFI = 0.921, NFI = 0.952, IFI = 0.969, TLI = 0.957, RMSEA = 0.088). Convergent validity was supported by an Average Variance Extracted of 0.636 and a Composite Reliability of 0.946. The scale also exhibited strong reliability with a Cronbach's α coefficient of 0.945, a split-half reliability coefficient of 0.903 and a test-retest reliability of 0.901.

CONCLUSIONS

This comprehensive translation and validation process confirms the suitability of the Chinese version of the RIS-10 for use among Chinese nursing interns.

Insomnia in cancer patients - A survey of health-care professionals' views and current practice in Romania

BACKGROUND

Changes in the quality of sleep are reported often in cancer patients and have a major impact on general health. However, insomnia tends to be insufficiently evaluated and managed.

AIM

The aim of the study was to analyze the perception of clinical staff working in oncology units regarding patients' sleep disorders. Furthermore, we assessed the prevalence of insomnia in this category of professionals.

MATERIALS AND METHODS

The study was cross sectional and used a descriptive and correlational design. Clinical personnel working in oncology departments were invited to complete a questionnaire regarding sleep problems in patients, and optionally, the Pittsburgh sleep quality index questionnaire was administered. Correlations between age, profession, experience, and their responses were statistically analyzed.

RESULTS

We gathered 101 responses, with 63.4% coming from doctors. With one exception, all professionals observed changes in sleep patterns in patients, but less than a third were actively looking for these problems and only three health professionals used questionnaires. No significant differences in answers were noted based on age, profession, or experience. Regarding professionals, 45.6% of them had impaired sleep based on the Pittsburgh questionnaire results.

CONCLUSION

Oncology staff are aware of the existence and impact of sleep problems, but active assessment for sleep problems is low. There is a relative high prevalence of poor sleep quality among oncology staff. In order to improve the well-being of patients, the quality of sleep should be documented as part of the care plan. The existence of guidelines is desirable.

Sleep and Safety among Healthcare Workers: The Effect of Obstructive Sleep Apnea and Sleep Deprivation on Safety

Almost one billion people worldwide are affected by Obstructive Sleep Apnea (OSA). Affected individuals experience disordered breathing patterns during sleep, which results in fatigue, daytime drowsiness, and/or sleep deprivation. Working under the influence of these symptoms significantly impairs work productivity and leads to occupational accidents and errors. This impact is seen in healthcare workers (HCWs) who are not immune to these conditions. However, poorly controlled OSA in this subset of individuals takes a heavy toll on patient care due to the increased risk of medical errors and can also alter the mental and physical well-being of the affected HCW in various ways. OSA and safety issues have been recognized and mitigated among the airline and transport industries; however, the healthcare industry lags in addressing these concerns. This article reviews hypersomnolence and sleep disorder as key clinical features of OSA and their effect on HCW safety.

Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol

Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS). Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: "regret and decision," "regret and physicians," and "regret and nurses." An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports-recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty. Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals. Spanish National Register (SL42129-20/598-E).

Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses

BACKGROUND

Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors.

METHODS

For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes.

RESULTS

Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective.

CONCLUSIONS

This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.

Associations of emotional burden and coping strategies with sick leave among healthcare professionals: A longitudinal observational study

OBJECTIVES

To investigate 1) whether care-related regrets (regret intensity, number of recent regrets) are associated with sick leave, independently of personality traits, perceived safety climate, and physical activity; and 2) whether these associations were mediated or moderated by coping strategies.

METHODS

Using a longitudinal international observational study (ICARUS), data were collected by the means of a weekly web survey. Descriptive and generalized estimation equations were performed.

RESULTS

A total of 276 newly practicing healthcare professionals (nurses, physicians, others) from 11 countries were included in this study. The average proportion of weeks with at least one day of sick leave was 3.2%. Nurses' sick leave increased with number of care-related regrets (Relative Risk [RR]=1.52; 95% Confidence Interval [CI]=[1.18; 1.95], p=.001), while physicians' sick leave increased with intensity of care-related regret (RR=1.21; 95%CI=[1.00; 1.21], p=.049). Coping was associated with lower risk of sick leave for nurses (RR _{problem-focused strategies} = 0.53; 95%CI=[0.37; 0.74], p=.001, and RR_{physical activity}=0.68; 95%CI:[0.54; 0.85], p<.001), but not for physicians. Nevertheless, the association of regret with sick leave remained significant even when adjusting for coping. Finally, this study did not find evidence of moderation by the coping strategies.

CONCLUSION

Regrets are associated with increased risks of sick leave, even in young healthcare professionals. Use of coping strategies partially mediated these associations in nurses. The results of this study should be used to inform interventions to reduce emotional burdens and enhance protective coping strategies.

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context

OBJECTIVE

The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context.

METHODS

Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work.

RESULTS

Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22.

CONCLUSION

PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

Back pain occurrence and treatment-seeking behavior among nurses: the role of work-related emotional burden

PURPOSE

To assess the association of back pain and treatment-seeking behavior for such pain with work-related emotional burden (regret about care), regret coping strategies, and physical burden among newly practicing nurses.

METHODS

We used data from the Impact of Care-related Regret Upon Sleep (ICARUS) cohort collected between 05.2017 and 07.2018 using web-based surveys (weekly for measures of emotional burden, physical burden and coping strategies, and monthly for back pain and seeking care). We investigated immediate associations and temporal influences between burdens and back pain with linear mixed models and cross-lagged Bayesian models, respectively. Coefficients were standardized to allow comparison between burdens. Logistic regression was used to examine the association of burdens with seeking care.

RESULTS

Among 105 nurses with an average follow-up of 3 months, 80 reported at least one episode of back pain. Neither physical nor emotional burdens had an immediate association with back pain. However, number of days with back pain in a given month was associated with an increase in both burdens during the previous month, with similar degrees of association (emotional: b = 0.24, physical: b = 0.21). Decision to seek treatment was associated with an increase in back pain frequency (OR 1.12, p = 0.04) and intensity (OR 1.80, p = 0.002) and a decrease in emotional burden (OR 0.95, p = 0.03). Coping strategies were associated neither with the occurrence of back pain nor with care-seeking.

CONCLUSION

While both emotional and physical burdens were associated with increased frequency of back pain the following month, emotional burden additionally showed a negative association with the decision to seek care.

Workplace violence and development of burnout symptoms: a prospective cohort study on 1823 social educators

PURPOSE

Burnout and workplace violence (WPV) have been associated in cross-sectional studies, but longitudinal studies with solid methods and adequate sample sizes are lacking. This study investigates whether WPV increases burnout symptoms during a 12-month period.

METHODS

Questionnaire data were collected on 1823 social educators at baseline and 12-month follow-up, coupled with additionally 12 monthly text-message surveys on exposure to WPV. Using general linear modelling for repeated measures, we estimated change over time in burnout symptoms in three WPV exposure groups (none, low, high).

RESULTS

A time by exposure to WPV interaction existed for development of burnout; F(2) = 7.2, p = 0.001 η² = 0.011. Burnout increased significantly within the group of low exposure; F(1) = 6.8, p = 0.01 and high exposure; F(1) = 6.7 p = 0.001, but not within the non-exposed F(1) = 2.1 p = 0.15. At follow-up, both the low exposed and high exposed had significantly higher levels of burnout compared to the non-exposed.

CONCLUSION

Exposure to WPV increases level of burnout within a 12-month period. We propose that assessment of burnout in future studies should utilize instruments capable of detecting small changes. We further propose that prevention against employee burnout could be improved using monitoring targeted at employees exposed to WPV.

Insomnia severity index: a psychometric investigation among Saudi nurses

BACKGROUND

Insomnia is the most prevalent sleep disorder, but it is widely untreated and under-diagnosed in Saudi Arabia. Moreover, no tool to screen insomnia has been validated in the Saudi population in general or nurses in particular. This study, therefore, assessed the psychometric validity of the Insomnia Severity Index (ISI) in Saudi nurses.

METHODS

A cross-sectional study with purposive sampling was performed with nurses (n = 134, age = 21-48 years) from Al Majmaah, Saudi Arabia. Both conventional and online survey methods using the ISI, a brief measure of metacognition, and a socio-demographics questionnaire were employed.

RESULTS

No ceiling or floor effects were found in the ISI total score (8.84 ± 5.07) or the factor scores, but the floor effect was found in the item scores. A two-factor model showed the best fit (Pclose .97, comparative fit index [CFI] 1.00, root mean square error of approximation [RMSEA] 0.00, non-significant χ²test, χ²/df 0.904). This model showed favorable configural, metric, scalar, and partial strict invariance across gender groups (CFI > .95, RMSEA < .05, χ²/df < 3, non-significant Δχ², ΔCFI ≤ .01). The internal consistency was adequate (Cronbach's alpha = 0.75, 0.78 for the two factors of the ISI). The lack of correlations between the ISI scores and the scores of the brief measure of the metacognition favored its divergent validity.

CONCLUSION

The ISI showed adequate psychometric validity for screening insomnia among Saudi nurses.

"We Won't Retire Without Skeletons in the Closet": Healthcare-Related Regrets Among Physicians and Nurses in German-Speaking Swiss Hospitals

Physicians and nurses are expected to systematically provide high-quality healthcare in a context marked by complexity, time pressure, heavy workload, and the influence of nonclinical factors on clinical decisions. Therefore, healthcare professionals must eventually deal with unfortunate events to which regret is a typical emotional reaction. Using semistructured interviews, 11 physicians and 13 nurses working in two different hospitals in the German-speaking part of Switzerland reported a total of 48 healthcare-related regret experiences. Intense feelings of healthcare-related regrets had far-reaching repercussions on participants' health, work-life balance, and medical practice. Besides active compensation strategies, social capital was the most important coping resource. Receiving superiors' support was crucial for reaffirming professional identity and helped prevent healthcare professionals from quitting their job. Findings suggest that training targeting emotional coping could be beneficial for quality of life and may ultimately lead to lower job turnover among healthcare professionals.

Internists' and intensivists' roles in intensive care admission decisions: a qualitative study

BACKGROUND

Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions.

METHODS

Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach.

RESULTS

Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner.

CONCLUSIONS

Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.

Too Imperfect to Fall Asleep: Perfectionism, Pre-sleep Counterfactual Processing, and Insomnia

Previous research suggests that certain dimensions of perfectionism are associated with insomnia. However, the exact processes whereby perfectionism may influence sleep have as yet remained unexplored. The present study tested the hypothesis that perfectionistic individuals are particularly prone to engage in counterfactual thinking and to experience counterfactual emotions (regret, shame, and guilt) at bedtime, which have been shown to impair sleep. One hundred eighty university students completed questionnaires on perfectionism, counterfactual processing, and insomnia severity. Analyses revealed that three dimensions of perfectionism were significantly related to insomnia severity: Concern over mistakes and doubts about action showed positive correlations, whereas organization showed a negative correlation. Moreover, the frequency of counterfactual thoughts and emotions at bedtime largely mediated the effects of these dimensions of perfectionism on insomnia severity. These findings highlight how personality-related patterns of behavior may translate into affective arousal at bedtime, thereby increasing the risk of insomnia.

Reciprocal relations between care-related emotional burden and sleep problems in healthcare professionals: a multicentre international cohort study

OBJECTIVE

To determine whether there are reciprocal relations between care-related regret and insomnia severity among healthcare professionals, and whether the use of different coping strategies influences these associations.

METHODS

This is a multicentre international cohort study of 151 healthcare professionals working in acute care hospitals and clinics (87.4% female; mean age=30.4±8.0 years, 27.2% physicians, 48.3% nurses and 24.5% other professions) between 2014 and 2017. Weekly measures of regret intensity, number of regrets, and use of coping strategies (Regret Coping Scale) and sleep problems (Insomnia Severity Index) were assessed using a web survey.

RESULTS

The associations between regret and insomnia severity were bidirectional. In a given week, regret intensity (b_{regret intensity→sleep}=0.26, 95% credible interval (CI) (0.14 to 0.40)) and number of regrets (b_{number of regrets→sleep}=0.43, 95% CI (0.07 to 0.53)) were significantly associated with increased insomnia severity the following week. Conversely, insomnia severity in a given week was significantly associated with higher regret intensity (b_{sleep→regret intensity}=0.14, 95% CI (0.11 to 0.30)) and more regrets (b_{sleep→number of regrets}=0.04, 95% CI (0.02 to 0.06)) the week after. The effects of regret on insomnia severity were much stronger than those in the opposite direction. The use of coping strategies, especially if they were maladaptive, modified the strength of these cross-lagged associations.

CONCLUSIONS

The present study showed that care-related regret and sleep problems are closely intertwined among healthcare professionals. Given the high prevalence of these issues, our findings call for the implementation of interventions that are specifically designed to help healthcare professionals to reduce their use of maladaptive coping strategies.

Impact of CAre-related Regret Upon Sleep (ICARUS) cohort study: protocol of a 3-year multicentre, international, prospective cohort study of novice healthcare professionals

INTRODUCTION

Healthcare professionals are particularly at risk of developing numerous physical and psychological health problems. The experiences of emotional burden associated with providing healthcare, notably care-related regret, have been associated with these health problems, but only using cross-sectional data so far. Evidence of a causal impact of regret has not been assessed. The Impact of CAre-related Regret Upon Sleep (ICARUS) study is the first prospective and international cohort study established to examine how newly practising healthcare professionals adapt to their challenging job by assessing the impact of care-related regret on sleep and job quitting.

METHOD AND ANALYSIS

The ICARUS cohort study will include newly practising healthcare professionals working in acute care hospitals and clinics recruited between May 2017 and November 2019. Data collection, which will begin as soon as the participant starts working with patients, will consist of a 1-year weekly assessment using a secure web survey. Follow-up data will be collected at 6, 12, 18 and 24 months after the end of the first year. We will collect detailed information on the experience of care-related regret (ie, highest regret intensity, accumulation of regrets and coping strategies related to regrets), sleep problems and job quitting. Moreover, quality of life, health status and burnout will be assessed during the follow-up. Several confounders factors, including sociodemographic characteristics, personality, night shifts and work environment characteristics, will be assessed.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of Geneva Canton, Switzerland (CCER2016-02041), the Ethics Committee of London South Bank University (HSCSEP/17/06) and the University Research Ethics Committee of Bedfordshire (UREC106). Other study centres deemed local ethical approval unnecessary since the main ethics committee (Geneva) had already accepted the project. Results will be published in relevant scientific journals and be disseminated in international conferences. Fully anonymised data and questionnaires will be freely accessible to everyone (scientists and general public).

Regret in Surgical Decision Making: A Systematic Review of Patient and Physician Perspectives

OBJECTIVE

Regret is a powerful motivating factor in medical decision making among patients and surgeons. Regret can be particularly important for surgical decisions, which often carry significant risk and may have uncertain outcomes. We performed a systematic review of the literature focused on patient and physician regret in the surgical setting.

METHODS

A search of the English literature between 1986 and 2016 that examined patient and physician self-reported decisional regret was carried out using the MEDLINE/PubMed and Web of Science databases. Clinical studies performed in patients and physicians participating in elective surgical treatment were included.

RESULTS

Of 889 studies identified, 73 patient studies and 6 physician studies met inclusion criteria. Among the 73 patient studies, 57.5% examined patients with a cancer diagnosis, with breast (26.0%) and prostate (28.8%) cancers being most common. Interestingly, self-reported patient regret was relatively uncommon with an average prevalence across studies of 14.4%. Factors most often associated with regret included type of surgery, disease-specific quality of life, and shared decision making. Only 6 studies were identified that focused on physician regret; 2 pertained to surgical decision making. These studies primarily measured regret of omission and commission using hypothetical case scenarios and used the results to develop decision curve analysis tools.

CONCLUSION

Self-reported decisional regret was present in about 1 in 7 surgical patients. Factors associated with regret were both patient- and procedure related. While most studies focused on patient regret, little data exist on how physician regret affects shared decision making.

Self-Rated Health and Sick Leave among Nurses and Physicians: The Role of Regret and Coping Strategies in Difficult Care-Related Situations

Moral distress - such as feeling strong regret over difficult patient situations - is common among nurses and physicians. Regret intensity, as well as the coping strategies used to manage regrets, may also influence the health and sickness absence of healthcare professionals. The objective of this study was to determine if the experience of regret related to difficult care-related situations is associated with poor health and sick leave and if coping strategies mediate these associations. Two cross-sectional surveys were conducted in Switzerland (Geneva, 2011 and Zurich, 2014). Outcomes were self-rated health (SRH) and sick leave in the last 6 months. We examined the associations of regret intensity with the most important care-related regret, number of recent care-related regrets, and coping strategies, using regressions models. Among 775 respondents, most reported very good SRH and 9.7% indicated absence from work during four working days or more. Intensity of the most important regret was associated with poor SRH among nurses and physicians, and with higher sick leave among nurses. Maladaptive emotion-focused strategies were associated with poor SRH among nurses, whereas adaptive emotion-focused strategies were positively associated with higher SRH and lower sick leave among physicians. Because care-related regret is an integral part of clinical practice in acute care hospitals, helping physicians and, especially, nurses to learn how to deal with negative events may yield beneficial consequences at the individual, patient care, and institutional level.

Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare

BACKGROUND

The regret intensity scale (RIS) and the regret coping scale for healthcare professionals (RCS-HCP) working in hospitals assess the experience of care-related regrets and how healthcare professional deal with these negative events. The aim of this study was to validate a German version of the RIS and the RCS-HCP.

METHODS

The RIS and RCS-HCP in German were first translated into German (forward- and backward translations) and then pretested with 16 German-speaking healthcare professionals. Finally, two surveys (test and 1-month retest) administered the scales to a large sample of healthcare professionals from two different hospitals.

RESULTS

Of the 2142 eligible healthcare professionals, 494 (23.1%) individuals (108 physicians) completed the cross-sectional web based survey and 244 completed the retest questionnaire. Participants (n = 165, 33.4% of the total sample) who reported not having experienced a regret in the last 5 years, had significantly more days of sick leave during the last 6 months. These participants were excluded from the subsequent analyses. The structure of the scales was similar to the French version with a single dimension for the regret intensity scale (Cronbach's alpha: 0.88) and three types of coping strategies for the regret coping scale (alphas: 0.69 for problem-focused strategies, 0.67 for adaptive strategies and 0.86 for the maladaptive strategies). Construct validity was good and reproduced the findings of the French study, namely that higher regret intensity was associated with situations that entailed more consequences for the patients. Furthermore, higher regret intensity and more frequent use of maladaptive strategies were associated with more sleep difficulties and less work satisfaction.

CONCLUSIONS

The German RIS and RCS-HCP scales were found valid for measuring regret intensity and regret coping in a population of healthcare professionals working in a hospital. Reporting no regret, which corresponds to the coping strategy of suppression, seems to be a maladaptive strategy because it was associated with more frequent sick day leaves.

Long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan: A national survey

BACKGROUND

Needlestick and sharps injuries are prevalent work-related injuries among nurses. Safety devices prevent only one-quarter of related injuries. More studies of modifiable risk factors are needed.

OBJECTIVES

To examine whether long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan.

DESIGN

Cross-sectional survey.

SETTINGS/PARTICIPANTS

This analysis included 19,386 full-time bedside nurses working in 104 hospitals across Taiwan.

METHODS

Participants filled out an anonymous questionnaire from July to September 2014. Chronic insomnia, needlestick injuries, and sharps injuries during the past year were each measured by a yes/no question. Multivariate logistic regression models were applied to examine the effects of long work hours and chronic insomnia on needlestick and sharps injuries, given with control for sex, marital status, educational level, age, years of practice, work unit, and hospital level in the model.

RESULTS

More than 70% of study nurses worked long hours during the previous week (>50h: 27.5%; 41-50h: 43.2%), and 15.5% of nurses reported chronic insomnia. The percentage of sharps injuries (38.8%) was higher than that for needlestick injuries (22.4%) during the previous year among nurses. After adjusting for potential confounders, logistic regression yielded significant results showing that those who worked 41 to 50h per week, >50h per week, and had chronic insomnia were 1.17 times (95% C.I.=1.04-1.32), 1.51 times (95% C.I.=1.32-1.72), and 1.45 times (95% C.I.=1.25-1.68) more likely to experience needlestick injuries, and 1.29 times (95% C.I.=1.17-1.42), 1.37 times (95% C.I.=1.23-1.53), and 1.56 times (95% C.I.=1.37-1.77) more likely to experience sharps injuries, respectively, than those who worked fewer hours and did not have insomnia.

CONCLUSIONS

This nationwide nurse survey showed that high rates of needlestick and sharps injuries persist in hospital nurses in Taiwan. The common problems of long work hours and chronic insomnia increase the risk of these injuries. We suggest that hospital managers follow regulations on work hours and optimize shift schedules for nurses to decrease related injuries.

Seasonal variations in sleep disorders of nurses

AIMS AND OBJECTIVES

To investigate the difference between nurses and the general population regarding seasonal variations in sleep disorders during 2004-2008. The effects of season and group interaction on sleep disorders with regard to different comorbidities were also examined.

BACKGROUND

Studies on seasonal variations in sleep disorders were mainly conducted in Norway for the general population. Furthermore, whether different comorbidities cause seasonal variations in sleep disorders in nurses remains unknown.

DESIGN

A retrospective study.

METHODS

Data from the Taiwan National Health Insurance Research Database were used in generalised estimating equation Poisson distribution models to investigate the differences in sleep disorders between nurses and the general population diagnosed with sleep disorders (each n = 7643) as well as the interaction effects of sleep disorders between the groups with respect to different seasons. Furthermore, the interaction effects between groups and seasons on sleep disorders in the subgroups of comorbid anxiety disorders and depressive disorders were studied.

RESULTS

Both the nurses and the general population had fewer outpatient visits for sleep disorders in winter than in other seasons. The nurses had fewer outpatient visits for sleep disorders than the general population did in each season. The nurses had more outpatient visits for sleep disorders in winter than in summer compared with the general population in the comorbid depressive disorder subgroup but not in the comorbid anxiety disorder subgroup.

CONCLUSIONS

Nurses and the general population exhibited similar seasonal patterns of sleep disorders, but nurses had fewer outpatient visits for sleep disorders than the general population did in each season. For nurses with comorbid depressive disorders, outpatient visits for sleep disorders were more numerous in winter than in summer, potentially because nurses with comorbid depressive disorders are affected by shorter daylight exposure during winter.

RELEVANCE TO CLINICAL PRACTICE

Depression and daylight exposure may be considered in mitigating sleep disorders in nurses.