Working Conditions and Mental Health of Nursing Staff in Nursing Homes

Guided self-help mindfulness-based intervention for increasing psychological resilience and reducing job burnout in psychiatric nurses: A randomized controlled trial

AIMS

The present study aimed to explore the effects of a guided self-help mindfulness intervention on psychological resilience and job burnout among psychiatric nurses.

BACKGROUND

Psychiatric nurses work in challenging and potentially high stress settings. Mindfulness interventions can improve psychological resilience and reduce job burnout of nurses. However, face-to-face delivery of mindfulness interventions may be inconvenient for individuals. Guided self-help interventions may be more accessible.

METHODS

This randomized controlled trial was conducted from January to August 2022. One hundred and eighteen psychiatric nurses were randomized into the intervention and control groups. The individuals in the intervention group received an 8-week guided self-help mindfulness intervention, while the individuals in the control group received a psycho-educational brochure. The Five Facet Mindfulness Questionnaire, the Connor-Davidson Resilience Scale and the Maslach Burnout Inventory-Human Services Survey were used to evaluate the levels of mindfulness, psychological resilience and job burnout, respectively.

RESULTS

After an 8-week intervention, compared with the control group, the levels of mindfulness and psychological resilience were higher, while the level of job burnout was lower in the intervention group.

CONCLUSIONS

The guided self-help mindfulness intervention can improve psychological resilience and reduce job burnout among psychiatric nurses.

Identifying work-related factors associated with work-family conflict of care workers in nursing homes: A cross-sectional study

AIMS

To investigate which work-related factors are associated with work-family conflict of care workers in nursing homes, this study aimed to: (a) describe the prevalence of work-family conflict of care workers in nursing homes and (b) assess the association of work-related factors with work-family conflict.

DESIGN

Cross-sectional multicentre sub-study based on data from the Swiss Nursing Homes Human Resources Project 2018.

METHODS

Data were collected between September 2018 and October 2019. Work-family conflict of care workers was assessed with the Work-Family Conflict Scale (range 1-5). Prevalence was described in percentages. We used multilevel linear regression to assess the association of time-based factors (working overtime or during one's free time, employment percentage, presenteeism, shift working) and strain-based factors (staffing adequacy, leadership support) with work-family conflict.

RESULTS

Our study sample consisted of 4324 care workers working in a total of 114 nursing homes. Overall, 31.2% of respondents stated to have experienced work-family conflict (>3.0 on the Work-Family Conflict Scale). The overall mean score of the study sample for work-family conflict was 2.5. Care workers experiencing presenteeism 10 or more days per year showed the highest scores for work-family conflict (mean: 3.1). All included predictor variables were significant (p < .05).

CONCLUSION

Work-family conflict is multifactorial. Possible intervention points to tackle work-family conflict could be strengthening care workers' influence in planning work schedules, enabling flexible planning to ensure adequate staffing, lowering presenteeism and implementing a supportive leadership style.

IMPACT

Care workers' jobs become less desirable when workplace demands interfere with family life. This study highlights the multifaceted nature of work-family conflict and suggests intervention options to prevent care workers from experiencing work-family conflict. Action is needed at nursing home and policy level.

Effects of a videoconference-based therapeutic exercise intervention on the musculoskeletal pain of eldercare workers: protocol for the ReViEEW randomized controlled trial

BACKGROUND

Prevalence of musculoskeletal pain is high among eldercare workers, and therapeutic exercise has shown to be effective for its management. Although telerehabilitation is an increasingly used alternative for delivering therapeutic exercise, no studies have assessed synchronous group telerehabilitation interventions for the management of musculoskeletal disorders. Thus, the aim of this article is to describe the protocol of a randomized controlled trial that will assess the effects of a videoconference-based group therapeutic exercise intervention on the musculoskeletal pain of eldercare workers.

METHODS

This multicenter trial will randomly assign 130 eldercare workers to either a control or experimental group. Participants in the control group will not receive any intervention, and participants in the experimental group will take part in a 12-week remote supervised videoconference-based intervention, consisting of 2 weekly 45-min group sessions. Each session will include 4 sets of 6 progressive resistance exercises for the lower limbs, upper limbs and trunk, performed with bodyweight and elastic bands at moderate-high intensity. Following the 12 weeks, participants in the experimental group will be provided with material for autonomously carry on the therapeutic exercises and advised to continue performing 2 weekly sessions on their own until a 48-week follow-up. Assessments will be performed at baseline, 12 and 48 weeks. Primary outcome will be average pain intensity in the low back during the last 7 days, measured by the 0-10 Numerical Rating Scale. Secondary outcomes will include additional measures of musculoskeletal pain, psycho-affective state, work-related variables, and physical fitness.

DISCUSSION

This will be the first trial, to our knowledge, assessing whether a remote delivery of a group therapeutic exercise intervention via videoconference is effective for reducing the musculoskeletal pain, improving the psycho-affective state and physical fitness, and enhancing the work-related parameters in eldercare workers. If successful, this study will provide innovative tools for implementing effective, scalable and affordable interventions to tackle musculoskeletal disorders in the workplace. It will also highlight the utility of telehealth, and address the importance of therapeutic exercise to manage musculoskeletal pain in a critical population for the future of the aging societies as it is the eldercare workers.

TRIAL REGISTRATION

The study protocol was prospectively registered at ClinicalTrials.gov (registration number: NCT05050526) on September 20, 2021.

Work-Family Conflict and Depression Among Healthcare Workers: The Role of Sleep and Decision Latitude

BACKGROUND

Healthcare workers report a higher incidence of depression than the general population. Work-family conflict is a risk factor, but the mechanisms explaining its association with depression are not well understood. This study examines the potential mediating and moderating role of sleep and decision latitude in translating work-family conflict into depression.

METHODS

In 2018, a cross-sectional survey was collected from healthcare workers (n = 1,059) in five public sector facilities in the northeast United States. The survey included questions on participants' work-family conflict, depression, sleep duration and disturbances, decision latitude, and other work environments and socio-demographic characteristics. Multivariable linear and Poisson regression modeling were used to examine associations among variables.

FINDINGS

There was a significant association between work-family conflict and depression (β = 2.70, p < .001). Sleep disturbances, although not short sleep duration, partially mediated this association. The association between work family-conflict and depression was stronger among workers with low decision latitude.

CONCLUSIONS

Depression was prevalent among healthcare workers and was associated with work-family conflict. Sleep disturbances served as a significant mediator, while decision latitude modified the strength of the association.

APPLICATION TO PRACTICE

Evidence-based interventions seeking to alleviate the effect of work-family conflict and improve healthcare workers' mental health should consider promoting employee sleep quality and improving employees' decision-making on the job.

Factors Related to Mental Health of Foreign Care Workers in Long-Term Care Facilities in Japan during the COVID-19 Pandemic-A Comparative Study

This study aimed to evaluate the factors related to the mental health of foreign care workers in Japan's long-term care (LTC) facilities and compare their results with those of native care workers. We conducted a cross-sectional survey covering 80 LTC facilities across Japan between August and November 2021. The survey mainly included mental health, workload, reward, sense of coherence, loneliness, COVID-19-specific factors and sociodemographic variables. The results show that workload was a distinct feature associated with the mental health of foreign care workers (n = 172) when compared with those of native care workers (n = 154). In addition, we found that the relationship between cultural adaptation and mental health in a sample of foreign care workers was mediated by loneliness and sense of coherence (SOC). Finally, we found that reward, loneliness, SOC, and COVID-19-specific factors had significant impacts on the mental health of both foreign and native care workers. These findings highlight the importance of support measures from the workplace for foreign care workers. Workplace interventions that focus on workload, reward, and sense of coherence strategies are required to address mental health improvement and may still be of value in dealing with the continuing COVID-19 pandemic.

Response to NIOSH Request for Information on Interventions to Prevent Work-Related Stress and Support Health Worker Mental Health

The root causes of health care worker strain and depression include excessive job demands, extended work schedules, little decision-making opportunity, assault, bullying, and fear of injury. Potential links between working conditions and opioid overuse have also been discussed, beginning with psychological job strain or with physical pain leading to medication use. Promising solutions have been identified and many would be cost-effective, as enhanced working conditions could improve workers' mental health, job satisfaction, retention, and patient outcomes. Considering the number of health care workers leaving work during the global COVID-19 pandemic, it is urgent to address preventable root causes. In 2021, the US Congress called for educating health workers and first responders on the primary prevention of mental health conditions and substance use disorders. The CDC issued a Request for Information; this submission summarized research from CPH-NEW, a NIOSH Center of Excellence in Total Worker Health®, supplemented by a selective literature review.

Identifying the most important workplace factors in predicting nurse mental health using machine learning techniques

OBJECTIVES

Nurses are at a high risk of developing mental health problems due to exposure to work environment risk factors. Previous research in this area has only examined a few factors within nurses' work environments, and those factors were not conceptualized with the goal of improving workplace mental health. The purpose of this study is to identify the most important work environment predictors of nurse mental health using a comprehensive and theoretically grounded measure based on the National Standard of Psychological Health and Safety in the Workplace.

METHODS

This is an exploratory cross-sectional survey study of nurses in British Columbia, Canada. For this study, responses from a convenience sample of 4029 actively working direct care nurses were analyzed using random forest regression methods. Key predictors include 13 work environment factors. Study outcomes include depression, anxiety, post-traumatic stress disorder (PTSD), burnout and life satisfaction.

RESULTS

Overall, healthier reports of work environment conditions were associated with better nurse mental health. More specifically balance, psychological protection and workload management were the most important predictors of depression, anxiety, PTSD and emotional exhaustion. While engagement, workload management, psychological protection and balance were the most important predictors of depersonalization, engagement was the most important predictor of personal accomplishment. Balance, psychological protection and engagement were the most important predictors of life satisfaction.

CONCLUSIONS

Routine assessment with standardized tools of nurses' work environment conditions and mental health is an important, evidence-based organizational intervention. This study suggests nurses' mental health is particularly influenced by worklife balance, psychological protection and workload management.

Workplace Integrated Safety and Health Program Uptake in Nursing Homes: Associations with Ownership

Workers in nursing homes are at high risk of occupational injury. Understanding whether—and which—nursing homes implement integrated policies to protect and promote worker health is crucial. We surveyed Directors of Nursing (DON) at nursing homes in three US states with the Workplace Integrated Safety and Health (WISH) assessment, a recently developed and validated instrument that assesses workplace policies, programs, and practices that affect worker safety, health, and wellbeing. We hypothesized that corporate and for-profit nursing homes would be less likely to report policies consistent with Total Worker Health (TWH) approaches. For each of the five validated WISH domains, we assessed the association between being in the lowest quartile of WISH score and ownership status using multivariable logistic regression. Our sample included 543 nursing homes, 83% which were corporate owned and 77% which were for-profit. On average, DONs reported a high implementation of TWH policies, as measured by the WISH. We did not find an association between either corporate ownership or for-profit status and WISH score for any WISH domain. Results were consistent across numerous sensitivity analyses. For-profit status and corporate ownership status do not identify nursing homes that may benefit from additional TWH approaches.

Working experience of certified nursing assistants in the greater New York City area during the COVID-19 pandemic: Results from a survey Study

This study aimed to examine the challenges and needs of certified nursing assistants (CNAs) working in nursing homes during the COVID-19 pandemic in the greater New York City area. Between September and November of 2020, a telephone survey was administered to and completed by 208 CNAs in the study area about various aspects of their working experience during COVID-19. CNAs reported significant exposure to COVID-19 and experienced additional emotional and financial strain due to the pandemic. CNAs also expressed the influence of COVID-19 on their work schedules and intent to continue working as CNAs, and strong interest in financial support and further training. This study offers empirical insights into the experiences of CNAs working in nursing homes during the pandemic, which are of unique value to inform future efforts to support CNAs and other long-term care providers in general and during public health emergencies in New York and beyond.

The influence of nursing home managers' leadership on person-centred care and stress of conscience: A cross-sectional study

Background

Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.

Methods

This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.

Results

Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.

Conclusion

Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.

Workplace violence and turnover intentions among nurses: The moderating roles of invulnerability and organisational Support - A cross-sectional study

AIMS AND OBJECTIVES

To investigate whether internal and external violence are associated with turnover intentions among nurses during demanding periods of work.

BACKGROUND

Workplace violence can negatively impact upon mental and physical health and turnover intentions. Research focusing on how dimensions of workplace violence, internal versus external, influence turnover intentions and the factors that mitigate these effect is lacking.

METHODS

An online cross-sectional survey of multi-item measures was used to collect data from 462 Iranian nurses. We employed path modelling and analysed the data using SPSS and PROCESS macro. A STROBE checklist was used to report findings.

RESULTS

Both dimensions, internal and external, of violence were positively associated with turnover intentions. Moreover, perceived invulnerability and organisational support moderates this association. When individuals perceived invulnerability and perceived organisational support are high, internal violence is no longer indirectly related to turnover intentions via job satisfaction. In a similar vein, when perceived invulnerability and perceived organisational support are low, external violence is not related to intentions to quit. When perceived invulnerability and perceived organisational support are high, however, external violence is indirectly and negatively related to intentions to quit.

CONCLUSIONS

Nurses who regard themselves as invulnerable might be motivated to quit when they experience workplace violence. However, they are motivated to stay on the job when they both perceive themselves as invulnerable and the organisation as supporting.

RELEVANCE TO CLINICAL PRACTICE

Organisations should reconsider their policies and approach towards workplace violence especially during periods of intensive work.

Managing apathy among people with dementia living in institutional settings: Staff's perceived gap between common and best practices

The aim of this study is to explore how staff manage apathy involving a person living with dementia (PLWD). Forty-two staff members working in four Spanish long-term care facilities were interviewed; 21 were nursing assistants and 21 technical staff. They read a vignette about a PLWD presenting apathy. Participants were asked (1) how a situation like that is commonly managed, and (2) how it should be managed. Responses were content-analyzed. Most participants (88.1%) mentioned having experienced a situation similar to the one described in the vignette. Behavior-focused strategies and person-centered strategies were the most frequently mentioned. As for best practices, person-centered strategies emerged as the preferred alternative, and technical staff mentioned them more frequently than assistant carers. Our findings stress the importance of organizational guidelines and staff development in the management of apathy in PLWD.

A Corporate Wellness Program and Nursing Home Employees' Health

Background: Many employed Americans suffer from chronic conditions like obesity, diabetes, and cardiovascular diseases. Worksite wellness programs provide opportunities to introduce health promotion strategies. While there is evidence of the effectiveness of workplace health promotion, this is tempered by concern that benefits may be less available to low-wage workers with inflexible working conditions. Objective: The aim was to evaluate a workplace health promotion (WHP) in the long-term care sector (skilled nursing facilities). Methods: Nursing home employees from 18 facilities within a single company were surveyed by a standardized, self-administered questionnaire. A company-sponsored WHP program was offered to the facilities, which were free to take it up or not. We categorized the facilities by level of program adoption. Cross-sectional associations were estimated between program category and prevalence of individual-level worker health indicators, adjusting for center-level working conditions. Results: A total of 1,589 workers in 5 job categories completed the survey. Average levels of psychological demands and social support at work were relatively high. Supervisor support stood out as higher in centers with well-developed WHP programs, compared to centers with no programs. There were no differences among program levels for most health outcomes. Workers in centers with well-developed programs had slightly lower average body mass index and (unexpectedly) slightly lower prevalence of non-smoking and regular aerobic exercise. Conclusions: Only small health benefits were observed from well-developed programs and working conditions did not appear to confound the negative results. This low-intensity, low-resourced workplace health promotion program may have benefited a few individuals but seems to have had only modest influence on average levels of the measured health indicators. Many nursing home employees experience obstacles to health behaviors; approaches that provide more environmental and economic supports for healthy behaviors, such as Total Worker Health®, may yield larger health benefits.

Association of care workers' job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan

OBJECTIVES

There is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents' functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes.

DESIGN

A retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff.

SETTING

Eighteen nursing homes in Japan.

PARTICIPANTS

Data were collected from 1000 residents with a required care level of 3-5 and from 412 care staff in nursing homes between October 2017 and March 2018.

OUTCOMES AND EXPLANATORY VARIABLES

Functional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness.

RESULTS

Functional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents' deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents' functional performance.

CONCLUSION

These results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.

Mental Disorder Symptoms Among Nurses in Canada

Background

Nurses face regular exposures to potentially psychologically traumatic events as part of their occupational responsibilities. Cumulative stress due to repeated exposure to such events is associated with poor mental health and an increased risk of developing clinically significant symptoms consistent with some mental disorders.

Purpose

The current study was designed to estimate rates of mental disorder symptoms among nurses in Canada and identify demographic characteristics that are associated with increased risk for mental disorder symptoms.

Method

An online survey was conducted with Canadian nurses in both English and French. Participants were recruited largely through the Canadian Federation of Nurses Unions (CFNU) member unions, non-CFNU member unions, and social media. The survey assessed current mental disorder symptoms using well-validated screening measures.

Results

A total of 4267 participants (93.8% women) completed the survey. Almost half of participants screened positive for a mental disorder (i.e., 47.9%). No gender differences emerged. Significant differences in proportions of positive screens based on each measure were found across demographic groups (e.g., age, province of residence, type of nurse).

Conclusions

The rate of positive screens appears much higher than mental disorder prevalence rates in the general Canadian population, but there were important methodological differences. The current results provide potentially important information to support researchers and healthcare administrators to investigate possible ways to mitigate and manage mental health in nursing workplaces.

Benchmarking working conditions for health and safety in the frontline healthcare industry: Perspectives from Australia and Malaysia

AIM

To present benchmarks for working conditions in healthcare industries as an initial effort into international surveillance.

BACKGROUND

The healthcare industry is fundamental to sustaining the health of Australians, yet it is under immense pressure. Budgets are limited, demands are increasing as are workplace injuries and all of these factors compromise patient care. Urgent attention is needed to reduce strains on workers and costs in health care, however, little work has been done to benchmark psychosocial factors in healthcare working conditions in the Asia-Pacific. Intercultural comparisons are important to provide an evidence base for public policy.

DESIGN

A cross-sectional design was used (like other studies of prevalence), including a mixed-methods approach with qualitative interviews to better contextualize the results.

METHODS

Data on psychosocial factors and other work variables were collected from healthcare workers in three hospitals in Australia (N = 1,258) and Malaysia (N = 1,125). 2015 benchmarks were calculated for each variable and comparison was conducted via independent samples t tests. Healthcare samples were also compared with benchmarks for non-healthcare general working populations from their respective countries: Australia (N = 973) and Malaysia (N = 225).

FINDINGS

Our study benchmarks healthcare working conditions in Australia and Malaysia against the general working population, identifying trends that indicate the industry is in need of intervention strategies and job redesign initiatives that better support psychological health and safety.

CONCLUSION

We move toward a better understanding of the precursors of psychosocial safety climate in a broader context, including similarities and differences between Australia and Malaysia in national culture, government occupational health and safety policies and top-level management practices.