Designing a Resilience Program for Critical Care Nurses

Qualitative Research on Mindfulness Interventions for Staff Nurses: A Review of the Literature

Complexity, workforce shortages, and escalating stressors in the healthcare setting have led to increased turnover and burnout of nursing staff. Mindfulness has been demonstrated to offer a variety of benefits to nurses. This article summarizes the qualitative research on the experience of mindfulness training and practice with the goal of providing evidence-based recommendations for nurse leaders on how to design and implement effective and well-adopted mindfulness programs.

Effectiveness of spaced education pedagogy in enhancing Nurses' knowledge on emotional resilience-A quasi-experimental trial

INTRODUCTION

Building resilience among nurses has been postulated as one of the key strategies to support nurses and retain them in the profession. This study aimed to evaluate the effectiveness, of spaced education pedagogy in enhancing Nurses' knowledge on emotional resilience. Secondary objectives include evaluation of the usability and acceptability of delivery of the training via a mobile application in one's own mobile device.

DESIGN

A quasi-experimental study with single group pre-test and post-test trial was conducted.

METHODS

Full-time registered nurses working in an acute care hospital were invited to participate from June 2021 to June 2022. The group used the mobile application daily for 1 month. Pre-test measurement includes socio-demographic data and baseline resilience level before the intervention. Post-test measurement includes resilience level, usability and acceptability of mobile-assisted cognitive-behavioral therapy measured upon completion of the training. The mobile application enabled the delivery of resilience educational content in small quantities through a repeating manner, with a concurrent evaluation of learner's understanding.

RESULTS

When compared to their baseline (mean = 24.38, SD = 5.50), participants reported significant increase in the Connor-Davison Resilience Scale score (mean = 26.33, SD = 5.57) (t = -4.40, p < 0.001). Upon 1 month usage of the mobile application, a higher percentage of the participants reported intermediate to high level of resilience (57.4%), as compared to prior usage (54.7%). Respondents reported knowledge of most useful strategies for their daily lives including: (i) managing negative emotions (54.1%); (ii) psychoeducation about mental health and the risks of burnout (44.7%); (iii) achieving work and life balance (43.5%); and (iv) depiction of workplace scenarios to demonstrate what can be and cannot be controlled during times of change (43.5%). Participants reported usability of the mobile application with a mean SUS score 70.5 (SD = 13.0), which was considered "acceptable." Overall, 82.3% of the participants found the mobile application appealing, 64.7% reported they were likely to use the mobile application in the future and 72.9% would recommend it to other nurses.

CONCLUSION

The mobile application provided nurses with the availability and convenience to access resilience building learning content integrated with the spaced education pedagogy.

CLINICAL RELEVANCE

The use of mobile-assisted cognitive behavioral training can aid in increasing nurses' resilience level. Nurses provided acceptable usability ratings and satisfactory acceptance of receiving training via the mobile application, showing promising opportunities in the improvement of overall well-being.

Interventions to support critical care nurse wellbeing: A scoping review

INTRODUCTION

Recruitment and retention of qualified nurses in critical care is challenging and has been further exacerbated by the COVID-19 pandemic. Poor staff wellbeing, including sickness absence and burnout contribute to a high staff turnover and staff shortages. This scoping review charts wellbeing interventions targeting nurses who work in adult critical care.

METHODS

Following the Joanna Briggs Institute scoping review methodology, five databases were searched: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid Embase, Ovid PsycINFO, and the Cochrane Library alongside a search for grey literature targeting national and international critical care nurse organisations. Primary research studies (qualitative, quantitative and mixed methods), as well as quality improvement studies and policy frameworks published from January 1997 to September 2022 were included. Studies conducted outside an adult critical care setting or not including adult critical nurses were excluded. Extracted data were charted using a series of tables.

RESULTS

26 studies met the inclusion criteria. Most of the interventions targeted personal rather than organisational strategies, focusing on resilience training, mindfulness-based interventions, and other psychological approaches. One intervention was not evaluated. Most of the rest of the studies reported their interventions to improve wellbeing. However, only one study evaluated the intervention for longer than six months.

CONCLUSION

Current evidence identified that critical care nurse wellbeing is an international concern affecting recruitment and retention. Most available wellbeing interventions take a psychological, personal approach. However, these may not address the complex interaction of organisational factors which impact adult critical care nurses.

IMPLICATIONS FOR CLINICAL PRACTICE

Further work is needed to identify and evaluate organisational approaches to improving wellbeing and to evaluate wellbeing interventions over a longer period of time. Critical care nurses should be included in the design of future wellbeing interventions.

The effectiveness of the training program on accepting and expressing emotions on the psychological resilience and depression levels of nurses: A two-year follow-up study

PURPOSE

This study aimed to examine the effectiveness of the training program which was based on cognitive behavioral theory on accepting and expressing emotions in terms of nurses' psychological resilience and depression levels.

DESIGN AND METHODS

The study is an intervention study with a control group conducted with pretest, posttest, and two-year follow-up test design in line with Consolidated Standards of Reporting Trials (CONSORT). The participants in the intervention group attended an eight-week accepting and expressing emotions training program, while those in the control group did not. The Psychological Resilience Scale for Adults (RSA) and Beck's Depression Inventory (BDI) were applied to both groups as pre-test, post-test and 6-month follow-up (T2), 12-month follow-up (T3) and 24-month follow-up (T4).

RESULTS

It was determined that there was a significant change in RSA scale scores of the intervention group, and that the effect of group ∗ time interaction for all scores was significant. An increase in the total score was found for all follow-up periods with respect to T1. A significant decrease was determined in BDI scores of the intervention group, and the effect of group-time interaction for all scores was found to be significant. It was found that there was a decrease in the scores of the intervention group in all follow-up periods with respect to T1.

CONCLUSIONS

The results obtained from the study showed that the training program conducted with groups on accepting and expressing emotions was effective on the nurses' psychological resilience and depression scores.

PRACTICE IMPLICATIONS

Training programs that develop the skills of accepting and expression emotions can help nurses find their thoughts underlying their emotions. Thus, depression levels of nurses can decrease, and their psychological resilience can improve. This situation can help in terms of reducing workplace stress of nurses and can cause their working life to be more effective.

Impact of Case Review Debriefings on Moral Distress of Extracorporeal Membrane Oxygenation Nurses

BACKGROUND

Moral distress occurs when nurses know the ethically correct action to take but are restrained from taking it. Moral distress is prevalent in nurses who work in intense stress situations, as do extracorporeal membrane oxygenation nurses.

LOCAL PROBLEM

Nurses who work in critical care settings have higher levels of moral distress than nurses who work in other practice areas. The purpose of this project was to evaluate the effectiveness of case review debriefings on moral distress of extracorporeal membrane oxygenation nurses.

METHODS

Thirty-nine critical care registered nurses with specialty training in extracorporeal membrane oxygenation were invited to participate in this clinical improvement project. The intervention consisted of 2 case review debriefings. The Moral Distress Scale-Revised and the Moral Distress Thermometer were used to measure long-term and acute (short-term) moral distress.

RESULTS

Of a potential range of 0 to 336, the mean Moral Distress Scale-Revised score was 134.0 before intervention and 131.8 after intervention. The frequency of experiencing moral distress did not change after intervention, but the level of moral distress increased after intervention. Moral Distress Thermometer scores decreased for 80% of participants and increased for 20%. Five items related to perceptions of prolonging death and suffering were the most frequent causes of moral distress.

CONCLUSIONS

Developing strategies and providing opportunities to mitigate moral distress are crucial to a healthy future nursing workforce. Implications include the potential for improved patient care, decreased turnover rates and costs, and improved nurse satisfaction rates.

COVID-19 effects on women's home and work life, family violence and mental health from the Women's Health Expert Panel of the American Academy of Nursing

BACKGROUND

The COVID-19 pandemic exaggerated women's roles in families as primary caretakers and overseers of family health. This is compounded by possible loss of work and resultant loss of health insurance.

PURPOSE

We examine how pandemic-related factors have altered women's roles and created stressors challenging stress adaptation and typical coping strategies, including how registered nurses have faced unique challenges.

FAMILY VIOLENCE AND PANDEMIC-RELATED MENTAL HEALTH CHALLENGES

Enforced stay-athome orders exaggerated by work-from-home has amplified family violence worldwide. Besides COVID-19 protective measures increasing greater contact with abusers, they limited women's access to help or support. Pandemic-related issues increased anxiety, anger, stress, agitation and withdrawal for women, children, and registered nurses.

DISCUSSION

More evidence about pandemic-related impacts on women's home and work lives, especially the scope of stressors and emotional/mental health manifestations is urgently needed. Policies to support interventions to improve mental health resilience are paramount.

Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study

BACKGROUND

Critical care practitioners have some of the highest levels of burnout in health care.

RESEARCH QUESTION

What are key drivers of burnout across the multidisciplinary ICU team?

STUDY DESIGN AND METHODS

We conducted a multicenter mixed-methods cohort study in ICUs at three diverse hospitals. We recruited physicians, nurses, respiratory therapists, and other staff members who worked primarily in an ICU. Participants completed the Maslach Burnout Inventory for Human Services Survey for Medical Personnel (MBI) and a qualitative focus group or interview using a phenomenologic approach. MBI subscales for emotional exhaustion, depersonalization, and lack of personal accomplishment were calculated. Emergent shared themes contributing to burnout were identified from qualitative interviews.

RESULTS

Fifty-eight providers (26 physicians, 22 nurses, six respiratory therapists, three pharmacists, and one case manager) participated. Ten participants (17.9%) described their burnout as moderate to high. However, participants scored moderate or high levels across the three MBI subscales (emotional exhaustion, 71.4%; depersonalization, 53.6%; and lack of personal achievement, 53.6%). Drivers of burnout aligned with three core themes: patient factors, team dynamics, and hospital culture. Individual drivers included medically futile cases, difficult families, contagiousness of burnout, lack of respect between team members, the increasing burden of administrative or regulatory requirements at the cost of time with patients, lack of recognition from hospital leadership, and technology. All were highly interconnected across the three larger domains. Despite differences in MBI scores, most provider types described very similar drivers of burnout.

INTERPRETATION

High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.

Are nurses prepared to respond to next infectious disease outbreak: A narrative synthesis

Aim

The review aimed to present a synthesis of nurses' preparedness for infectious disease and the components of emergency preparedness.

Design

Narrative synthesis.

Methods

A systematic search and screening for relevant studies were conducted to locate the relevant articles. The included studies were examined for scientific quality using the Mixed Methods Appraisal Tool. The findings of included studies were synthesized by a narrative synthesis approach.

Results

Totally 15 studies were included, and 4 themes associated with nurses' preparedness for pandemic were identified: knowledge and skills, psychological preparation, external resources, and attitude and intention.

Conclusions

Most nurses express a positive willingness to respond to epidemics, although they do not believe they are adequately prepared. Some measures should be taken for improving nurses' emergency preparedness, including providing ongoing training, protective equipment, safe working environment and psychological intervention, improving nurses' resilience and accelerating the sharing of scientific information about epidemics.

Post-traumatic growth trajectories among frontline healthcare workers during the COVID-19 pandemic: A three-wave follow-up study in mainland China

OBJECTIVES

The COVID-19 pandemic has taken a significant toll on people worldwide for more than 2 years. Previous studies have highlighted the negative effects of COVID-19 on the mental health of healthcare workers (HCWs) more than the positive changes, such as post-traumatic growth (PTG). Furthermore, most previous studies were cross-sectional surveys without follow-ups. This study draws on PTG follow-up during the COVID-19 outbreak at 12-month intervals for 2 years since 2020. The trajectories and baseline predictors were described.

METHODS

A convenience sampling method was used to recruit frontline nurses or doctors at the COVID-19-designated hospital who were eligible for this study. A total of 565 HCWs completed the 2 years follow-up and were used for final data analysis. The latent growth mixture models (GMM) was used to identify subgroups of participants with different PTG trajectories. Multinomial logistic regression model was used to find predictors among sociodemographic characteristics and resilience at baseline.

RESULTS

Four trajectory PTG types among HCWs were identified: 'Persistent, "Steady increase", "High with drop", and "Fluctuated rise." Comparing the "Persistent low" type, the other three categories were all associated with older age, higher education. Furthermore, "Persistent low" was also negatively associated with resilience at baseline.

CONCLUSION

The PTG of HCWs with different characteristics showed different trends over time. It is necessary to increase the measure frequency to understand the PTG status in different times. Improving HCW's resilience could help improve staff PTG.

Critical Care Nurse Burnout in Veterans Health Administration: Relation to Clinician and Patient Outcomes

BACKGROUND

Critical care nurses have a burnout rate among the highest of any nursing field. Nurse burnout may impact care quality. Few studies have considered how temporal patterns may influence outcomes.

OBJECTIVE

To test a longitudinal model of burnout clusters and associations with patient and clinician outcomes.

METHODS

An observational study analyzed data from annual employee surveys and administrative data on patient outcomes at 111 Veterans Health Administration intensive care units from 2013 through 2017. Site-level burnout rates among critical care nurses were calculated from survey responses about emotional exhaustion and depersonalization. Latent trajectory analysis was applied to identify clusters of facilities with similar burnout patterns over 5 years. Regression analysis was used to analyze patient and employee outcomes by burnout cluster and organizational context measures. Outcomes of interest included patient outcomes (30-day standardized mortality rate and observed minus expected length of stay) for 2016 and 2017 and clinician outcomes (intention to leave and employee satisfaction) from 2013 through 2017.

RESULTS

Longitudinal analysis revealed 3 burnout clusters among the 111 sites: low (n = 37), medium (n = 68), and high (n = 6) burnout. Compared with sites in the low-burnout cluster, those in the high-burnout cluster had longer patient stays, higher employee turnover intention, and lower employee satisfaction in bivariate models but not in multivariate models.

CONCLUSIONS

In this multiyear, multisite study, critical care nurse burnout was associated with key clinician and patient outcomes. Efforts to address burnout among nurses may improve patient and employee outcomes.

Posttraumatic growth and positive determinants in nursing students after COVID-19 alarm status: A descriptive cross-sectional study

PURPOSE

To determine the relationship between posttraumatic growth (PTG), psychological flexibility, and psychological resilience of nursing students after the COVID-19 alarm status.

DESIGN AND METHODS

This descriptive cross-sectional study was conducted with nursing students (N = 292) studying at a nursing school of a university. The data collection instruments included a form on descriptive variables, and the PTG, psychological flexibility, and psychological resilience scales. Descriptive statistics, independent-samples t test, ANOVA, correlation, simple, and hierarchical linear regression analyses were used to analyze the data.

FINDINGS

The mean scores regarding psychological flexibility, psychological resilience, and PTG were 27.56 ± 11.06, 18.10 ± 5.75, and 63.49 ± 20.64, respectively. While psychological flexibility explained 36.7% of the total variance in psychological resilience, the predictive effect of seven descriptive variables, including psychological flexibility and psychological resilience, on PTG was determined as 13.4%.

PRACTICE IMPLICATIONS

PTG, psychological flexibility, and psychological resilience may help nursing students prepare for their transition to the profession.

Critical care nursing during the COVID-19 pandemic: a story of resilience

In this article, an intensive care unit (ICU) nurse provides some reflections on caring for patients with COVID-19 and relates her lived experience to the concept of resilience. Similarities and differences to pre-pandemic understandings of resilience are drawn out and factors that mediate acute stress, resilience and psychological recovery during a pandemic are considered. Resources to support ICU nurses and other healthcare staff to manage stress and promote wellbeing are signposted, and important research directions that warrant attention are recommended. The story is one of learning and hope and, importantly, it captures key lessons that can equip healthcare staff with positive coping strategies in a time of unprecedented pressure.

An investigation of the effects of an anger management psychoeducation programme on psychological resilience and affect of intensive care nurses

BACKGROUND

It is known that intensive care nurses experience stressful events more frequently than nurses working in other units. Experiencing stressful events frequently may reduce the psychological resilience of intensive care nurses and cause them to express their tension and negative emotions as anger. However, nurses' failure to manage their anger may also lead to medical errors and adversely affect the quality of healthcare services.

PURPOSE

This study aims to investigate the effects of an anger management psychoeducation programme on psychological resilience and affect of intensive care nurses.

METHODS

Using a self-controlled design, this study was conducted with nurses working in a tertiary intensive care unit of a private hospital in Turkey. The participants were randomly and equally distributed to the study group (n = 16) and the control group (n = 16). The participants in the study group attended an eight-week anger management psychoeducation programme, while those in the control group did not. The Psychological Resilience Scale for Adults (RSA) and Positive and Negative Affect Scale (PANAS) were applied to both groups as pre-test and post-test. In addition, one month after the post-test, RSA and PANAS were administered again to determine the stability of the impact of the psychoeducation program on the participants.

RESULTS

No significant change over time was observed in the scores of the control group from the overall scale (all ıntra-group comparison p-values > 0.05), while a significant change over time was observed in the scores of the study group from the overall scale (all ıntra-group comparison p-values < 0.001). Although it was observed that both groups' positive affect scores changed over time (both ıntra-group comparison p-values < 0.05), the paired comparison revealed that the scores of the control group were similar. On the other hand, it was observed that the study group's positive effect scores increased significantly after the psychoeducation programme but remained similar in the follow-up period. Furthermore, only the study group's negative affect scores decreased over time, this decrease continued in the follow-up period.

CONCLUSIONS

The study concludes that the anger management psychoeducation programme affected the psychological resilience and emotional state of intensive care nurses.

Psychological Resilience and Health Among Older Adults: A Comparison of Personal Resources

OBJECTIVES

Research on life course inequality and successful aging has sought to understand how events and challenges may lead to poor outcomes in later life for some individuals, while others fare well in the face of adversity. Among internalized resources, research suggests psychological resilience is protective in the face of challenges, but little is known about the predictive efficacy of this measure compared to other resources such as mastery. This paper examines connections between psychological resilience and later life health compared to other internalized resources.

METHOD

Standardized associations between 4 resources (resilience, mastery, optimism, hopelessness) and 5 health outcomes were tested using short-term health transitions and longer term health trajectories in a structural equation modeling (SEM) framework using the Leave Behind Questionnaire (LBQ) and linked Health and Retirement Study (HRS) between 2006/2008 and 2014/2016 (n = 11,050-12,823).

RESULTS

Psychological resilience had consistent and robust associations with health transitions and trajectories. Further, the effects of this resource were generally 4-10 times greater than for mastery, optimism, and hopelessness in combined models. Trajectory analyses replicate these findings and suggest the beneficial associations of resilience over time were persistent for some health outcomes, and cumulative for others.

DISCUSSION

The results suggest that psychological resilience is powerfully associated with health in later life, with substantially greater predictive efficacy than other commonly used resource measures. Future research should establish how this intrapersonal resource works alongside structural and interpersonal resources to promote and protect health and functioning in the face of challenges and adversity.

Managing Moral Distress in the Workplace:: Creating a Resiliency Bundle

Nurse leaders within a 43-bed pediatric intensive care unit introduced a pre- and post-implementation evidence-based practice project to determine which resilience enhancing techniques were helpful among a multidisciplinary team. A statistically significant increase in post-intervention group resilience (79.9 to 83.4, p < 0.0001) was achieved within 6 months of the “resiliency bundle” implementation. Forty-seven critical care staff including registered nurses, respiratory therapists, unit secretaries, medical doctors, chaplains, child life specialists, patient care techs, and nurse practitioners self-selected resiliency bundle components and provided their feedback and resilience level pre- and post-implementation. Preferred uses of resilience enhancement techniques were analyzed by discipline, experience level, and age.

Self-care as an ethical obligation for nurses

As members of the largest and most trusted healthcare profession, nurses are role models and critical partners in the ongoing quest for the health of their patients. Findings from the American Nurses Association Health Risk Appraisal suggested that nurses give the best patient care when they are operating at the peak of their own wellness. They also revealed that 68% of the surveyed nurses place their patients' health, safety, and wellness before their own. Globally, several nursing codes of ethics include the requirement of self-care. Often, these codes embed the responsibility to protect and promote one's own health within the clearly described obligation to provide safe patient care. The American Nurses Association Code of Ethics for Nurses is unique in that it states explicitly that nurses must adopt self-care as a duty to self in addition to their duty to provide care to patients. One of the basic assumptions of Watson's Philosophy and Science of Caring is that caring science is the essence of nursing and the foundational disciplinary core of the profession. Watson's theory of human caring provides support for the engagement in self-care. Two important value assumptions of Watson's Caritas are that "we have to learn how to offer caring, love, forgiveness, compassion, and mercy to ourselves before we can offer authentic caring and love to others" and we also must "treat ourselves with loving-kindness and equanimity, gentleness, and dignity before we can accept, respect, and care for others within a professional caring-healing model." Embedded within several caritas processes is an outline for a holistic approach to caring for self and others that can guide nurses to improve their mental, physical, emotional, and spiritual health.

The need for empathetic healthcare systems

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.

Exploratory and Confirmatory Factor Analysis of the Maslach Burnout Inventory to Measure Burnout Syndrome in Critical Care Nurses

BACKGROUND AND PURPOSE

Burnout syndrome is common in critical care nursing. The Critical Care Societies Collaborative recently released a joint statement and call to action on burnout in critical care professionals.

METHODS

We conducted an exploratory factor analysis and confirmatory factor analysis (CFA) of the 22-item MBI.

RESULTS

The exploratory factor analysis identified three factors but after questions were removed; we were left with a 2-factor, 10-item abridged version of the MBI-HSS to test with CFA modeling. The CFA indicated conflicting fit indices.

CONCLUSIONS

we conducted an exploratory and CFA of the abridged MBI-HSS in critical care nurses from the United States and found the two-factor model was the best fit achieved.

Exploring the relationship between resilience and grit among nursing students: A correlational research study

BACKGROUND

Nurse turnover is a critical issue around the world. Finding factors that can increase job persistence in nursing can have a positive impact on both the quality and cost of health care. Resilience and grit have been studied as factors that help an individual persist in the pursuit of their goals. Resilience and grit are related terms that have frequently been used interchangeably, although some studies suggest that they are different constructs. Determining if they are different constructs is important as we seek to develop qualities in new nurses that increase their job persistence and satisfaction.

OBJECTIVES

The purpose of this study was to explore the relationship between resilience and grit in pre-licensure nursing students.

DESIGN/SETTING

This descriptive correlational study was conducted at a midsize private University in the United States.

PARTICIPANTS

The convenience sample consisted of students from 3 pre-licensure programs: Traditional Bachelor of Science in Nursing (TBSN), Accelerated Bachelor of Science in Nursing (ABSN) and Direct Entry Masters of Science in Nursing (DEMSN). The final sample was 348 students: 79% TBSN, 7% ABSN and 14% DEMSN.

METHODS

Resilience was measured with the Conner-Davidson Resilience 10 item scale. Grit was measured utilizing the Short Grit Scale.

RESULTS

Inspection of the interfactor correlations suggest that resilience and grit scales are distinct, though tend to correlate well. Notably, the relationship between resilience and the persistent effort component of grit was moderate. That correlation was higher than the relationship between the consistent interest component of grit and resilience.

CONCLUSION

This study concludes that grit and resilience are related concepts but are not synonymous. Being mindful of the difference in these two attributes may be important in the development of educational offerings in both Schools of Nursing and in new nurse residency programs to increase retention in nursing.

Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study

BACKGROUND

Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs).

PURPOSE

This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being.

METHODS

A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout.

RESULTS

The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout.

IMPLICATIONS FOR PRACTICE

The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.

Creating a Care for the Caregiver Program in a Ten-Hospital Health System

Critical care clinicians involved serious adverse events may experience a constellation of distressing emotions that may interfere with home and work life. Offering support after a serious adverse event may restore a clinician's ability to cope with the event, reestablish emotional balance and assist a clinician to function capably in the workplace and at home. A description of a care for the caregiver program implementation at a 10-hospital health system provides a roadmap to implement this program in other hospitals and health systems.

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

AIM

To assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors.

BACKGROUND

Literature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels.

METHODS

A cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses.

RESULTS

57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (ρ = 0.03, r² = -0.28), number of family dependents (ρ = 0.03, r² = -0.27), and years of nursing experience (ρ = 0.03, r² = -0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (ρ = 0.01, r² = -0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (ρ < 0.01), age group (ρ = 0.03), shift schedule (ρ = 0.02), and nursing experience (ρ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals.

CONCLUSIONS

More than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.

Factors Correlated to Job Stress among ICU Nurses in Surabaya Indonesia

Introduction: Job stress is a major barrier to the attainment of safety, health, andwellness among nurses. Understanding factors job stress among nurses is veryimportant to provide alternatives solution to ease the stress in the future. However,there are limited studies with respect to factors related to stress in Intensive CareUnit (ICU) nurses particularly in Indonesian context. This study aimed to identifyfactors correlated to job stress among ICU nurse in three public hospitals.Methods: A correlational study was carried on ICU nurses who hands-on ICUnursing care. Data were collected using questionnaires. Descriptive statistic andSpearman correlation were used to analyze the correlation between perceived jobburden, working condition, quality of nursing work life, perceived organizationalsupport, and stress among ICU nurses.Results: A total of 91 respondents (32 male and 59 female) were involved to thestudy comprises of two different educational backgrounds (59 Diploma III and 32Bachelor degree). The statistical analysis using Pearson correlation found thatworkload (0.003), working condition (0.000), quality of nursing work life (0.000),perceived organizational support (0.000) significantly correlated to job stressamong ICU nurses.Conclusion: All studied factors correlated to job stress among ICU nurses. Allfactors had moderate correlation with nurses’ job stress and working condition hashighest strong correlation compare to the other factors. Its implies from the resultthat management of the hospital may provide more attention to job stress amongnurses to maintain optimum performance to provide nursing care for patientsparticularly critically ill patients in ICU.