What keeps nurses happy? Implications for workforce well-being strategies

The association between workload, alcohol use, and alcohol misuse among psychiatrists in China

Aim

Survey alcohol use and workload among Chinese psychiatrists and explore their associations.

Methods

We conducted an online questionnaire among psychiatrists working in large psychiatric institutions across the country. We collected data including demographic factors, alcohol use, and workload. Alcohol use was assessed using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and workload-related questions included working hours, night shifts, and caseloads.

Results

In total, 3,549 psychiatrists completed the survey. Nearly half (47.6%) reported alcohol use, and the percentage of alcohol use in males (74.1%) was significantly higher than in females. 8.1% exceeded the AUDIT-C cutoff scores for probable alcohol misuse (19.6%in males and 2.6%in females). AUDIT-C scores were significantly correlated with working hours per week (p = 0.017) and the number of outpatient visits per week (p = 0.006). Regressional analysis showed that alcohol use was significantly associated with the following factors: longer working hours (Working more than 44 h/week, OR = 1.315), having an administrative position (OR = 1.352), being male (OR = 6.856), being single (OR = 1.601), being divorced or widowed (OR = 1.888), smoking (OR = 2.219), working in the West (OR = 1.511) or the Northeast (OR = 2.440). Regressional analysis showed that alcohol misuse was significantly associated with the following factors: fewer night shifts (Three to four night shifts/month, OR = 1.460; No more than 2 night shifts/month, OR = 1.864), being male (OR = 4.007), working in the Northeast (OR = 1.683), smoking (OR = 2.219), frequent insomnia (OR = 1.678).

Conclusion

Nearly half of the psychiatrists in China reported alcohol use and 8.1% had probable AUD. Alcohol consumption is significantly associated with several workload-related factors, such as long working hours, heavy caseload, and administrative duties. Alcohol misuse was inversely associated with the number of night shifts per month. While the direction of causality is unclear, our findings may help identify vulnerable professional groups and develop more targeted interventions to improve healthcare professionals' well-being.

The Use of Music to Manage Burnout in Nurses: A Systematic Review

OBJECTIVE

There is a high prevalence of burnout in nurses. This systematic review investigates the use of music to manage burnout in nurses.

DATA SOURCE

MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched.

STUDY INCLUSION AND EXCLUSION CRITERIA

Full-text articles were selected if the study assessed the use of music to manage burnout in nurses. Burnout was defined according to the International Classification of Diseases 11th Revision.

DATA EXTRACTION

Data were extracted using an Excel sheet. The second and third authors independently extracted study characteristics, frequency and type of music engagement, measures of burnout, and burnout outcomes (occupational stress, coping with stress, and related symptoms such as anxiety).

DATA SYNTHESIS

Study and outcome data were summarized.

RESULTS

The literature search resulted in 2210 articles and 16 articles were included (n = 1205 nurses). All seven cross-sectional studies reported upon nurses' self-facilitated use of music including music listening, playing instruments, and music entertainment for coping or preventing stress, supporting wellbeing, or enhancing work engagement. Externally-facilitated music engagement, including music listening, chanting, percussive improvisation, and song writing, was reported in the four randomized controlled trials and five cohort studies with reductions in burnout outcomes.

CONCLUSIONS

Self-facilitated and externally-facilitated music engagement can help to reduce burnout in nurses.

Resilience Improves the Quality of Life and Subjective Happiness of Physiotherapists during the COVID-19 Pandemic

Resilience is an individual characteristic that protects mental health. However, its impact on the lives of Brazilian physiotherapists during COVID-19 is not known. This study aimed to analyze whether resilience modulates the perceived quality of life (QoL) and subjective happiness (SH) of physiotherapists who work with COVID-19 patients, compared with those who do not. A cross-sectional study was conducted between 22 August and 22 October 2020. Physiotherapists working in critical and non-critical hospital sectors were invited to participate in the study. The participants completed sociodemographic questionnaires and were graded on the 14-item Resilience Scale, 36-item Short-Form Health Survey (SF-36), and the Subjective Happiness Scale. In total, 519 physiotherapists were enrolled in the study. Physiotherapists with low resilience who worked with COVID-19 patients reported lower scores on the SF-36 subscales (except for social functioning) and the Subjective Happiness Scale, compared with those with high resilience who did not work with COVID-19 patients. These responses were modulated by age, sex, absence from work, receipt of personal protective equipment, host leadership, and practice and maintenance of regular physical activity. In conclusion, physiotherapists with low resilience who worked with COVID-19 patients presented lower perceptions of QoL and SH, compared with the other study participants.

The role of Covid-19 outbreak on well-being of healthcare employees of Turkey by considering gender differences

In this paper, we explore the role of the Covid-19 outbreak on the well-being of healthcare employees (HE) in Turkey by adopting a survey method with 680 (188 men and 492 women) participants. Our results indicate that both the outbreak negatively affects the well-being of HE, and women face more levels of fear, negative feelings and violence than men. Within the context of this research, we contribute to the literature by considering the changing living conditions in the outbreak and adopting a comprehensive approach to reveal sub-level of well-being as subjective and psychological well-being rather than focusing on only mental health like previous studies.

The effects of nurses' perceived stress and life satisfaction on their emotional eating behaviors

PURPOSE

To examine the effects of the nurses' perceived stress and life satisfaction on their emotional eating behaviors.

DESIGN AND METHODS

A cross-sectional study was conducted among a random sample of 297 nurses in a research hospital.

FINDINGS

There is a negative correlation between nurses' emotional eating and life satisfaction (β = -0.192, p < 0.001), and a positive correlation between emotional eating and perceived stress (β = 0.392, p < 0.001). Perceived stress, life satisfaction, and marital status constituted 24% of the factors affecting emotional eating behaviors.

PRACTICE IMPLICATIONS

Psychiatric nurses would benefit from developing effective training programs that support nurses in making healthy lifestyle choices.

Global emotional and spiritual well-being and resilience of Advanced Practice Nurses during the COVID-19 pandemic: A cross-sectional study

Aim

To evaluate the impact of the COVID‐19 pandemic on the emotional and spiritual well‐being and resilience of a global sample of Advanced Practice Nurses.

Design

A web‐based cross‐sectional mixed methods study. Survey data were collected from Advanced Practice Nurses globally over a 2‐month period ending on 31 August 2020.

Methods

The Warwick‐Edinburgh Mental Well‐being Scale, FACIT‐12 Spiritual Well‐being Scale and Connor‐Davidson Resilience Scale 10 were used to quantify emotional and spiritual well‐being and resilience of Advanced Practice Nurses' globally. The survey was distributed internationally using snowball sampling via a secure platform (Qualtrics). Results were analysed using various bivariate tests for associations and group differences.

Results

Nine hundred and twenty‐eight Advanced Practice Nurses from 53 countries participated in the study. Study participants reported meaningfully lower scores in resilience and emotional well‐being compared with non‐pandemic scores. Participants from countries with well‐developed Advanced Practice Nurses roles reported lower resilience and well‐being scores compared with those from countries where Advanced Practice Nurses roles are still being developed. Each scale revealed significant positive associations with the other scales.

Conclusions

Emotional and spiritual well‐being and resilience of Advance Practice Nurses has been significantly impacted during the COVID‐19 pandemic. Regardless of their work location, work hours, credential or demographics, the APNs in our study reported lower levels of resilience and mental well‐being compared with typical scores on the instruments.

Health-related behaviors, self-rated health, and predictors of stress and well-being in nursing students

BACKGROUND

Nursing students are at increased risk for the consequences of stress on wellbeing. Little is known about nursing students' health promoting behaviors and how these relate to health, stress, and well-being.

PURPOSE

The purpose was to describe perceived stress and measures of well-being (self-compassion, happiness, and life satisfaction) along with self-reported health promoting behaviors and health status in order to identify factors that could affect stress and well-being in nursing students.

METHODS

A multi-site team employed cross-sectional research methods to explore well-being, stress, and potential physical and emotional health-relevant factors in undergraduate nursing students. Baccalaureate Nursing students from three nursing programs in North Texas participated in a web-based survey. Undergraduate students (n = 417) reported being junior or senior level in a traditional (74.1%) or an alternative nursing training program (on-line, fast-track, or weekend nursing program; 24.9%) in the fall of 2019. Recruitment fliers went to a total of 2264 potential participants via university e-mail. Consenting students completed online surveys collecting demographic and health related factors as well as measures of well-being and stress.

RESULTS

More than half (56.6%) of students reported worsening health since starting nursing school. Exercise and meditation were related to higher measures of well-being and lower stress, but this relationship diminished in the multivariate model when considering individual demographic and health related factors. Our multivariate model suggests that self-rated health status remains a main potential predictor of reduced stress and improved well-being.

CONCLUSIONS

Self-reported health factors are related to wellbeing in nursing students. Targeted interventions to improve well-being among nursing students may be necessary and would fit with national recommendations for nursing education programs. Resiliency skills training with mindfulness practices may help nursing students reduce stress, improve overall well-being, and equip students to avoid burnout and stress-related illness once in the workforce.

Discriminating Metabolic Health Status in a Cohort of Nursing Students: Protocol for a Cross-Sectional Study

BACKGROUND

Obesity is currently a worldwide health crisis. Nurses are integral members of the primary health care team and have an important role in managing obesity and administering physical activity (PA) for patients. However, research shows that nurses tend to be overweight or obese, have poor metabolic health, and do not meet PA recommendations. This is problematic because PA is linked to both physiological and psychological well-being and may also influence how nurses counsel their patients. Nursing students are the next generation of nurses; however, there is limited research examining PA (among other lifestyle factors) and metabolic health in nursing students.

OBJECTIVE

The goal of this research is to examine multiple lifestyle factors (including PA, nutrition, sleep, and stress) and determine whether these factors are associated with metabolic health in full-time undergraduate nursing students.

METHODS

An estimated 320 nursing students (18 years of age and older) will be assessed for their metabolic health. Metabolic status will be determined by measuring body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage [skinfold measures (FitSystems Inc)], resting blood pressure [automated oscillatory (Omron Healthcare Inc)], and fasting blood glucose (glucometer). Lifestyle factors will also be measured, including PA and sleep [the International Physical Activity Questionnaire (IPAQ) and 7-day accelerometry (wGT3X-BT, Actigraph LLC)], nutrition [3-day diet log (Nutritionist Pro, Axxya Systems)], and stress [the Depression Anxiety Stress Scale, heart rate variability assessments, and salivary cortisol (ELISA, Eagle Biosciences)]. The association between metabolic status and PA, sleep quantity and quality, nutrition, and stress will be examined by linear regression analyses. Differences by year of study in metabolic health status, PA, sleep, nutrition, and stress will be examined by 1-way analyses of variance (ANOVAs). To determine the ability of PA, sleep, nutrition, and stress to discriminate prevalent overweight and obesity or poor metabolic status, logistic regression and receiver operating characteristic (ROC) curves will be constructed. Statistical analyses will be performed in Stata (version 16.1, StataCorp LLC).

RESULTS

Based on pilot data, we believe senior nursing students will have worse metabolic health (ie, higher BMI and WHR, increased body fat percentage, higher blood pressure, and increased fasting blood glucose) compared to first-year students. We hypothesize that poor PA participation, poor sleep quantity and quality, increased food intake, poor nutrition, and increased stress will be associated with worse metabolic health in full-time nursing students. The study received funding in February 2020. Due to the coronavirus disease 2019 (COVID-19) pandemic, work on this study has been delayed. We are currently completing our application for institutional research ethics approval. Data collection is projected to begin in January 2021, with data collection and analyses expected to be completed by May 2022.

CONCLUSIONS

This study will be the first published research to examine the relationship between lifestyle choices and metabolic status in nursing students attending a Canadian institution. More importantly, the results of this study will support the development of an informed intervention that will target the identified lifestyle factors, improving the physiological and mental health and well-being of nursing students.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/21342.

Correlation Between Subjective Happiness and Pleasant Activities at Workplace in Nursing Staff for Older Individuals in Japan

The purpose of this study was to investigate the correlations between nursing staff's mental health, number of years worked, night shifts performed, and pleasant activities at the workplace. One hundred forty-three subjects who had no missing data were analyzed. Questions consisted of basic attributes, subjective happiness scale (SHS), and pleasant activities conducted at the workplace. Denouements of SHS indicated a significant trend for the main effect, with more pleasant activities in the high SHS group than the low SHS group. The interaction was significant, with fewer pleasant activities in participants in the low SHS group who worked the night shift compared with those who worked the night shift regardless of work experience. The outcomes of this study suggest that it is essential to expand the repertoire of pleasant activities at the workplace to increase the subjective happiness of nursing staff for older individuals.

Moderating Role of Self-Esteem Between Perceived Organizational Support and Subjective Well-Being in Chinese Nurses: A Cross-Sectional Study

Purpose

Nurses are undertaking tremendous physical and psychological pressure, which may reduce their subjective well-being (SWB). This study is aimed to identify the relationship among perceived organizational support (POS), self-esteem, and SWB, and to further explore whether self-esteem could be a moderator in the association between POS and SWB in Chinese nurses.

Materials and Methods

This study was conducted in Liaoning Province in China, in 2018. 606 valid questionnaires were collected. Demographic factors, job conditions, the Index of Well-Being, Survey of Perceived Organizational Support (SPOS), and Rosenberg's Self Esteem Scale (RSES) were included in each questionnaire. The association among POS, self-esteem, and POS × self-esteem interaction with SWB were examined by hierarchical multiple regression analysis. The interaction was visualized by using simple slope analysis.

Results

Average score of SWB in Chinese nurses was 8.27 ± 2.64. Being married was positively related to SWB, while having longer work time per week, having night shift and dissatisfied with nurse-patient relationship were correlated with lower SWB. POS and self-esteem were important factors for SWB. Self-esteem could moderate the relationship between POS and SWB. When self-esteem was higher, POS had a greater effect on SWB.

Conclusion

Subjective well-being of nurses in the study was at a low level. Self-esteem could moderate the association between POS and SWB. More interventions related to POS and self-esteem will be helpful to improve SWB among nurses.

The Trojan War inside nursing: an exploration of compassion, emotional labour, coping and reflection

Compassionate care is fundamental to nursing. However, when delivering compassionate care, the expected emotional state may not always spontaneously arise, risking a dissonance between authentic and displayed emotions. Nurses may therefore be required to engage in some form of emotional regulation strategy, to conform with assumed professional rules on emotional display. In both the dissonance and emotional regulation, there are risks on which nurses need to reflect. In this article, the end of the Trojan War as depicted in Homer's The Iliad and Virgil's The Aeneid is used as an allegory to illustrate the dangers and advantages of using response- or antecedent-focused strategies for emotional regulation. Response-focused strategies are reactive in nature-they could build resilience over time but may leave students and newly qualified nurses feeling exposed. An 'emotional curriculum' to include emotional intelligence in nurse education could equip the students with a more proactive approach to developing resilience rather than defensive practice. Using a narrative as an allegory may help to explore the application of these concepts in nursing practice.