Western Journal of Nursing Research最新文献

Background: Working for extended hours in a physically and mentally demanding profession has subjected nurses to occupational fatigue. Limited evidence exists about nurse fatigue and alertness changes throughout shift work and their relationship with medication errors and near misses.

Purpose: The purposes of this study were to: (1) assess the relationship between nurses' fatigue and alertness, (2) evaluate nurses' fatigue and alertness changes throughout their shift, and (3) examine the relationship between nurses' fatigue, alertness, and medication errors and near misses.

Methods: This prospective study is part of a larger mixed-method study. Fatigue and alertness data from 14 work and non-workdays were collected from a convenience sample of 90 nurses. A wearable actigraph (Readiband^TM) was used to measure alertness, while ecological momentary assessment (EMA) using text messaging was used to measure nurses' fatigue.

Results: A 1-unit increase in fatigue was associated with a 1.06-unit reduction in nurses' alertness score (β = -1.06, 95% CI: [-1.33, -0.78], p < .01). Night-shift nurses experienced a 31-point reduction in alertness from the start to the end of the work shift. Nurses' fatigue, but not alertness, was associated with medication errors and near misses (OR = 1.26, 95% CI [1.07, 1.48], p = .01).

Conclusion: Initiating fatigue mitigation measures during mid-shift, especially for night-shift nurses, may be a viable option to mitigate fatigue and alertness deterioration among nurses and to maintain patient safety. The multifaceted nature of fatigue, as captured by EMA, is a stronger predictor of medication errors and near misses than device-measured alertness.

Background: Paid caregivers are needed to support older adults, but caregiver burden contributes to high turnover rates. Assistive technologies help perform activities of daily living (ADLs) and can reduce caregiver burden, but little is known about how they impact paid caregivers.

Objective: This scoping review provides an overview of evidence on using assistive technology to reduce burdens on paid caregivers working with older adults.

Design: The review was conducted from May to August 2022. The eligibility criteria included: (1) publication within 5 years in peer-reviewed journals, (2) investigation of assistive technology, (3) main participants include paid caregivers supporting older adults, and (4) describing impacts on caregiver burden. Searches were conducted in 6 databases, generating 702 articles. The charted data included (1) country of study, (2) participant care roles, (3) study design, (4) main outcomes, and (5) types of assistive technology. Numerical description and qualitative content analysis of themes were used.

Results: Fifteen articles reporting on studies in 9 countries were retained for analysis. Studies used a variety of quantitative (8/15), qualitative (5/15), and mixed (2/15) methods. Technologies studied included grab bars and handrails, bidet seats, bed transfer devices, sensor and monitoring systems, social communication systems, and companion robots. Articles identified benefits for reducing stress and workload, while paid caregivers described both positive and negative impacts.

Conclusions: Literature describing the impact of assistive technology on paid caregivers who work with older adults is limited and uses varied methodologies. Additional research is needed to enable rigorous evaluation of specific technologies and impacts on worker turnover.

Background: Physical violence against nurses is a concern in the United States; however, its prevalence is not well quantified.

Objective: We sought to describe the prevalence of workplace violence against nurses in the United States over a 22-year period.

Methods: A meta-analysis was performed following a literature search of English texts through Scopus, CINAHL Plus, and Ovid MEDLINE. Inclusion criteria included the following: (1) primary reports of workplace violence incidents in the United States against nurses, (2) perpetrator was a patient, family member, or visitor, and (3) publications between January 1, 2000, and June 21, 2022. Reports where prevalence rates for nurses could not be calculated were excluded. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

Results: Thirty-seven studies met the inclusion criteria; 27 030 nurses were included. The pooled prevalence of workplace violence was 0.35 (95% confidence interval [CI]: 0.29-0.42; Q = 3189.40; I² = 98.87). Pooled rates of workplace violence increased from 30% in 2000 to 2004 to 43% in 2020 to 2022; however, the overlapping CIs indicate that the increase may not be statistically significant. The mean prevalence of reported workplace violence among nurses who work in the emergency department, in corrections, and psychiatric mental health settings (pooled prevalence = 0.59, 95% CI: 0.46-0.71) was higher than that of nurses who worked in all other settings (pooled prevalence = 0.24, 95% CI: 0.18-0.30).

Conclusions: Workplace violence is a significant and potentially increasing problem for nurses in the United States. This critical problem requires an effective response from nurse policymakers.

Background: Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic.

Objective: The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic.

Methods: A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession.

Results: Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position.

Conclusions: Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.

Background: The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery.

Purpose: The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave.

Methods: This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice.

Results: The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave.

Conclusions: While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system.

Background: Understanding the relationship between mental health and COVID-19 prevention practices is crucial but challenging considering COVID-19's impact on mental well-being. Liberia, a West African country, had well-documented rates of depression and anxiety prior to COVID-19. Liberia responded aggressively to COVID-19 while case counts remained low; thus, it is an ideal setting to study the relationship of mental health and COVID-19 prevention practices.

Methods: A validated cross-sectional survey was administered to 250 randomly selected residents of Montserrado county, Liberia in June 2021, asking about their mental health and adherence to COVID-19 prevention practices. The survey included the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 to assess for anxiety and depression, respectively. Responses were analyzed using Spearman correlation and regression.

Results: Scores indicative of depression were present in 43% (95% confidence interval [CI]: 37-49) of participants; scores indicative of anxiety were present in 41% (95% CI: 34-47). Self-reported adherence to COVID-19 prevention practices was middling and varied greatly by behavior. Higher scores for depression and anxiety were significantly associated with lower adherence to COVID-19 prevention practices.

Conclusions: Results indicate that while the spread of COVID-19 has certainly affected mental health, it is likely that pre-existing mental health conditions affected the spread of COVID-19 through lower adherence to prevention practices. Policymakers should consider investing in mental health services as an important step in managing future epidemics, and the needs of people with poor mental health when designing epidemic responses, particularly in low-income countries where the burdens of adherence are likely to be greater.

Background: There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions.

Objective: The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients.

Methods: A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson's correlations, and logistic regression were used to describe relationships.

Results: Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment.

Conclusion: Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.

Background: Adults with diabetes and impaired memory and executive functions are more likely to experience difficulties in diabetes self-management and achieving glycemic targets. The purpose of this systematic review was to evaluate the evidence of the effects of cognitive-focused interventions on cognitive ability, diabetes self-management, and management of glycemic levels for middle-aged adults and older adults with diabetes.

Methods: A systematic review of randomized controlled/clinical trials published in English between 2012 and 2022 was conducted. A search was performed using 5 databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) in addition to hand-searching. The search terms included diabetes, adults, cognitive-focused intervention, cognition, self-management, and hemoglobin A_1C (HbA_1C).

Results: Eleven studies met the inclusion criteria. Cognitive ability and diabetes self-management were assessed using different measurements, and glycemic levels were measured with HbA_1C. Nine studies applied cognitive training, one provided working memory training, and one used occupational therapy. Eight studies combined cognitive training with a co-intervention, including self-efficacy, lifestyle management, physical training, chronic disease self-management program, square-stepping exercise, psychoeducational intervention, and empowerment. Eight studies showed statistically significant improvements in at least one cognitive domain.

Conclusions: Cognitive-focused interventions have a positive effect on improving memory and executive function. However, the evidence of cognitive-focused interventions on diabetes self-management and glycemic levels has not been established. Future studies to improve cognition using effective strategies to improve cognitive function enhancing diabetes self-management behaviors and managing glycemic levels are warranted.

Background: Over 22% of patients with heart failure (HF) are transported by emergency medical services (EMSs) for a primary complaint of pain. The relationship between a primary complaint of pain on hospitalization status, mortality, or length of stay following transport by EMS is understudied.

Objectives: The objective of this study was to determine whether a primary complaint of pain during EMS transport predicted hospitalization status, mortality, or inpatient length of stay.

Methods: In this retrospective longitudinal cohort study, data were analyzed from electronic health records of 3539 patients with HF. Descriptive statistics and multivariate logistic and linear regression analyses were used to achieve study objectives.

Results: Demographics were mean age 64.83 years (standard deviation [SD] = 14.58); gender 57.3% women, 42.7% men; self-reported race 56.2% black, 43.2% white, and 0.7% other. Of 3539 patients, 2346 (66.3%) were hospitalized, 149 (4.2%) died, and the mean length of stay was 6.02 (SD = 7.55) days. A primary complaint of pain did not predict increased odds of in-hospital mortality but did predict 39% lower odds of hospitalization (p < .001), and 26.7% shorter length of stay (p < .001). Chest pain predicted 49% lower odds of hospitalization (p < .001) and 34.1% (p < .001) shorter length of stay, whereas generalized pain predicted 45% lower odds of hospitalization (p = .044) following post-hoc analysis.

Conclusions: A primary complaint of chest pain predicted lower odds of hospitalization and shorter length of stay, possibly due to established treatment regimens. Additional research is needed to examine chronic pain rather than a primary complaint of pain.