The latest medical research on Medical Administration
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Request AccessAssociations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units: a multicentre survey.
J Nurse ManagementTo explore whether perceived overqualification increases the risk of burnout, and whether transformational leadership negatively moderates this relationship.
Perceived overqualification might contribute to burnout and lead to poor experience of transformational leadership, and transformational leadership might be associated with burnout. However, these relationships have not yet been confirmed.
A multicentre cross-sectional study. A total of 321 nurses from intensive care units were recruited from six tertiary hospitals. Scale of Perceived OverQualification, Transformational Leadership Questionnaire and emotional exhaustion subscale of the Maslach Burnout Inventory-General Survey were employed to collect the data. Hierarchical multiple regression and bootstrap resampling were applied to analyse the data.
Burnout was positively associated with perceived overqualification and negatively associated with transformational leadership (each p < 0.05). Transformational leadership significantly mediated the relationship between perceived overqualification and burnout (b = -0.6389, 95% confidence interval: -0.8706, -0.4072).
Our findings indicated that perceived overqualification and transformational leadership directly or indirectly affect burnout among nurses from intensive care units. Implications for nursing managers Personal and organizational-oriented interventions utilizing nurses' overall qualifications and implementing transformational leadership should be employed by nurse managers to alleviate burnout and promote the work performance of nurses from intensive care units.
BURNOUT, RESILIENCE AND PSYCHOLOGICAL FLEXIBILITY IN FRONTLINE NURSES DURING THE ACUTE PHASE OF THE COVID-19 PANDEMIC (2020) IN MADRID-SPAIN.
J Nurse ManagementIn April 2020, Spain was the country with the highest number of patients infected by COVID-19 in Europe. The pressure on healthcare providers has had a direct impact on nurses and their mental health.
To demonstrate the causal relationship between resilience, acceptance, experiential avoidance, psychological inflexibility and burnout syndrome, all of which are measured with validated questionnaires.
This was designed as a transversal correlational study with nurses who worked during the acute phase of the pandemic in public hospitals in the Community of Madrid with patients diagnosed with COVID-19 in COVID-19 medical hospitalisation units, emergency services and intensive care units. Google Forms was used to obtain an informed consent sheet, sociodemographic variables, and the following questionnaires: 10 CD-Risk, Connor-Davidson Risk Resilience Scale, Acceptance and Action Questionnaire-II and the Maslach Burnout Inventory.
The final sample included 375 nurses with a high number of consecutive days of direct exposure to an infected patient and a very high number of consecutive days without rest; almost 18% suffered from COVID-19. The nurses presented medium levels of resilience, medium levels of experiential avoidance and medium levels as measured for emotional exhaustion, personal accomplishment and depersonalization. We also found a predictive correlation between all the dimensions of the burnout questionnaire in relation to the data obtained from the resilience questionnaire.
The scores show the necessity to implement preventive measures to avoid fatal psychological consequences for nurses.
Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review.
BMJ OpenTo assess predictive performance of universal early warning scores (EWS) in disease subgroups and clinical settings.
Randomised trials and observational studies of internal or external validation of EWS to predict deterioration (mortality, intensive care unit (ICU) transfer and cardiac arrest) in disease subgroups or clinical settings.
We identified 770 studies, of which 103 were included. Study designs and methods were inconsistent, with significant risk of bias (high: n=16 and unclear: n=64 and low risk: n=28). There were only two randomised trials. There was a high degree of heterogeneity in all subgroups and in national early warning score (I2=72%-99%). Predictive accuracy (mean area under the curve; 95% CI) was highest in medical (0.74; 0.74 to 0.75) and surgical (0.77; 0.75 to 0.80) settings and respiratory diseases (0.77; 0.75 to 0.80). Few studies evaluated EWS in specific diseases, for example, cardiology (n=1) and respiratory (n=7). Mortality and ICU transfer were most frequently studied outcomes, and cardiac arrest was least examined (n=8). Integration with electronic health records was uncommon (n=9).
Methodology and quality of validation studies of EWS are insufficient to recommend their use in all diseases and all clinical settings despite good performance of EWS in some subgroups. There is urgent need for consistency in methods and study design, following consensus guidelines for predictive risk scores. Further research should consider specific diseases and settings, using electronic health record data, prior to large-scale implementation.
PROSPERO CRD42019143141.
Compassion satisfaction and compassion fatigue in frontline nurses during the COVID-19 pandemic in Wuhan, China.
J Nurse ManagementTo investigate the compassion satisfaction and compassion fatigue among Chinese frontline nurses during the COVID-19 pandemic in Wuhan, China and to explore the related factors.
Frontline nurses undertake a huge nursing workload with a risk of infection, causing great pressure on them and making them face a risk of compassion fatigue during the pandemic.
A cross-sectional online survey was conducted from March 9 to March 15, 2020. A total of 1582 nurses caring for critical patients with COVID-19 participated. Compassion satisfaction and compassion fatigue (comprising burnout and secondary traumatic stress) were assessed with the Professional Quality of Life Scale, and resilience was measured with the Chinese 10-item Connor-Davidson Resilience Scale.
Moderate levels of compassion satisfaction (36.99±6.71), burnout (24.14±5.33) and secondary traumatic stress (24.53±5.24) were experienced by frontline nurses. Resilience and perceived work pressure were the main predictors.
The compassion fatigue of frontline nurses should be considered. Strategies aiming to reduce stress and enhance resilience, such as training about psychological adjustment, developing professional skills, and creating a supportive workplace environment, are several options.
Changes in distress and turnover intentions among hospital-based nurses working during the first eight months of the COVID-19 pandemic in Denmark. A prospective questionnaire study.
J Nurse ManagementTo describe changes in distress among Danish hospital-based nurses during the early month of the COVID-19 pandemic and to examine predictors of distress and turnover intentions.
Outbreak of infectious diseases such as the COVID-19 pandemic can increase the likelihood that health professionals suffer from poor mental health even after the outbreak.
A prospective study among 426 Danish hospital-based nurses during the early month of the pandemic. Participants completed self-administered questionnaires regarding mental health and COVID-19 worries, as well as turnover intentions.
Nurses with brief work experience reported higher increase in distress. Feeling unsafe at work, having low trust in in management, and being anxious for relatives were associated with increased distress. Finally, feeling unsafe at work, being anxious for relatives, and having low trust in management were predictors of intention to change job.
Knowledge of risk factors for psychological distress as well as predictors of turnover intention is necessary and may provide nurses and healthcare systems with the ability to respond better against future pandemics, and to retain nurses in the organization and in the profession.
Factors Facilitating or Inhibiting the Capacity for Effective Leadership Among Front-Line Nurse Managers: A Scoping Review.
J Nurse ManagementThe purpose of this scoping review is to map and synthesize research studies addressing the factors that impact leadership behaviors of Front-Line Nurse Managers.
Leadership is a fundamental component of the role of Front-Line Nurse Managers. Ineffective leadership is associated with costly outcomes; thus, organizations seek effective strategies to facilitate consistent demonstration of leadership behaviors.
Available evidence captures the influence of personal characteristics, education, competency, and formal social support on leadership capacity. The role of informal social support was not captured.
Multiple personal and environmental factors influence the capacity for leadership behaviors among Front-Line Nurse Managers. Strategies such as leadership development programs, mentorship and peer support programs, and work environments that support relational and structural support may increase leadership capacity for Front-Line Nurse Managers IMPLICATIONS FOR NURSING MANAGEMENT: Senior nurse leaders can use the results of this review to guide implementation of evidence-based strategies to recruit and retain Front-Line Nurse Managers.
The Experience of Moral Distress by Chief Nurse Officers during the COVID-19 Pandemic: A Descriptive Phenomenological Study.
J Nurse ManagementTo explore the moral distress experiences of chief nurse officers during the COVID-19 pandemic.
Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders.
A descriptive phenomenological study with content analysis.
Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress, and factors that reduce moral distress CONCLUSION: Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic.
Extraordinary situations such as pandemics have factors which led to moral distress for a Chief Nursing Officer (CNO). Healthcare systems in which nurse managers are excluded from decision-making processes, have a traditional hierarchical structure that ignores CNOs professional autonomy, contribute to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress, and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills, the use of scientific knowledge, and take responsibility in their managerial role.
Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation: a nationwide cohort study.
BMJ OpenMental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving rhythm control therapies for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with a lower use of antiarrhythmic therapies (AATs).
We identified 239 222 patients (mean age 72.6±13.2 years; 49.8% women) with incident AF, in whom the prevalence of any MHC was 19.9%.
Lower overall use of any AAT emerged in patients with any MHC than in those without MHC (16.9% vs 22.9%, p<0.001). Any MHC, depression, bipolar disorder, anxiety disorder and schizophrenia were all associated with lower incidence of any AAT with adjusted subdistribution HRs of 0.790 (95% CI 0.771 to 0.809), 0.817 (0.796 to 0.838), 0.811 (0.789 to 0.835), 0.807 (0.785 to 0.830) and 0.795 (0.773 to 0.818), respectively. Adjusted rates of AAD, cardioversion and catheter ablation use were lower in all MHC groups compared with patients without MHC. The findings in patients with any MHC were confirmed in propensity score matching analysis.
Among patients with AF, a clear disparity exists in AAT use between those with and without MHCs.
ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.
Is self-rated health associated with cardiovascular risk factors and disease in a low-income setting? A cross-sectional study from the Amazon Basin of Brazil.
BMJ OpenPrior studies have suggested that self-rated health may be a useful indicator of cardiovascular disease. Consequently, we aimed to assess the relationship between self-rated health, cardiovascular risk factors and subclinical cardiac disease in the Amazon Basin.
Cardiovascular risk factors and subclincial cardiac disease by echocardiography.
In participants from the Amazon Basin of Brazil we obtained self-rated health according to a Visual Analogue Scale, ranging from 0 (poor) to 100 (excellent). We performed questionnaires, physical examination and echocardiography. Logistic and linear regression models were applied to assess self-rated health, cardiac risk factors and cardiac disease by echocardiography. Multivariable models were mutually adjusted for other cardiovascular risk factors, clinical and socioeconomic data, and known cardiac disease.
A total of 574 participants (mean age 41 years, 61% female) provided information on self-rated health (mean 75±21 (IQR 60-90) points). Self-rated health (per 10-point increase) was negatively associated with hypertension (OR 0.87 (95% CI 0.78 to 0.97), p=0.01), hypercholesterolaemia (OR 0.89 (95%CI 0.80 to 0.99), p=0.04) and positively with healthy diet (OR 1.13 (95%CI 1.04 to 1.24), p=0.004). Sex modified these associations (p-interaction <0.05) such that higher self-rated health was associated with healthy diet and physical activity in men, and lower odds of hypertension and hypercholesterolaemia in women. No relationship was found with left ventricular ejection fraction <45% (OR 0.97 (95% CI 0.77 to 1.23), p=0.8), left ventricular hypertrophy (OR 0.97 (95% CI 0.76 to 1.24), p=0.81) or diastolic dysfunction (OR 1.09 (95% CI 0.85 to 1.40), p=0.51).
Self-rated health was positively associated with health parameters in the Amazon Basin, but not with subclinical cardiac disease by echocardiography. Our findings are of hypothesis generating nature and future studies should aim to determine whether assessment of self-rated health may be useful for screening related to policy-making or lifestyle interventions.
Clinicaltrials.gov: NCT04445103; Post-results.
Mortality of Puerto Ricans in the USA post Hurricane Maria: an interrupted time series analysis.
BMJ OpenTo determine death occurrences of Puerto Ricans on the mainland USA following the arrival of Hurricane Maria in Puerto Rico in September 2017.
Hurricane Maria.
We found an increase in mortality for persons of Puerto Rican origin during the 6-month period following the hurricane (October 2017 through March 2018), suggesting that deaths among these persons were 3.7% (95% CI 0.025 to 0.049) higher than would have otherwise been expected. In absolute terms, we estimated 514 excess deaths (95% CI 346 to 681) of persons of Puerto Rican origin that occurred on the mainland USA, concentrated in those aged 65 years or older.
Our findings suggest an undercounting of previous deaths as a result of the hurricane due to the systematic effects on the displaced and resident populations in the mainland USA. Displaced populations are frequently overlooked in disaster relief and subsequent research. Ignoring these populations provides an incomplete understanding of the damages and loss of life.
Describing, predicting and explaining adherence to total skin self-examination (TSSE) in people with melanoma: a 12-month longitudinal study.
BMJ OpenTo describe trajectories in melanoma survivors' adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline.
The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from time-stamped TSSE data recorded by the ASICA intervention app.
Latent growth mixture models identified three TSSE adherence trajectories (adherent -41%; drop-off -35%; non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0.21, 95% CI 0.06 to 0.81, p=0.023) and were more depressed (OR=1.31, 95% CI 1.06 to 1.61, p=0.011) than people who were adherent. People whose adherence dropped off over time had less well-developed action plans (OR=0.78, 95% CI 0.63 to 0.96, p=0.016) and lower self-efficacy about TSSE (OR=0.92, 95% CI 0.86 to 0.99, p=0.028) than people who were adherent.
Adherence to monthly TSSE in people treated for melanoma can be differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention.
ClinicalTrials.gov Registry (NCT03328247).
Associations between social fragmentation, socioeconomic deprivation and suicide risk across 1887 municipalities in Japan, 2009-2017: a spatial analysis using the Bayesian hierarchical model.
BMJ OpenPrevious studies have indicated that spatial variation in suicide mortality is associated with area-specific socioeconomic characteristics, such as socioeconomic deprivation and social fragmentation. However, most of these studies have been conducted in the West and findings from Asian countries are limited. This study aims to investigate associations between socioeconomic characteristics and suicide mortality rates across 1887 municipalities in Japan between 2009 and 2017. We also assessed these associations by gender and age group.
Suicide data were obtained from the suicide statistics of the Ministry of Health, Labour and Welfare in Japan and included information on the number of suicides by gender, age and municipality location. Social fragmentation, socioeconomic deprivation and urbanicity were used as socioeconomic characteristics in this study and were created from survey data obtained from the 2010 census. Bayesian hierarchical models were used to examine associations between socioeconomic characteristics and suicide risk.
Suicide rates were significantly higher in municipalities with higher levels of deprivation, with a rate ratio of 1.13 (95% credible interval: 1.10 to 1.17) in the highest quartile compared with the lowest. Higher levels of urbanicity had significantly lower suicide rates, with a rate ratio of 0.79 (95% credible interval: 0.77 to 0.82) in the highest quartile compared with the lowest. However, associations between exposures and suicide varied considerably by gender and age. Among both men and women aged 0-39 years, fragmentation was significantly associated with suicide, with rate ratios of 1.07 and 1.15 for men and women, respectively, in the highest quartile compared with the lowest.
Suicide prevention in Japan should particularly focus on areas with high levels of deprivation or low levels of urbanicity. Furthermore, young Japanese people residing in the most fragmented municipalities were also at high risk of suicide, and appropriate measures need to be taken.
