The State of Rest Break Practices Among 12-Hour Shift Hospital Nurses in the United States.

OBJECTIVE: This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses. BACKGROUND: Nurses often miss, skip, or take interrupted breaks. To improve the quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them. METHODS: Survey data from 806 nurses were collected between October and November 2021. RESULTS: Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks. CONCLUSION: Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.

Effect of surgical mask on fMRI signals during task and rest.

Wearing a face mask has become essential to contain the spread of COVID-19 and has become mandatory when collecting fMRI data at most research institutions. Here, we investigate the effects of wearing a surgical mask on fMRI data in n = 37 healthy participants. Activations during finger tapping, emotional face matching, working memory tasks, and rest were examined. Preliminary fMRI analyses show that despite the different mask states, resting-state signals and task activations were relatively similar. Resting-state functional connectivity showed negligible attenuation patterns in mask-on compared with mask-off. Task-based ROI analysis also demonstrated no significant difference between the two mask states under each contrast investigated. Notwithstanding the overall insignificant effects, these results indicate that wearing a face mask during fMRI has little to no significant effect on resting-state and task activations.

Influence of Hospital Outdoor Rest Space on the Eye Movement Measures and Self-Rating Restoration of Staff.

Objective: To investigate the effect of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff. Background: Relieving the pressure of hospital staff through exposure to hospital outdoor rest space is essential, but there is a scarcity of research on the impact of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff, especially for large Chinese hospitals. Methods: Cross-analysis was conducted based on the eye movement measures of 76 staff members obtained by eye movement tracking equipment in combination with the self-rating restoration scale and hospital outdoor rest space picture attributes (element proportion and position, brightness and saturation). Results: The differences in eye movement measures of different staff attributes (occupation, age, and gender) were identified, and the effects of hospital outdoor rest space picture attributes on the eye movement measures and self-rating restoration scale of staff were summarized. A number of proposals were also formulated: hospital outdoor rest space should be set up close to the working area of the group of medical staff; attention should be paid to the actual needs of senior staff members and the work pressure of junior nurses; the exposure to natural environment should be increased and the proportion of hard artificial elements should be reduced; the natural environment should be placed in the visual center; the saturation and brightness of hospital outdoor rest space should be increased; and staff members should have access to the sky environment in a variety of ways. Conclusion: The present study is an empirical study of evidence-based design on hospital outdoor rest space in China, and the results reveal the effects of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff.

Efficacy of cardiopulmonary resuscitation performance while wearing a powered air-purifying respirator.

BACKGROUND: The use of personal protective equipment for respiratory infection control during cardiopulmonary resuscitation (CPR) is a physical burden to healthcare providers. The duration for which CPR quality according to recommended guidelines can be maintained under these circumstances is important. We investigated whether a 2-min shift was appropriate for chest compression and determined the duration for which chest compression was maintained in accordance with the recommended guidelines while wearing personal protective equipment. METHODS: This prospective crossover simulation study was performed at a single center from September 2020 to October 2020. Five indicators of CPR quality were measured during the first and second sessions of the study period. All participants wore a Level D powered air-purifying respirator (PAPR), and the experiment was conducted using a Resusci Anne manikin, which can measure the quality of chest compressions. Each participant conducted two sessions. In Session 1, the sequence of 2 min of chest compressions, followed by a 2-min rest, was repeated twice; in Session 2, the sequence of 1-min chest compressions followed by a 1-min rest was repeated four times. RESULTS: All 34 participants completed the study. The sufficiently deep compression rate was 65.9 ± 31.1% in the 1-min shift group and 61.5 ± 30.5% in the 2-min shift group. The mean compression depth was 52.8 ± 4.3 mm in the 1-min shift group and 51.0 ± 6.1 mm in the 2-min shift group. These two parameters were significantly different between the two groups. There was no significant difference in the other values related to CPR quality. CONCLUSIONS: Our findings indicated that 1 min of chest compressions with a 1-min rest maintained a better quality of CPR while wearing a PAPR.

The effects of wearing facemasks on oxygenation and ventilation at rest and during physical activity.

BACKGROUND: Facemasks are recommended to reduce the spread of SARS-CoV-2, but concern about inadequate gas exchange is an often cited reason for non-compliance. RESEARCH QUESTION: Among adult volunteers, do either cloth masks or surgical masks impair oxygenation or ventilation either at rest or during physical activity? STUDY DESIGN AND METHODS: With IRB approval and informed consent, we measured heart rate (HR), transcutaneous carbon dioxide (CO2) tension and oxygen levels (SpO2) at the conclusion of six 10-minute phases: sitting quietly and walking briskly without a mask, sitting quietly and walking briskly while wearing a cloth mask, and sitting quietly and walking briskly while wearing a surgical mask. Brisk walking required at least a 10bpm increase in heart rate. Occurrences of hypoxemia (decrease in SpO2 of ≥3% from baseline to a value of ≤94%) and hypercarbia (increase in CO2 tension of ≥5 mmHg from baseline to a value of ≥46 mmHg) in individual subjects were collected. Wilcoxon signed-rank was used for pairwise comparisons among values for the whole cohort (e.g. walking without a mask versus walking with a cloth mask). RESULTS: Among 50 adult volunteers (median age 33 years; 32% with a co-morbidity), there were no episodes of hypoxemia or hypercarbia (0%; 95% confidence interval 0-1.9%). In paired comparisons, there were no statistically significant differences in either CO2 or SpO2 between baseline measurements without a mask and those while wearing either kind of mask mask, both at rest and after walking briskly for ten minutes. INTERPRETATION: The risk of pathologic gas exchange impairment with cloth masks and surgical masks is near-zero in the general adult population.

Temporal dynamics of resting EEG networks are associated with prosociality.

As prosociality is key to facing many of our societies' global challenges (such as fighting a global pandemic), we need to better understand why some individuals are more prosocial than others. The present study takes a neural trait approach, examining whether the temporal dynamics of resting EEG networks are associated with inter-individual differences in prosociality. In two experimental sessions, we collected 55 healthy males' resting EEG, their self-reported prosocial concern and values, and their incentivized prosocial behavior across different reward domains (money, time) and social contexts (collective, individual). By means of EEG microstate analysis we identified the temporal coverage of four canonical resting networks (microstates A, B, C, and D) and their mutual communication in order to examine their association with an aggregated index of prosociality. Participants with a higher coverage of microstate A and more transitions from microstate C to A were more prosocial. Our study demonstrates that temporal dynamics of intrinsic brain networks can be linked to complex social behavior. On the basis of previous findings on links of microstate A with sensory processing, our findings suggest that participants with a tendency to engage in bottom-up processing during rest behave more prosocially than others.

Humility and Acceptance: Working Within Our Limits With Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

SYNOPSIS: The term long COVID was coined by patients to describe the long-term consequences of COVID-19. One year into the pandemic, it was clear that all patients-those hospitalized with COVID-19 and those who lived with the disease in the community-were at risk of developing debilitating sequelae that would impact their quality of life. Patients with long COVID asked for rehabilitation. Many of them, including previously healthy and fit clinicians, tried to fight postviral fatigue with exercise-based rehabilitation. We observed a growing number of patients with long COVID who experienced adverse effects from exercise therapy and symptoms strikingly similar to those of myalgic encephalomyelitis (ME). Community-based physical therapists, including those in private practice, unaware of safety issues, are preparing to help an influx of patients with long COVID. In this editorial, we expose growing concerns about long COVID and ME. We issue safety recommendations for rehabilitation and share resources to improve care for those with postviral illnesses. J Orthop Sports Phys Ther 2021;51(5):197-200. doi:10.2519/jospt.2021.0106.

Energy expenditure and feeding practices and tolerance during the acute and late phase of critically ill COVID-19 patients.

BACKGROUND & AIMS: Different metabolic phases can be distinguished in critical illness, which influences nutritional treatment. Achieving optimal nutritional treatment during these phases in critically ill patients is challenging. COVID-19 patients seem particularly difficult to feed due to gastrointestinal problems. Our aim was to describe measured resting energy expenditure (mREE) and feeding practices and tolerance during the acute and late phases of critical illness in COVID-19 patients. METHODS: Observational study including critically ill mechanically ventilated adult COVID-19 patients. Indirect calorimetry (Q-NRG+, Cosmed) was used to determine mREE during the acute (day 0-7) and late phase (>day 7) of critical illness. Data on nutritional intake, feeding tolerance and urinary nitrogen loss were collected simultaneously. A paired sample t-test was performed for mREE in both phases. RESULTS: We enrolled 21 patients with a median age of 59 years [44-66], 67% male and median BMI of 31.5 kg/m2 [25.7-37.8]. Patients were predominantly fed with EN in both phases. No significant difference in mREE was observed between phases (p = 0.529). Sixty-five percent of the patients were hypermetabolic in both phases. Median delivery of energy as percentage of mREE was higher in the late phase (94%) compared to the acute phase (70%) (p = 0.001). Urinary nitrogen losses were significant higher in the late phase (p = 0.003). CONCLUSION: In both the acute and late phase, the majority of the patients were hypermetabolic and fed enterally. In the acute phase patients were fed hypocaloric whereas in the late phase this was almost normocaloric, conform ESPEN guidelines. No significant difference in mREE was observed between phases. Hypermetabolism in both phases in conjunction with an increasing loss of urinary nitrogen may indicate that COVID-19 patients remain in a prolonged acute, catabolic phase.

Association of Timing and Balance of Physical Activity and Rest/Sleep With Risk of COVID-19: A UK Biobank Study.

Behavioral lifestyle factors are associated with cardiometabolic disease and obesity, which are risk factors for coronavirus disease 2019 (COVID-19). We aimed to investigate whether physical activity, and the timing and balance of physical activity and sleep/rest, were associated with SARS-CoV-2 positivity and COVID-19 severity. Data from 91,248 UK Biobank participants with accelerometer data and complete covariate and linked COVID-19 data to July 19, 2020, were included. The risk of SARS-CoV-2 positivity and COVID-19 severity-in relation to overall physical activity, moderate-to-vigorous physical activity (MVPA), balance between activity and sleep/rest, and variability in timing of sleep/rest-was assessed with adjusted logistic regression. Of 207 individuals with a positive test result, 124 were classified as having a severe infection. Overall physical activity and MVPA were not associated with severe COVID-19, whereas a poor balance between activity and sleep/rest was (odds ratio [OR] per standard deviation: 0.71; 95% confidence interval [CI], 0.62 to 0.81]). This finding was related to higher daytime activity being associated with lower risk (OR, 0.75; 95% CI, 0.61 to 0.93) but higher movement during sleep/rest being associated with higher risk (OR, 1.26; 95% CI, 1.12 to 1.42) of severe infection. Greater variability in timing of sleep/rest was also associated with increased risk (OR, 1.21; 95% CI, 1.08 to 1.35). Results for testing positive were broadly consistent. In conclusion, these results highlight the importance of not just physical activity, but also quality sleep/rest and regular sleep/rest patterns, on risk of COVID-19. Our findings indicate the risk of COVID-19 was consistently approximately 1.2-fold greater per approximately 40-minute increase in variability in timing of proxy measures of sleep, indicative of irregular sleeping patterns.

Factors associated with work-related burnout in NHS staff during COVID-19: a cross-sectional mixed methods study.

OBJECTIVES: To measure work-related burnout in all groups of health service staff during the COVID-19 pandemic and to identify factors associated with work-related burnout. DESIGN: Cross-sectional staff survey. SETTING: All staff grades and types across primary and secondary care in a single National Health Service organisation. PARTICIPANTS: 257 staff members completed the survey, 251 had a work-related burnout score and 239 records were used in the regression analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Work-related burnout as measured by the Copenhagen Burnout Inventory; (2) factors associated with work-related burnout identified through a multiple linear regression model; and (3) factors associated with work-related burnout identified through thematic analysis of free text responses. RESULTS: After adjusting for other covariates (including age, sex, job, being able to take breaks and COVID-19 knowledge), we observed meaningful changes in work-related burnout associated with having different COVID-19 roles (p=0.03), differences in the ability to rest and recover during breaks (p<0.01) and having personal protective equipment concerns (p=0.04). Thematic analysis of the free text comments also linked burnout to changes in workload and responsibility and to a lack of control through redeployment and working patterns. Reduction in non-COVID-19 services has resulted in some members of staff feeling underutilised, with feelings of inequality in workload. CONCLUSIONS: Our analyses support anecdotal reports of staff struggling with the additional pressures brought on by COVID-19. All three of the factors we found to be associated with work-related burnout are modifiable and hence their effects can be mitigated. When we next find ourselves in extraordinary times the ordinary considerations of rest and protection and monitoring of the impact of new roles will be more important than ever.

The Physiological Impact of Masking Is Insignificant and Should Not Preclude Routine Use During Daily Activities, Exercise, and Rehabilitation.

PURPOSE: Masking has been employed as a strategy for reducing transmission of a variety of communicable diseases. With the outbreak of SARS-CoV-2, many countries have implemented mandatory public masking. However, the perceived impact of mask use on pulmonary function has been a deterrent to public compliance with recommendations. COVID-19 has shed light on the impact that comorbid cardiac and pulmonary conditions may have on disease severity. This knowledge has led to increased primary and secondary prevention efforts for which exercise and rehabilitation are central. The importance of safe methods of exercise while mitigating risk of viral transmission is paramount to global recovery from the pandemic and prevention of future outbreaks. METHODS: We constructed a focused literature review of the impact of various masks on pulmonary function at rest and with exercise. This was then incorporated into recommendations for the integration of masks with exercise and rehabilitation in the COVID-19 era. RESULTS: While there is a paucity of evidence, we identified the physiological effects of masking at rest and during exercise to be negligible. The perceived impact appears to be far greater than the measured impact, and increased frequency of mask use leads to a physiological and psychological adaptive response. CONCLUSIONS: Masking during daily activities, exercise, and rehabilitation is safe in both healthy individuals and those with underlying cardiopulmonary disease. Rehabilitation participants should be reassured that the benefits of masking during COVID-19 far outweigh the risks, and increased frequency of mask use invokes adaptive responses that make long-term masking tolerable.

Effects of wearing a FFP2 mask on indirect calorimetry measurements: A pilot study.

BACKGROUND & AIMS: During the coronavirus disease 2019 (COVID-19) pandemic the use of Indirect calorimetry (IC) during nutritional rehabilitation program requires special precautions due to possible contagions for patients and health professionals. We evaluated in a sample of healthy subjects the agreement between oxygen consumption (VO2 mL/min), carbon dioxide production (VCO2 mL/min), respiratory quotient (RQ) and resting energy expenditure (REE kcal/24 h/day) measured by IC with and without a filtering facepiece mask. MATERIALS: 10 subjects with a mean (SD) age of 43 (10) years and a body mass index of 25.2 (5.8) kg/m2 underwent indirect calorimetry both with and without a class 2 filtering facepiece mask (FFP2), in random order. The limits of agreement (LOA) and the concordance correlation coefficient (CCC) were used to evaluate the interchangeability of the measurement conditions. RESULTS: The LOA between REE measured with and without FFP2 (-111 to 189 kcal/day) were comparable to those for repeated IC tests without wearing masks and CCC (0.95) showed substantial agreement. CONCLUSIONS: We observed high agreement between REE measured by IC with and without FFP2 mask. These procedures are interchangeable in clinical practice.

Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services.

BACKGROUND: The COVID-19 pandemic is a public health challenge that puts health systems in a highly vulnerable situation. Nurses in critical care units (CCUs) and hospital emergency services (HESs) have provided care to patients with COVID-19 under pressure and uncertainty. OBJECTIVE: To identify needs related to safety, organisation, decision-making, communication and psycho-socio-emotional needs perceived by critical care and emergency nurses in the region of Madrid, Spain, during the acute phase of the epidemic crisis. METHODS: This is a cross-sectional study (the first phase of a mixed methods study) with critical care and emergency nurses from 26 public hospitals in Madrid using an online questionnaire. RESULTS: The response rate was 557, with 37.5% reporting working with the fear of becoming infected and its consequences, 28.2% reported elevated workloads, high patient-nurse ratios and shifts that did not allow them to disconnect or rest, while taking on more responsibilities when managing patients with COVID-19 (23.9%). They also reported deficiencies in communication with middle management (21.2%), inability to provide psycho-social care to patients and families and being emotionally exhausted (53.5%), with difficulty in venting emotions (44.9%). CONCLUSIONS: Critical care and emegency nurses may be categorised as a vulnerable population. It is thus necessary to delve deeper into further aspects of their experiences of the pandemic.

Hypermetabolism and Coronavirus Disease 2019.

BACKGROUND: Hypermetabolism has been described in stress states such as trauma, sepsis, acute respiratory distress syndrome, and severe burn injuries. We hypothesize that patients with Coronavirus disease 2019 (COVID-19) may develop a hypermetabolic state, which may be a major contributing factor to the extraordinary ventilatory and oxygenation demands in patients with COVID-19. METHOD: Resting energy expenditure (REE), carbon dioxide production (VCO2 ), and oxygen consumption (VO2 ) were measured by indirect calorimetry on 7 critically ill patients with COVID-19. RESULTS: The median measured REE was 4044 kcal/d, which was 235.7% ± 51.7% of predicted. The median VCO2 was 452 mL/min (range, 295-582 mL/min), and the median VO2 was 585 mL/min (range, 416-798 mL/min). CONCLUSION: Critically ill patients with COVID-19 are in an extreme hypermetabolic state. This may explain the high failure rates for mechanical ventilation for these patients and highlights the potential need for increased nutrition requirements for such patients.