Pride and adversity among nurses and physicians during the pandemic in two US healthcare systems: a mixed methods analysis.

BACKGROUND: Our aims were to examine themes of the most difficult or distressing events reported by healthcare workers during the first wave of COVID-19 pandemic in two US health care systems in order to identify common themes and then to relate them to both behavioral theory and measures of anxiety and depression. METHODS: We conducted a cross-sectional survey of nurses and physicians during the early phases of the COVID-19 pandemic in the US. An emailed recruitment letter was sent, with about half choosing to supply open-ended responses relevant to thematic analysis. We measured symptoms of anxiety and depression separately, captured demographics, and asked two open-ended questions regarding events that were the most difficult or stressful, and reinforced pride. We reported descriptive statistics and coded thematic categories for their continuum "pride" and "distress" the factors related to fostering well-being according to the Self-Determination Theory. RESULTS: Themes that emerged from these narratives were congruent with prediction of Self-Determination theory that autonomy-supportive experiences will foster pride, while autonomy-thwarting experiences will cause distress. Those who reported distressful events were more anxious and depressed compared to those who did not. Among those who reported incidences that reinforced pride in the profession, depression was rarer compared to those who did not. These trends were evident after allowing for medical history and other covariates in logistic regressions. CONCLUSION: Causal claims from our analysis should be made with caution due to the cross-sectional research design. Understanding perceptions of the pandemic by nurses and physicians may help identify and manage sources of distress, and suggest means of mitigating the risk of mental health distress through autonomy-supportive policies.

A Cross-Sectional Survey of the Workplace Factors Contributing to Symptoms of Anxiety and Depression Among Nurses and Physicians During the First Wave of COVID-19 Pandemic in Two US Healthcare Systems.

BACKGROUND: Anxiety and depression among physicians and nurses during the COVID-19 pandemic in the USA are not well described and their modifiable causes are poorly understood. METHODS: We conducted a cross-sectional survey of symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) among physicians and nurses in two US healthcare systems in June through September 2020; participation rate was 5-10%. We described features of work as well as their perceptions and associated concerns in relation to the risk of anxiety and depression, while controlling for health history via regression and path analyses. RESULTS: About a third of 684 nurses and 185 physicians surveyed showed symptoms of anxiety or depression, and the excess of symptoms of mood disorders was particularly prominent in nurses. The belief that one was infected was a dominant correlate of both anxiety and depression. This belief was more associated with history of symptoms of pneumonia than the contact with COVID-19 diagnosed patients. Factors found to be associated with reduced anxiety and depression in this working environment were having confidence in the competent use of and access to personal protective equipment, maintaining usual working hours, being surrounded by colleagues who were both sufficient in numbers and not stressed, and the support of immediate family and religious communities. Involvement in aerosol-generating procedures with infected patients was linked with lower depression in nurses but higher among physicians. Likewise, the setting of recent patient encounters affected risk of anxiety and depression differently for physicians and nurses. CONCLUSIONS: Our findings may help develop mitigation measures and underscore the need to help nurses and physicians bear the psychological burden of the COVID-19 pandemic and similar events in the future.

Comparison of 12-Hour Biweekly Versus 6-Hour Weekly Shifts on Fatigue in Student Nurses.

BACKGROUND: Some challenges affecting student nurse learning include student fatigue, clinical recovery time, and hindered clinical experiences due to students experiencing long clinical shifts. AIM: The aim of this study was to evaluate the differences between 12-hour biweekly and 6-hour weekly shifts on student nurse fatigue. METHODS: A descriptive research design was used with second-year nursing students (N = 80) upon completion of their clinical rotations of four distinct cohorts during 2019-2020. All students in these cohorts were invited to complete the Occupational Fatigue Exhaustion Recovery (OFER15) online survey, developed and validated to assess the full spectrum of fatigue. RESULTS: There were no statistically significant differences in acute fatigue, chronic fatigue, or the inter-shift recovery subscale for the 6-hour and 12-hour clinical groups. Student nurses, like registered nurses, would likely prefer to choose between a 6-hour and 12-hour clinical shift depending on their individual circumstances. In the parameters of this study, there was no statistical significance in shift length and student nurse fatigue. LINKING EVIDENCE TO ACTION: Student nurse fatigue levels can affect learning inside and outside of nursing clinical experiences. In this study, no statistical significances were found between 6-hour and 12-hour clinical experiences in second-year nursing students. Offering both the 6-hour and 12-hour clinical experiences provides flexibility for students, clinical sites, and the school of nursing.

Confronting Incivility in the Online Classroom.

Confronting incivility in the online classroom can significantly benefit from spiritual approaches that address behaviors on a continuum of mild to aggressive. This may include the need to intervene when covert or overt threats occur. Electronic communications can lead to misperceptions and misunderstandings between students and faculty. Lack of understanding of diverse cultures, life experiences, and professional and spiritual histories can lead to behaviors that are perceived as intentionally hostile when, in fact, they are not. It is important in the online classroom to differentiate between the two and establish expected virtual classroom behaviors.

Contrast-Induced Acute Kidney Injury: Comparison of Preventative Therapies.

Contrast medium is used daily for diagnostic and interventional procdures as a means to visualize blood vessels. The administration of contrast dye, however, can lead to an acute reduction in kidney function. This complication can impact length of hospital stay, risk of dialysis, and increased hospital mortality. Common preventative measures include N-acetylcysteine and intravenous hydration. The evidence reviewed revealed hydration to be the more effective treatment to reduce the risk of acute kidney injury.

Effect of Nocturnal Dialysis on Prognosis in Adult Patients: A Review of the Literature.

Compared to conventional hemodialysis dialysis, nocturnal hemodialysis represents a more effective modality for receiving hemodialysis and has been associated with a 25% reduction in risk of death and improved quality of life. This article identifies the evidence about the mortality and morbidity risk for patients undergoing conventional hemodialysis vs. nocturnal hemodialysis.

The Effectiveness of Clinically Indicated Replacement of Peripheral Intravenous Catheters: An Evidence Review With Implications for Clinical Practice.

BACKGROUND: Current clinical guidelines from the Centers for Disease Control and Prevention (CDC; 2011) state that peripheral intravenous catheters are to be replaced every 72-96 hr to prevent infection and phlebitis in the adult patient. It is unclear whether this practice reduces the incidence of phlebitis or other infections. AIM: The aim of this study was to examine levels I and II evidence to determine if replacing peripheral intravenous catheters only when clinically indicated compared to every 72-96 hr increases the adult patient's risk for infection or phlebitis. METHODS: The following patient or population, intervention, comparison, outcome question was used to search the literature databases PubMed, ClinicalKey, ProQuest, Ovid SP, and CINAHL: In the adult patient requiring a peripheral vascular catheter (P), does replacing the catheter only when clinically indicated (I) compared to replacing the catheter every 72-96 hr (C) increase the occurrence of phlebitis and infection (O)? A set of specific search criteria along with critical appraisal tools was used to identify relative studies. RESULTS: Four level II randomized controlled trials with no less than 155 subjects, and two level I meta-analyses reviewing a total of 13 research studies indicated that the replacement of peripheral intravenous catheters only when clinically indicated does not increase patient risk of phlebitis or infection when compared to the current practice of routine replacement between 72 and 96 hr in the adult patient population. LINKING EVIDENCE TO ACTION: The current practice of replacing peripheral intravenous catheters every 72-96 hr does not decrease the incidence of phlebitis or infection when compared to replacing catheters when clinically indicated in the adult population. By translating this research into current practice, healthcare costs and nursing care time will decrease, and unnecessary invasive procedures would be eliminated thereby increasing patient safety and satisfaction.

The use of tranexamic acid in joint replacement surgery.

Perioperative bleeding is a prevalent risk of elective joint replacement surgery that can lead to allogeneic blood transfusions, delayed discharge, and slowed physical therapy progress. Antifibrinolytics such as tranexamic acid (TXA) have been used in various surgical procedures to reduce bleeding; however, the use of TXA in orthopaedic surgery is not widespread. The purpose of this article is to determine whether the use of TXA in joint replacement surgery reduces total blood loss and lowers the need for allogeneic blood transfusions without adding additional surgical risk and cost. All reviewed meta analyses and systematic reviews analyzed did show a statistically significant reduction in total blood loss and reduction in the need for allogeneic blood transfusions. Therefore, researchers conclude that intravenous TXA use does decrease total blood loss and allogeneic blood transfusion needs. Thus, its use should be included in orthopaedic clinical practice guidelines due to its overall positive effect on outcomes.

The role of probiotics in diarrheal management.

Current evidence demonstrates that probiotics reduce diarrheal duration from a number of etiologies. Professional nursing practice based on evidence and clinical expertise supports a diet-containing probiotics to manage acute diarrhea. Dietary limitations included in the BRAT (bananas, rice, applesauce, and toast) diet recommended by many nurses need to be reexamined in light of the newest evidence.

Examining childhood bullying and adolescent suicide: implications for school nurses.

Adolescent suicide is a preventable tragedy yet is still the third leading cause of death in young people of age 10-24. Contrary to the idea that childhood bullying is a normal part of growing up or a rite of passage, it is now correlated with adolescent suicidality. An integrative review of the contemporary, extant literature was conducted to examine the following question: Are adolescents who have been involved in childhood bullying or cyberbullying as victim, offender, or victim/offender at greater risk for suicidality than those who have not. It is important to empower school nurses with current and evidence-based information regarding childhood bullying and examine empirical science and tools to effectively address the current serious problem of adolescent suicide risk assessment and intervention.

Enhancing assessment of interpersonal violence (IPV) pregnancy-related homicide risk within nursing curricula.

Pregnancy and motherhood traditionally represent evolution of the next generation; yet, contemporary research and analyses confirm that this time can also be manifested in fear by the expectant mother within an environment of battering, cruelty, physical and emotional abuse, and sexual assault. Often to the surprise of many healthcare providers, the Centers for Disease Control and Prevention have consistently reported that Interpersonal Violence (IPV) related homicide is a leading cause of traumatic death among new and expectant mothers. In spite of these staggering statistical and anecdotal findings, universal screening for violence during pregnancy continues to be minimal. Forensic nurses might be prompted to respond to the consequences of violence and its resultant negative effects on expectant mothers by strategically incorporating systematic and consistent assessment into foundational nursing curricula regarding IPV as a leading risk factor for injury or death.

A review and application of suicide prevention programs in high school settings.

Teen suicide is a terrible tragedy and is the third leading cause of death among high school children aged 14 to 19. School based intervention programs have been regarded as an effective and essential means of addressing this problem. A comprehensive review of the extant literature provides examination of the risk and protective factors of suicide in this age group, the development of these programs, the current state of the science and recommendations for enhanced assessment and intervention.