Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program.

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

Comparison of Alabama Nurse Experiences Between Practice Areas During the Early COVID-19 Pandemic.

BACKGROUND: According to the Total Worker Health® framework, safety culture including a reasonable workload among healthcare workers is essential to the security and well-being of patients, staff, and healthcare organizations. Evaluating the impact of the pandemic on the nursing workforce in different practice areas is critical for addressing workforce health and sustainability. The purpose of this study was to compare work and selfcare experiences among Alabama nurses between practice areas and the early pandemic years (2020 vs. 2021). METHODS: A secondary analysis of cross-sectional Alabama State Nurses Association (ASNA) survey data was conducted. Kruskal-Wallis analysis of variance, Wilcoxon rank, and false discovery rates were examined. RESULTS: There were 1,369 and 2,458 nurse survey responses in 2020 and 2021, respectively. By 2021, nurses reported worsening staff shortages, a greater need for retired and new graduate nurses to help with the workload burden, and perceptions of heavier emergency department workloads. Lower proportions of nurses reported the ability to engage in self-care activities and satisfaction with state and federal crisis management. Intensive care nurses were more likely to report staffing shortages while also reporting the lowest ability to engage in self-care. CONCLUSIONS: Overall, the Alabama nursing workforce perceived worsening work conditions in 2021 compared to when the pandemic began. Practice areas varied greatly in their responses, with acute and intensive care areas perceiving more difficult work conditions. Total Worker Health® programs should be designed to promote and support nurses' well-being based on their experience and the needs of specific practice areas.

Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis.

BACKGROUND: The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs. PURPOSE: To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework. METHODS: A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis. FINDINGS: Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity. CONCLUSION: Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.

Using item response theory to develop a shortened practice environment scale of the nursing work index.

The 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) has been frequently used globally to measure the nurse work environment. However, due to its length and subsequent respondent burden, a more parsimonious version of the PES-NWI may be desirable. Item response theory (IRT) is a statistical technique that assists in decreasing the number of items in an instrument without sacrificing reliability and validity. Two separate samples of nurses in the United States (one called the "internal data source" and the other called "external data source"; sample sizes = 843 and 722, respectively) were analyzed. The internal data source was randomly split into training (n = 531) and validating data sets (n = 312), while a separate whole external data source was used as the final validating data set. Using IRT with training data, we removed nine items; two additional items were removed based on recommendations from a previous study. Confirmatory factor analyses supported the validity of the measurement model with the 20-item of PES-NWI in both internal and external validation data sources. The correlations among subscales between 31- and 20-item versions were high magnitude for five subscales in both validation data sets (τ = 0.84-0.89). Ultimately, we identified a 20-item version of the PES-NWI which demonstrated adequate validity and reliability properties while decreasing data collection burden yet maintaining a similar factor structure to the original instrument. Additional research may be necessary to update the items themselves on the PES-NWI.

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes.

GOAL: The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS: We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS: Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS: Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.

Identifying and Decreasing Sharps Injuries Through Root Cause Analysis in a Large Urban Hospital System.

BACKGROUND: Despite safety mandates and interventions, sharps injuries remain an occupational risk for registered nurses (RNs). Sharps and needlestick injuries increase the risk of exposure to blood-borne pathogens. Post-exposure direct and indirect costs of these percutaneous injuries have been estimated at about US$700 per incident. The goal of this quality improvement project was to identify root causes of sharps injuries for RNs at a large urban hospital system. METHODS: A retrospective evaluation of sharps injuries sustained by RNs, identification epsication of themes or root causes, and the development of a fishbone diagram to sort the causes into categories to identify workable solutions were conducted. Fisher's exact tests were performed to identify association between variables and root causes. FINDINGS: A total of 47 sharps injuries were reported from January 2020 through June 2020. Among sharps injuries sustained by nurses, 68.1% were among nurses 19 to 25 years of age and 57.4% reported job tenure of 1 to 2 years. There was a statistically significant association between root causes and tenure range, gender, and procedure type (p < .05) with moderate effect size (Cramer's V = 0.35-0.60). Technique also was a primary cause of sharps injuries for blood draw (77%), discontinuing line (75%), injection (46%), intravenous (IV) start (100%), and suturing (50%). CONCLUSIONS/APPLICATIONS TO PRACTICE: Technique and patient behavior were primary root causes of sharps injuries in this study. More sharps injuries caused by technique occurred among nurses with job tenure of 1 to 10 years, female, blood draw, discontinuing line, injection, IV start, and suturing procedures. The root cause analysis identified tenure, technique, and behavior as potential root causes of sharps injuries specifically occurring most during blood draw and injections at a large urban hospital system. These findings will inform nurses, especially new nurses in the proper use of safety devices and behaviors to prevent injury.

Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross-sectional study.

AIMS: The aims of this work are to (1) investigate the work environment, resilience, burnout, and turnover intention and (2) examine how work environment and personal resilience impact burnout and turnover intention among nurse leaders in the midst of the COVID-19 crisis. BACKGROUND: The COVID-19 pandemic introduced tremendous stressors to nurse leaders, for example, managing the complex staffing situation while balancing patients' and family's needs. METHODS: During May to September 2021, an electronic survey was sent out to nurse leaders in Birmingham, Alabama, USA, and surrounding areas. RESULTS: Fifty-six respondents were included in the study. The composite score of the work environment measure was moderately to highly related to resilience [ρ (rho) = .59] and burnout [ρ = -.63 to -.68] but had small association to intent to leave [ρ = -.30]. The resilience was highly correlated to burnout [ρ = -.53 to -.59] and moderately associated to intent to leave [ρ = -.32]. CONCLUSIONS: A better work environment for nurse leaders is related to higher resilience, lower burnout, and lower turnover intention. Resilience impacts burnout and turnover intention among nurse leaders. IMPLICATIONS FOR NURSING MANAGEMENT: Health care organizations and stakeholders should implement effective strategies to improve the work environment, which could lead to enhanced resilience, reduced burnout, and lower turnover intention of their nurse leaders especially during and following this pandemic.

Values elicitation among adults making health-related decisions: A concept analysis.

AIM: To conduct a concept analysis of values elicitation in the context of health care and treatment decision-making and formulate a conceptual definition. BACKGROUND: Values elicitation is a commonly cited term for an activity to help patients identify values and evaluate their application in health care decision-making, yet it remains ambiguous and difficult to differentiate from similar concepts. DESIGN: Concept analysis. DATA SOURCE: Three databases, including PubMed, CINAHL Plus, and Scopus, were searched from inception to February 2021. REVIEW METHODS: Walker and Avant's eight-stage method was used to identify attributes, cases, antecedents, consequences, and empirical referents and formulate a conceptual definition. RESULTS: The concept analysis identified 3 attributes, 10 consequences, 7 antecedents, and 3 empirical referents. Our analysis defines values elicitation as an intentional process whereby individuals explore their core beliefs, alone or with others, to (1) determine their preference, or a lack thereof, between health or treatment options, and (2) frame decisions. CONCLUSIONS: The findings have the potential to influence the identification, discussion, and measurement of values elicitation by nurses and researchers across disciplines. Further exploration of this concept is warranted as the literature continues to emerge.

Improving Hearing Protection Device Noise Attenuation Through Fit-Testing in an Occupational Health Clinic.

BACKGROUND: Occupational noise-induced hearing loss (NIHL) is the second most common medical disability for military veterans and accounts for 24% of all hearing loss in the United States. Hearing loss negatively affects health and billions of dollars are spent annually for direct and indirect medical costs and lost work productivity. Proper hearing protection device (HPD) fit can prevent NIHL. Quantitative fit-testing systems to determine personal attenuation rates (PARs) are available, but not widely utilized. Without quantitative testing, validating appropriate fit and attenuation to a permissible exposure level to prevent NIHL is difficult. METHODS: A quality improvement project measured 100 employees enrolled in a hearing conservation program (HCP) to determine if they obtained a target PAR after inserting the HPDs in their "usual" fashion. Those who did not obtain target PAR (n = 27) received an evidence-based intervention that demonstrated proper HPD fit by a skilled trainer followed by a repeat attempt by the participant to replicate the feel of the demonstrated HPD placement. PAR was subsequently measured to assess for appropriate noise attenuation. FINDINGS: Seventy-one percent achieved target PAR (≥ 20 decibels) at baseline testing. After the intervention, 91 of 100 participants had achieved target PAR, a 20% improvement. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Findings suggest this evidence-based intervention was an effective strategy for improving HPD fit for employees enrolled in HCPs. This intervention may prevent occupational hearing loss and decrease the health and socioeconomic impacts of NIHL.

Development and Testing of the Quality Improvement Self-efficacy Inventory.

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.

Modeling Patient Risk for Hospital-Acquired Pressure Injuries During COVID-19: A Retrospective Study.

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.

Nurse Burnout Syndrome and Work Environment Impact Patient Safety Grade.

BACKGROUND: Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified. PURPOSE: This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. METHODS: A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals. RESULTS: In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P < .05) and work environment (OR for +1 SD ranging 4.35-4.89; P < .001) were related to the outcome of patient safety grade after controlling for nurse characteristics. CONCLUSIONS: Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level.

Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence.

ABSTRACT: The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.

Psychometric properties of Copenhagen Burnout Inventory among nurses.

Worldwide, nurses have been reporting high levels of burnout. Given the high prevalence of nurse burnout, measurements of burnout need to be carefully considered for their validity and reliability. Our research team used a relatively new instrument to measure burnout among nurses: the Copenhagen Burnout Inventory (CBI). This 19-item instrument measures burnout in three dimensions: Personal, Work-related, and Client-related Burnout. However, the psychometric properties of the CBI have not been examined in nurses. Thus, the purpose of this study was to determine the psychometric properties of the CBI in a state-wide survey of inpatient staff nurses. A total of 928 registered nurses working in Alabama-area hospitals (N = 42 hospitals) participated in this study. Confirmatory factor analysis resulted in an adequate fit to the data and supported construct validity. As evidence of convergent validity, the CBI was moderately to highly correlated with measures of the overall work environment, job satisfaction, and intent to leave, in the anticipated directions. The Cronbach's alphas for Personal Burnout, Work-related Burnout, and Client-related Burnout were 0.91, 0.89, and 0.92, respectively, demonstrating excellent internal consistency reliability for the subscales. Based on our data, the CBI demonstrates adequate validity and reliability for measuring burnout among frontline nurses. As nurses provide care to the most vulnerable patients in healthcare systems, their psychological well-being is important due to the impact on quality of care on patient outcomes. The availability of the CBI on its website allows nurses, nurse managers, and researchers to evaluate burnout in a variety of nursing populations with no licensing costs.

Nurse Burnout Predicts Self-Reported Medication Administration Errors in Acute Care Hospitals.

BACKGROUND: Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs). METHODS: A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined. RESULTS: All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = -0.17 to -0.21), years in nursing (r = -0.10 to -0.17), years of hospital work (r = -0.07 to -0.10), and work environment (r = -0.24 to -0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p < .05). CONCLUSIONS: Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.

Post-Traumatic Stress Disorder in Intensive Care Unit Nurses: A Concept Analysis.

BACKGROUND: Intensive care unit (ICU) nurses are at an increased risk of post-traumatic stress disorder (PTSD) due to their stressful work environment. Using the Walker and Avant conceptual analysis method, we sought to review the literature to better understand PTSD as it pertained to ICU nurses and its impact on their lives, patient care, and health care organizations. METHODS: For the review, we searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO. The keyword searches included the terms "post-traumatic stress disorder" AND "psychological stress" AND "intensive care unit nurses." Abstract and full text reviews were conducted. Ten articles met our inclusion criteria of being published in the past 10 years (2010-2020), peer reviewed, written in English, and referred specifically to PTSD and psychological stress in ICU nurses. FINDINGS: Antecedents for PTSD in ICU nurses are their stressful work environment, where exposure to traumatic events is experienced, and a lack of support from their manager, coworkers, and organization. Defining attributes for ICU nurses with PTSD included reexperiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Consequences identified included burnout, job dissatisfaction, and the intention to leave their job. The conceptual definition of PTSD in ICU nurses was illustrated by the attributes, antecedents, consequences, model case, empirical referents, and by the negative impact on the nurse, patients, and the health care organization. CONCLUSION/APPLICATION TO PRACTICE: Hospital administrators, nurse managers, and occupational health nurses should ensure that policies and interventions are in place to recognize and reduce the risk of PTSD among ICU nurses.