Centrality statistics of symptom networks of schizophrenia: a systematic review.

The network theory of psychological disorders posits that systems of symptoms cause, or are associated with, the expression of other symptoms. Substantial literature on symptom networks has been published to date, although no systematic review has been conducted exclusively on symptom networks of schizophrenia, schizoaffective disorder, and schizophreniform (people diagnosed with schizophrenia; PDS). This study aims to compare statistics of the symptom network publications on PDS in the last 21 years and identify congruences and discrepancies in the literature. More specifically, we will focus on centrality statistics. Thirty-two studies met the inclusion criteria. The results suggest that cognition, and social, and occupational functioning are central to the network of symptoms. Positive symptoms, particularly delusions were central among participants in many studies that did not include cognitive assessment. Nodes representing cognition were most central in those studies that did. Nodes representing negative symptoms were not as central as items measuring positive symptoms. Some studies that included measures of mood and affect found items or subscales measuring depression were central nodes in the networks. Cognition, and social, and occupational functioning appear to be core symptoms of schizophrenia as they are more central in the networks, compared to variables assessing positive symptoms. This seems consistent despite heterogeneity in the design of the studies.

Wellbeing measures for workers: a systematic review and methodological quality appraisal.

Introduction: Increasing attention on workplace wellbeing and growth in workplace wellbeing interventions has highlighted the need to measure workers' wellbeing. This systematic review sought to identify the most valid and reliable published measure/s of wellbeing for workers developed between 2010 to 2020. Methods: Electronic databases Health and Psychosocial Instruments, APA PsycInfo, and Scopus were searched. Key search terms included variations of [wellbeing OR "well-being"] AND [employee* OR worker* OR staff OR personnel]. Studies and properties of wellbeing measures were then appraised using Consensus-based Standards for the selection of health Measurement Instruments. Results: Eighteen articles reported development of new wellbeing instruments and eleven undertook a psychometric validation of an existing wellbeing instrument in a specific country, language, or context. Generation and pilot testing of items for the 18 newly developed instruments were largely rated 'Inadequate'; only two were rated as 'Very Good'. None of the studies reported measurement properties of responsiveness, criterion validity, or content validity. The three instruments with the greatest number of positively rated measurement properties were the Personal Growth and Development Scale, The University of Tokyo Occupational Mental Health well-being 24 scale, and the Employee Well-being scale. However, none of these newly developed worker wellbeing instruments met the criteria for adequate instrument design. Discussion: This review provides researchers and clinicians a synthesis of information to help inform appropriate instrument selection in measurement of workers' wellbeing. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79044, identifier: PROSPERO, CRD42018079044.

General well-being of intensive care nurses: A prototype analysis.

BACKGROUND: Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses. AIMS: To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized. DESIGN: Prototype analysis. METHODS: Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization. RESULTS: Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15). CONCLUSIONS: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being. RELEVANCE TO CLINICAL PRACTICE: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care.

The increasing demand for palliative care in New Zealand presents a potential threat to the quality of service delivery. One strategy to overcome this is through the implementation of valid and reliable patient-reported outcome measures. This mixed-methods study aimed to (1) implement measurement-based palliative care (MBPC) in a community palliative care service in Auckland, New Zealand; (2) evaluate the clinical utility of MBPC perceived by clinicians; (3) describe patient characteristics as measured by the Integrated Palliative Care Outcome Scale (IPOS), the Australasian Modified Karnofsky Performance Scale (AKPS), and Phase of Illness (POI); and (4) evaluate the internal consistency of the IPOS. Participants were over 18 years of age from a community outpatient palliative care service. In a phased approach to implementation, healthcare staff were educated on each instrument used for patient assessment. Uptake and internal consistency were evaluated through descriptive statistics. An interpretive descriptive methodology was used to explore the clinical utility of MBPC through semi-structured interviews with seven clinical staff members. Individual patient assessments (n = 1507) were undertaken predominantly on admission, with decreasing frequency as patients advanced through to the terminal phase of their care. Mean total IPOS scores were 17.97 (SD = 10.39, α = 0.78). The POI showed that 65% of patients were in the stable phase, 20% were in the unstable phase, 9% were in the deteriorating phase, and 2% were in the terminal phase. Clinicians reported that MBPC facilitated holistic and comprehensive assessments, as well as the development of a common interdisciplinary language. Clinicians expressed discomfort using the psychosocial and spiritual items. Measurement-based palliative care was only partially implemented but it was valued by staff and perceived to increase the quality of service delivery. Future research should determine the optimal timing of assessments, cultural responsivity for Maori and Pacific patients, and the role of MBPC in decision support for clinicians.

Nurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta-synthesis.

AIM: Describe the reported lived experiences of nurses who have participated at any stage of voluntary assisted dying (VAD), from the initial request to the end of life. DESIGN: A qualitative meta-synthesis. DATA SOURCES: Databases searched were CINAHL, MEDLINE, Emcare, Scopus and PsycInfo. The search was undertaken in September 2021 with no date limitations. Qualitative studies were considered if published in English, reported primary data analysis of nurses' experiences who had been involved in VAD and reported direct quotes from nurses. REVIEW METHODS: Qualitative studies meeting the selection criteria were critically appraised, then an open card-sort method was applied. Quotes from nurses were organized to group similar experiences, constructing themes and metaphors across studies as a new understanding of nurses' experiences of VAD. RESULTS: Eight studies were included. Three major themes were constructed: An orderly procedure, reflecting the need for structure to feel adequately prepared; A beautiful death, reflecting the autonomy the patient exercised when choosing VAD facilitated an exceptionally positive death; and Psychological and emotional impact, where nurses recognized the emotional and ethical weight that they carried for themselves and the team when undertaking VAD. CONCLUSION: Nurses may benefit from clear policy, supervision and communication training to support them as countries transition to providing VAD services. Policy provides nurses with confidence that they are undertaking the steps of VAD correctly and provides a layer of emotional protection. Communication training specific to VAD is necessary to prepare nurses to recognize their own emotional experiences when responding to the needs of the patient and their family. IMPACT: VAD is increasingly becoming a legal option that nurses are encountering in their professional practice. Understanding nurses' experiences of being involved in VAD is required to support nurses in countries where VAD is becoming available to prepare professionally and psychologically.

Predictors of Life Satisfaction in New Zealand: Analysis of a National Dataset.

The study aim was to determine prevalence and predictors of life satisfaction in New Zealand. In this observational cross-sectional study, a sample of 10,799 participants from NZ were drawn from the Gallup World Poll from 2006 to 2017. Data were analysed using regression analysis and ANOVA. Prevalence of life satisfaction across time varied little from a high of 7.61 (SD = 1.6) in 2007 to a low of 7.23 (SD = 1.73) in 2011 (range 0-10). Satisfaction with standards of living predicted life satisfaction regardless of age or gender. For males across all age groups and females up to age 40 years, positive experiences and satisfaction with household income were important predictors. Being married was an important predictor for males over 40 years and feeling satisfied with their current city was important for females across all ages and for men under 40. The levels of life satisfaction changed over time, possibly due to major national events. Satisfaction with standards of living was found to predict life satisfaction regardless of age or gender. These results provide a path for policy focus towards increased life satisfaction.

Intelligent Palliative Care Based on Patient-Reported Outcome Measures.

CONTEXT: The growth of patient reported outcome measures data in palliative care provides an opportunity for machine learning to identify patterns in patient responses signifying different phases of illness. OBJECTIVES: The study will explore if machine learning and network analysis can identify phases in patient palliative status through symptoms reported on the Integrated Palliative Care Outcome Scale (IPOS). METHODS: A partly cross-sectional and partially longitudinal observational study was undertaken using the Australasian Karnofsky Performance Scale (AKPS); Integrated Palliative Care Outcome Scale (IPOS); Phase of Illness (POI). Patient palliative records (n = 1507, 65% stable, 20% unstable, 9% deteriorating, 2% terminal) from 804 adult patients enrolled in a New Zealand palliative care service were analysed using a combination of statistical, machine learning and network analysis techniques. RESULTS: Data from IPOS showed considerable variation with phase. Also, network analysis showed clear associations between items by phase. Six machine learning techniques identified the most important variables for predicting possible transition between phases of illness. Network analysis for all patients showed that Poor Appetite and Loss of Energy were central IPOS items, with Loss of Energy linked to Drowsiness, Shortness of Breath and Lack of Mobility on the one hand, and Poor Appetite linked to Nausea, Vomiting, Constipation and Sore and Dry Mouth on the other. CONCLUSION: These preliminary results, when coupled with the latest technological developments in mobile apps and wearable technology, could point the way to increased use of digital therapeutics in continuous palliative care monitoring.

The occupational impact of bowel cancer: Survivors' voices and advancing the role of occupational therapy assessment and intervention.

INTRODUCTION: The aim of this study was to investigate the occupational impact (i.e., how engagement in occupation is affected) of having had bowel cancer and the role of occupational therapy with bowel cancer survivors and their significant others. METHODS: Two rounds of semi-structured interviews were carried out with individuals who had completed treatment for bowel cancer, with interviews designed to gain insight into their occupational experiences post treatment. Thematic analysis was utilised to construct themes and patterns founded on the perceptions of participants. Analysis involved concurrent data collection and analysis, constant comparative analysis, and iterative analysis. FINDINGS: Eighteen participants were interviewed, with occupational impact evident across multiple aspects of everyday life. Four themes were identified: Changes in eating habits, changes in toileting habits, changes in relationships, and rethinking occupational choices. CONCLUSION: Findings of the occupational impact of having had bowel cancer reveal a possible role for occupational therapists with people affected by bowel cancer. Occupation focused assessments and self-management programmes are identified as a possible means of meeting the needs of this population, making use of the experiences of peers to provide a credible, relatable voice.

A novel way to quantify schizophrenia symptoms in clinical trials.

BACKGROUND: A major problem in quantifying symptoms of schizophrenia is establishing a reliable distinction between enduring and dynamic aspects of psychopathology. This is critical for accurate diagnosis, monitoring and evaluating treatment effects in both clinical practice and trials. MATERIALS AND METHODS: We applied Generalizability Theory, a robust novel method to distinguish between dynamic and stable aspects of schizophrenia symptoms in the widely used Positive and Negative Symptom Scale (PANSS) using a longitudinal measurement design. The sample included 107 patients with chronic schizophrenia assessed using the PANSS at five time points over a 24-week period during a multi-site clinical trial of N-Acetylcysteine as an add-on to maintenance medication for the treatment of chronic schizophrenia. RESULTS: The original PANSS and its three subscales demonstrated good reliability and generalizability of scores (G = 0.77-0.93) across sample population and occasions making them suitable for assessment of psychosis risks and long-lasting change following a treatment, while subscales of the five-factor models appeared less reliable. The most enduring symptoms represented by the PANSS were poor attention, delusions, blunted affect and poor rapport. More dynamic symptoms with 40%-50% of variance explained by patient transient state including grandiosity, preoccupation, somatic concerns, guilt feeling and hallucinatory behaviour. CONCLUSIONS: Identified dynamic symptoms are more amendable to change and should be the primary target of interventions aiming at effectively treating schizophrenia. Separating out the dynamic symptoms would increase assay sensitivity in trials, reduce the signal to noise ratio and increase the potential to detect the effects of novel therapies in clinical trials.

Intensive care nurses' well-being: A systematic review.

BACKGROUND AND PURPOSE: Unique work challenges of intensive care nurses can cause both stress and distress to nurses, evident in prevailing literature regarding burnout, compassion fatigue, and moral distress. Identifying factors contributing to intensive care nurses' well-being would complement this focus on nurse ill-being, supporting the development of workplace well-being initiatives. The review seeks to balance the existing negatively skewed evidence base by investigating intensive care nurses' well-being rather than ill-being. OBJECTIVES: The objective of this review was to systematically identify, appraise, and synthesise primary research reporting intensive care nurses' well-being. METHODS: The electronic search strategy included (1) bibliographic databases for published work and (2) forward and backward citation searches. Key search terms included [critical OR intensive] AND [nurs*] AND [well*]. Inclusion criteria were as follows: (1) population: critical or intensive care nurses working with adult or mixed adult and paediatric patients, (2) study type: primary research studies, (3) outcome: intensive care unit nurses' well-being, and (4) publication available in the English language. Studies were excluded if the group of intensive care nurses was not independently reported. Included studies were critically appraised, and results were synthesised and presented descriptively. Semantics of the included studies were explored to identify frequently used terms. RESULTS: Four primary research studies met the inclusion criteria, focussing on spiritual well-being, team commitment, emotional well-being, and the effects of a mindfulness programme. The studies were heterogeneous in terms of study focus, definitions, and measures, with small sample sizes, and of variable quality and generalisability. CONCLUSIONS: The well-being of intensive care nurses is currently understudied. Conceptualising intensive care nurses' well-being, understanding correlates of well-being, and testing workplace interventions to improve well-being remain significant opportunities for future research.

Conceptual model for intensive care nurse work well-being: A qualitative secondary analysis.

BACKGROUND: There had been little focus on the well-being of intensive care nurses until a recent programme of research found work well-being to be best described as a collection of elements, a multifaceted construct. Strengtheners of intensive care nurses' work well-being were found to extend across individual, relational, and organizational resources. Actions such as simplifying their lives, giving and receiving team support, and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. AIMS AND OBJECTIVES: To synthesize intensive care nurse perceptions of work well-being characteristics and strengtheners to identify opportunities for job crafting and redesign. DESIGN: This was a qualitative secondary analysis. METHODS: Intensive care nurse work well-being characteristics and strengtheners were explored using applied thematic analysis and pre-design, open card-sort technique. RESULTS: Five facets were identified in the analysis: (a) healthy, (b) authentic, (c) meaningful, (d) connected, and (e) innovative. These five facets were described from a theoretical perspective and illustrated as a conceptual model for intensive care nurse job crafting and redesign. CONCLUSIONS: The proposed conceptual model contributes new knowledge to be explored in meaningful discussions about intensive care nurse work well-being and empirically investigated in terms of construct validity and theory development. Furthermore, the model provides practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being across a range of levels. RELEVANCE TO CLINICAL PRACTICE: Opportunities for job crafting and redesign were identified and presented in a conceptual model of intensive care nurse work well-being. This model provides individual nurses, intensive care teams, health care organizations, and workers' well-being programme and policy developers practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being.

Bibliometric mapping of intensive care nurses' wellbeing: development and application of the new iAnalysis model.

BACKGROUND: Intensive care nurse wellbeing is essential to a healthy healthcare workforce. Enhanced wellbeing has widespread benefits for workers. Bibliometrics enables quantitative analysis of bourgeoning online data. Here, a new model is developed and applied to explore empirical knowledge underpinning wellbeing and intensive care nurse wellbeing in terms of size and impact, disciplinary reach, and semantics. METHODS: Mixed methods bibliometric study. Firstly, a new model coined 'iAnalysis' was developed for the analysis of published data. Secondly, iAnalysis was applied in two studies to examine wellbeing and ICU nurse wellbeing. Study one explored data from a title search with search terms [wellbeing OR well-being], identifying 17,543 records with bibliographic data. This dataset included 20,526 keywords. Of the identified records, 10,715 full-text manuscripts were retrieved. Study two explored data from a topic search with search terms [(intensive OR critical) AND (nurs*) AND (wellbeing OR well-being)], identifying 383 records with bibliographic data. This dataset included 1223 author keywords. Of the identified records, 328 full-text manuscripts were retrieved. RESULTS: Once data were collected, for size and impact, WoS Clarivate Analytics™ and RStudio™ were used to explore publication dates, frequencies, and citation performance. For disciplinary reach, RStudio™ (with the Bibliometrics™ package & Vosviewer™ plugin) was used to explore the records in terms of country of publication, journal presence, and mapping of authors. For semantics, once the bibliographic data was imported to RStudio™ (with the Bibliometrics™ package & Vosviewer™ plugin) keyword co-occurrences were identified and visualised. Full-text manuscripts were imported to NVivo™ to explore word frequencies of both the keywords and full-text manuscripts using the word frequency search. For both studies, records were predominantly published in the past 5 years, in English language, and from USA. The highest keyword co-occurrence for study one was "health and well-being", and for study two, "family and model". CONCLUSIONS: Terms commonly associated with 'illbeing', as opposed to 'wellbeing', were highly prevalent in both study datasets, but more so in intensive care nurse wellbeing data. Intensive care nurse wellbeing was virtually absent in this literature. The iAnalysis model provided a practice-friendly tool to explore a large source of online published literature.

Strengthening workplace well-being: perceptions of intensive care nurses.

BACKGROUND: Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses' ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses' workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective. AIMS AND OBJECTIVES: Identify intensive care nurses' perspectives of strategies that strengthen their workplace well-being. DESIGN: An inductive descriptive qualitative approach was used to explore intensive care nurses' perspectives of strengthening work well-being. METHOD: New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being. FINDINGS: Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems' strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other. CONCLUSIONS: Strengtheners of intensive care nurses' workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change. RELEVANCE TO CLINICAL PRACTICE: Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.

A Rasch Analysis of the Integrated Palliative Care Outcome Scale.

CONTEXT: Accurate assessment of a patient's palliative care needs is essential for the timely provision of treatment and support. The Integrated Palliative Care Outcome Scale (IPOS) is an ordinal measure possessing acceptable psychometric properties, but its ability to discriminate precisely between individual symptom levels has not been rigorously investigated. OBJECTIVES: The study aimed to conduct Rasch analysis of the IPOS to evaluate and enhance precision of the instrument. METHODS: Responses of 300 community-dwelling palliative care patients were subjected to Rasch analysis using the partial credit model. RESULTS: Initial analysis supported the use of the Rasch model and acceptable reliability (person separation index = 0.77) was observed; however, unsatisfactory model fit was found. Local dependency between items was resolved through the creation of super-items, which increased model fit, reliability (person separation index = 0.80), and unidimensionality. There were no misfitting super-items or differential item functioning by age, rater, sex, or ethnicity. The IPOS showed satisfactory coverage of symptoms within the present clinical sample, with the ability to assess higher severity patients. CONCLUSION: The modified IPOS showed excellent reliability for a clinical measure in assessing the overall palliative care needs of a patient. The provided ordinal-to-interval conversion table accounts for unique contribution of each symptom to the overall symptom burden and easy to use without the need to modify the original IPOS format.

Quality appraisal of workers' wellbeing measures: a systematic review protocol.

BACKGROUND: Measuring wellbeing has never been so important. With the rapid growth of workplace wellbeing interventions, determining their effectiveness is not only good science but also good practice. A wide variety of wellbeing measures exist in the literature but it is not always clear what they are measuring, nor which measures best meet study objectives. This study seeks to identify the most valid and reliable measure/s of workers' wellbeing. METHODS: Measures will be included if they were (1) designed for measuring workers' wellbeing and (2) available in English. We will use a three-staged electronic search strategy to identify studies that include measures that meet the inclusion criteria: (1) electronic bibliographic databases for published work, (2) reference lists of studies with included measures, and (3) the reference list of previously published reviews. The following electronic bibliographic databases will be searched: OVID: psycINFO, psycTESTS, Cochrane library, AMED, Health and Psychosocial instruments; PubMed; PubPsych; Europe PMC; Scopus and Google Scholar. Database key search terms will include [wellbeing OR "well-being"] AND [employee* OR worker* OR staff OR personnel], and a validated search filter will be applied for the measurement properties. The methodological quality of the included studies will be assessed and rated. Then, this quality assessment of the included studies will be considered in the quality assessment of the measurement instruments. Finally, recommendations for the most appropriate instrument to measure workers' wellbeing will be reported. DISCUSSION: This systematic review will evaluate the quality of instruments that measure workers' wellbeing. The findings of this review will improve clarity for researchers and clinicians in the appropriate instrument selection in the measurement of workers' wellbeing. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018079044.

Intensive care nurse conceptions of well-being: a prototype analysis.

BACKGROUND: Accurately conceptualizing intensive care nurse work well-being is fundamental for successful engagement with workplace well-being interventions. Little is currently known about intensive care nurse work well-being. AIMS: The study aimed to identify intensive care nurses' conceptions of work well-being and ascertain whether the term 'work well-being' is prototypically organized. METHODS: Three linked studies conceptualize intensive care nurse well-being. For study one, participants listed key features of work well-being as free-text responses. Study two measured whether there was prototypical organization of these responses. Study three sought to confirm the prototypical organization of the term 'work well-being' through narrative ratings. RESULTS: A total of 82 New Zealand intensive care nurses were randomly allocated to the three studies; 65 participated. In study one (n = 23), the most frequently endorsed elements included: workload (n = 14), job satisfaction (n = 13) and support (n = 13). In study two (n = 25), the highest rated elements included: feeling valued, respect, support, work-life balance and workplace culture. Elements of support, work-life balance and workload were in the top five most frequently endorsed elements and were also rated in the top 12 most central. Overall, the ratings of centrality and number of endorsements were positively correlated (r = 0.35, P < 0.05). In study three (n = 17), nine participants selected the same rating across both narratives with no differentiation on the 11-point scale and were excluded from analysis. The mean score for the central narrative was 7.88 and for the peripheral narrative was 7.38. Confirmatory analyses did not reach statistical significance. CONCLUSIONS: Unique conceptions of work well-being were identified. Workload and work-life balance were central characteristics. Feeling valued and experiencing respect and support were considered most important. RELEVANCE TO CLINICAL PRACTICE: Intensive care nurse conceptions of work well-being are fundamental for future measures of work well-being and future interventional studies and initiatives.