The Effects of an Educational Program on the Professional Quality of Life and Health of Nurses: A Cluster Experimental Design.

BACKGROUND: The complexity of the healthcare environment and intense workloads may negatively impact the health and professional quality of life (ProQOL) of nurses. Prior research has identified a significant association in nurses between ProQOL and health. Developing an intervention to improve the ProQOL and health of nurses may benefit the quality of nursing care. PURPOSE: The aim of this study was to explore the effects of a compassion fatigue Resiliency, mindfulness Respiration, and Relatives and friends' support (i.e., 3Rs) educational program on ProQOL, physical health, and mental health in nurses. METHODS: A cluster experimental design was used in this study to recruit registered nurses at two regional teaching hospitals in southern Taiwan as participants. The experimental group (n = 67) attended the 4-week (2-hours-per-week) 3R educational program. The control group (n = 57) received no intervention. The outcome variables, including compassion satisfaction, burnout, secondary traumatic stress, physical health, and mental health, were measured at baseline, at the end of the intervention (immediate effect), at 4 weeks postintervention (short-term effect), and at 12 weeks postintervention (medium-term effect). The study was conducted from May 2017 to December 2017. RESULTS: Increases in compassion satisfaction and mental health and decreases in secondary traumatic stress were significantly greater in the experimental group than in the control group between baseline and all three posttest time points. Moreover, burnout decreased and physical health improved more significantly in the experimental group than in the control group between the baseline and end of intervention time points (p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 3R educational program intervention, integrating compassion fatigue resiliency, mindfulness respiration, and support from relatives and friends, had immediate and positive effects on ProQOL as well as physical and mental health. Moreover, the intervention was shown to have short-term and medium-term positive effects on compassion satisfaction, secondary traumatic stress, and mental health. Nursing managers may apply programs that integrate compassion fatigue resiliency, mindfulness respiration, and relatives and friends' support to improve ProQOL and health in nurses.

Quantification of the severity of outflow stenosis of hemodialysis fistulas with a pulse- and thrill-based scoring system.

BACKGROUND: Hyper-pulsatility of hemodialysis arteriovenous fistula (AVF) is the basic physical examination finding when there is outflow stenosis. The arm elevation test can also be utilized to detect outflow stenosis. If there is no significant outflow stenosis, the AVF should collapse, at least partially, because of the effect of gravity when the AVF-bearing arm is elevated to a level above that of the heart. However, if there is significant outflow stenosis, the portion of the AVF downstream of the stenosis will collapse, while the portion upstream of the stenosis will remain distended (Clin J Am Soc Nephro 8:1220-7, 2013). In our daily practice, when performing the arm elevation test, we not only observe the collapsibility of the access outflow but also palpate the outflow to identify a background thrill that sometimes disappears with the arm at rest, only to reappear when the arm is elevated. If there is no thrill upon arm elevation, we assume that the outflow stenosis is severe and refer to this condition as "physical examination significant outflow stenosis" (PESOS). The aim of this study is to characterize PESOS using percentage stenosis and Doppler flow parameters. METHODS: We performed a case-control study using data collected prospectively between June 2019 and December 2019. A pulse- and thrill-based score system was developed to assess the severity of AVF outflow stenosis. We recorded the outflow scores and Doppler measurements performed in 84 patients with mature fistulas over a 6-month period. Angiograms were reviewed to determine the severity of outflow stenosis, which was assessed by calculation of percentage stenosis. RESULTS: Receiver operating characteristic analysis showed that a cutoff value of ≥74.44% stenosis discriminated PESOS from other AVF outflow scores, with an area under the curve of 0.9011. PESOS diagnosed cases with ≥75% outflow stenosis in an AVF, with a sensitivity of 80.39%, a specificity of 78.79%, a positive predictive value of 85.42%, and a negative predictive value of 72.22%. CONCLUSIONS: PESOS can be used to diagnose ≥75% outflow stenosis in an AVF, with or without a significant collateral vein, and its diagnostic accuracy is high. The use of PESOS as an indicator for treatment implies that physical examination may represent a useful surveillance tool.

Associations of professional quality of life and social support with health in clinical nurses.

AIM: To explore the associations of the professional quality of life and social support with health in nurses. BACKGROUND: Physical and mental health may be associated with absence from work among nurses. Few studies have explored the associations of professional quality of life and social support on the physical and mental health of nurses. METHODS: This was a cross-sectional study. In total, 294 nurses were recruited from a hospital in Southern Taiwan. A self-report questionnaire was used to collect data. RESULTS: Burnout, secondary traumatic stress and social support from relatives or friends were important factors of physical and mental health. Interactions between support from relatives or friends and secondary traumatic stress are important factors in physical health. CONCLUSION: Reducing burnout and secondary traumatic stress is important for physical and mental health of nurses. Increasing social support from relatives or friends may be useful to reduce the negative effects of secondary traumatic stress on the physical health of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers could design interventions to reduce and prevent nurses from being influenced by burnout and secondary traumatic stress. Educating nurses to build effective social networks with relatives or friends and to seek support when experiencing secondary traumatic stress may also be needed.

[A nurse's experience caring for a patient with breast cancer who had been previously reported dead by her family].

This article describes the author's experience caring for a female with breast cancer who was reported dead by her family four years earlier due to a long-term disappearance. She had been transferred multiple times hospital to hospital due to inability to afford medical care. Data were collected via observations, interviews, and physical assessments. The author identified four primary problems, including impaired tissue integrity, pain, being compelled to abandon treatment due to financial status, desire for familial support, and sense of guilt toward her family. The author used Watson's Caring Theory to build trust with the patient and provided guidance on wound treatment, pain relief, and rebuilding family relationships in order to help restore the patient's identity and financial aid. As a result, the patient was able to transfer to a public hospital where she received free medical assistance and regained hope in her therapy. However, the palliative-care coordinator misinterpreted the referral and, as a result, experienced moral distress. After clarifying and explaining the meaning and importance of the patient referral, the coordinator accepted her and continued care. This case report can provide a reference for nurses caring for patients without personal identity or financial aid. Nurses should be aware of the presence of moral distress in other medical team members. Early recognition and timely management of team members' moral distress is fundamental to providing the best quality of care for patients and their families.

[Compassion fatigue: a concept analysis].

Compassion fatigue is a relatively new term in nursing. This term describes mood swings experienced by healthcare providers that are both complex in origin and intensify over time due to cumulative stress. Quality of care can be affected if compassion fatigue goes untreated. This paper presents a concept analysis of compassion fatigue using Walker & Avant's method. Results show the defining attributes of compassion fatigue to include: 1. accumulated patient and family suffering; 2. sufferer unable to release built-up stresses effectively; and 3. negative effects on physical, psychological, and spiritual health. Identified antecedents of compassion fatigue included: (1) working as a healthcare provider; (2) investing sympathy in others over a long period of time; and (3) ignoring stress symptoms and personal emotional needs over time. Identified consequences of compassion fatigue included: (1) decreased coping ability; (2) damage / destruction of patient relationship; and (3) increased medical care costs. This study conducted a concept analysis to offer a better understanding of the concept of compassion fatigue and provide a reference for nursing practice and compassion fatigue-related nursing research.

Evaluation of a Leadership Orientation Program in Taiwan: preceptorship and leader competencies of the new nurse manager.

The Leadership Orientation Program is designed to provide new nurse managers with the experience and support that assures them of a smooth transition from their current roles to being managers. The main objective of this study was to gain an understanding of the relationship that exists between a nursing preceptorship and a new nurse manager's competencies; it also attempted to establish a predictive model of leader competencies to improve the program. A descriptive cross-sectional research design and rigorous questionnaires were used in this study. Fifteen new nurse managers, 101 staff nurses, and 20 nurse administrators were recruited from those engaged in ongoing preceptorship. Over the course of the study statistically significant improvements in preceptorship were noted in both new manager educational background and support from staff nurses. Eighty-five percent of new nurse managers had good or excellent performance ratings (Mean=84.25%). The significant predictive factors of nurse leader competencies were the educational background of new managers and the teaching resources available with regard to preceptorship (R(2)=88.5%, F=6.86, p<0.001).