The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design.

AIMS: To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. DESIGN: Nested diary study. METHODS: Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. RESULTS: Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. CONCLUSION: The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. IMPACT: By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Resilience in late adolescence/young adulthood: Rising to the occasion?

The developmental period of late adolescence/young adulthood is characterized by transitioning to an independent individual with a self-identity, established health habits and the components of resilience: (1) confidence in one's abilities (personal competence) and (2) the ability to adapt to changes (acceptance of self and life). This two-wave, prospective study examines the associations among self-identity, health habits and resilience in 18 year olds (n = 149) before military service and six months afterward. The questionnaire included validated scales of resilience and self-identity, as well as instruments measuring health habits, family environment and demographic characteristics. Cross-sectional findings indicated that resilience at baseline was associated with gender-male (p < .05), lower distress (p < .001) and higher identity-affirmation/belonging (p < .05). Longitudinal findings showed that resilience was associated with changes of distress (p < .05) and the resilience component of personal competence (p < .001). Cross-sectional and longitudinal perspectives on 18-year-old military recruits portrayed different pictures. The cross-sectional findings showed that resilience was associated with lower distress and higher feelings of affirmation/belonging (self-identity); however, longitudinal findings showed that resilience was predicted by the ability to adapt to changes under stress. Resilient 18 year olds demonstrated the ability to adapt to stressful situations, but psychological distress may impede the development of self-identity.

The relationship between quick return shift schedules and burnout among nurses: A prospective repeated measures multi-source study.

BACKGROUND: In today's world, essential health care services are expected round the clock, leading to distinct shift work requirements. A notable aspect is the "quick return," where the rest interval between nursing shifts is <11 h. Preliminary research suggests a potential association between quick return schedules, diminished sleep quality, and possible nurse burnout. Yet, the motivation of nurses could potentially moderate this relationship. OBJECTIVE: To examine a moderated-mediation model, whereby sleep duration and nurse's motivation act together to mediate the link between quick return schedules and nurse's burnout. DESIGN: A prospective repeated measures (4-5 nursing shifts per nurse) multi-source (self-report and objective measures) study. SETTING: Internal and surgical departments across one large and one medium scale teaching hospitals in Israel. PARTICIPANTS: Registered nurses who provide direct patient care (n = 79) across 369 shifts. METHODS: Nurses completed a questionnaire containing personal information and information regarding their shifts during the study week. They wore an accelerometer (a wrist worn device that monitors and records an individual's activity level) during a work-week to objectively determine their sleep duration, completed a motivation questionnaire at the beginning of each shift, and completed a burnout questionnaire at the end of the week. Mixed-model regression analysis was used to test a moderated-mediation model following Hayes' recommendations, whereby the joint effect of sleep duration and motivation mediates the link between quick return schedules and burnout. RESULTS: The moderated-mediation model was supported. Quick return schedules were negatively statistically significantly associated with sleep duration (b = -126.54, SE = 20.85, p < 0.001); so that more frequent quick return schedules were related to shorter sleep duration. However, no direct correlation was observed between sleep duration and burnout (p = 0.171). A statistically significant interaction was observed between sleep duration and motivation (b = 0.00, SE = 0.00, p < 0.001) concerning burnout. Thus, nurses with lower motivation were prone to experiencing higher levels of burnout with shorter sleep duration compared to nurses with higher motivation. CONCLUSIONS: The mediating role of sleep duration, moderated by motivation, plays a role in the connection between quick return schedules and burnout. This indicates that nurses can sustain their work motivation even within the demands of quick return schedules, consequently mitigating burnout levels. To prioritize employees' well-being, organizations should adopt shift work structures that minimize quick return schedules and extend nurses' sleep duration. Consequently, managers must employ strategies to enhance nurses' motivation when addressing scenarios that necessitate quick return schedules.