Factors protecting Swiss nurses' health during the COVID-19 pandemic: a longitudinal study.

BACKGROUND: The COVID-19 pandemic reached Europe in early 2020 and impacted nurses over a prolonged period, notably causing heavy work overloads. Exposure to sources of stress in such situations is inevitable, which can put nurses' health at risk. The present study took a salutogenic approach to investigating nurses' health and the principal factors protecting it found in the literature (i.e., resilience, post-traumatic growth, social support, and certain organizational factors), as well as how those elements evolved from February 2021 to September 2022. METHODS: All nurses working at eight French-speaking Swiss hospitals who accepted to disseminate the study to their employees were invited to complete an online questionnaire at four time points (February 2021, September 2021, March 2022, and September 2022: T0, T1, T2, and T3, respectively) and respond to items measuring their health, factors protecting their health, and their perceived stress levels. Data were analyzed using random-intercept linear regression models. RESULTS: A cumulated total of 1013 responses were collected over all measurement points (625 responses at T0; 153 at T1; 146 at T2; 89 at T3). Results revealed that nurses' health had not changed significantly between measurements. However, their perceived stress levels, feelings of being supported by their management hierarchies, and belief that they had the means to deliver a high quality of work all diminished. At every measurement point, nurses' health was negatively associated with perceived stress and positively associated with resilience, perceived social support, and the belief that they were provided with the means to deliver a high quality of work. CONCLUSION: Despite the difficult conditions caused by the pandemic, the factors recognized as protective of nurses' health played their role. The lack of improvements in nurses' health in periods when the pandemic's effects lessened suggests that the pressure they were experiencing did not drop during these moments. This phenomenon may have been due to the need to clear backlogs in scheduled surgery and the work overloads caused by prolonged staff absences and nurses quitting the profession. Monitoring changes in nurses' health is thus crucial, as is establishing measures that promote factors protective of their health. Organizational factors influencing nurses' working conditions are also key and should not be neglected.

Émotions des infirmières au chevet des malades hospitalisés pour la COVID-19. Recherche qualitative consensuelle.

The COVID-19 pandemic has created unprecedented working conditions, with repercussions on the daily lives of nurses. The events experienced positively or negatively in their clinical practice have aroused a variety of emotions for them. The objective of this research is to describe and categorize the events that provoked emotions in nurses who volunteered to accompany COVID-19 victims in a Belgian academic hospital during the first wave of the pandemic by identifying what these emotions were. The researchers used Hill's Consensual Qualitative Research method. Nineteen semi-structured individual interviews were conducted. After the full transcription of the recordings, the data were analyzed by the research team. The results show that the emotions felt by the participants were caused by thirty-seven types of events (categories) grouped into nine families (domains). COVID-19 is viewed negatively by the participants who express fear of this serious and contagious disease. When they talk about the experiences of patients and their families, their discourse alternates between joy at having been able to provide help and care and sadness at not having been able to be effective in all circumstances. Participants share a positive experience and express joy in recalling the COVID-19 outbreak as an exceptional event that they coped with through their personal and professional experience and resources, their relationships with colleagues on the interprofessional team, and the responses of the nursing department and hospital.

Effects of an educational intervention to strengthen humanistic practice on haemodialysis nurses' caring attitudes and behaviours and quality of working life: a cluster randomised controlled trial.

BACKGROUND: Nurses are trained to establish a trusting relationship with patients to create an environment promoting patients' quality of life. However, in tech-heavy care settings, such as haemodialysis units, dehumanising practices may emerge and take root for various reasons to the potential detriment of both patients and nurses. For patients, this may lead to a deterioration of quality of life and, ultimately, of health status. For nurses, it may cause a deterioration of the work environment and, in turn, of quality of working life. Based on Watson's Theory of Human Caring, we developed a brief educational intervention for haemodialysis nurses to strengthen their humanistic practice in the aim of improving the nurse-patient relationship and nurse quality of working life.. The intervention was tested by way of an experimental design. METHODS: One hundred and one haemodialysis nurses, recruited in ten hospitals in French-speaking Switzerland, were randomised into an experimental group that received the intervention and a control group. The nurse-patient relationship was measured with the Caring Nurse-Patient Interaction Scale (EIIP-70) and nurse quality of life at work was measured with the Quality of Work Life Questionnaire at four time points: pre-intervention, intervention completion, and six-month and one-year follow-ups. Random intercept regression analysis was used to evaluate change over time in the two variables under study. RESULTS: The intervention appeared to reinforce nurse attitudes and behaviours geared to a more humanistic practice. The effect seemed to fade over time but, 1 year post-intervention, six dimensions of the nurse-patient relationship (hope, sensibility, helping relationship, expression of emotions, problem solving, teaching) scored above baseline. Nurse quality of working life, too, seemed positively impacted. The cultural dimension of nurse quality of working life, that is, the degree to which everyday work activities attune with personal and cultural values, seemed positively impacted, as well, with improvement stable throughout the year following the intervention. CONCLUSIONS: Results support a positive effect of the intervention over both the short term and the medium-to-long term. A brief intervention of the sort may constitute an effective means to improve the nurse-patient relationship by preventing or reducing dehumanising practices. TRIAL REGISTRATION: NCT03283891 .

Scope of nursing practice on a surgery ward: A time-motion study.

AIM: To log the activities of registered nurses and nursing assistants on a visceral surgery ward. BACKGROUND: By prioritizing their activities, nurses fail to exercise their full scope of practice even though this is essential for health care systems to function effectively and efficiently. METHOD: A descriptive observational time-motion study was conducted over a period of 48 days. The activities of nurses (n = 24) and nursing assistants (n = 9) were logged over the course of their entire work shifts, both in the day and at night. RESULTS: In all, 499 hr of observation were logged. Tasks that fell under the dimensions of care activities and of communication and care coordination, which cover documentation, non-care activities and delegated medical tasks, were the ones that took up most of the nurse work time. Patient assessment, relational care, therapeutic teaching/coaching, and knowledge updating and utilization were categories that nurses were under-engaged in. CONCLUSION: The study shows that the scope of nursing practice was not optimal. IMPLICATION FOR NURSING MANAGEMENT: The results can serve to improve the work environment of carers, optimize the use of human resources and increase the visibility and efficiency of nursing work.

Effects on nurses' quality of working life and on patients' quality of life of an educational intervention to strengthen humanistic practice among hemodialysis nurses in Switzerland: a protocol for a mixed-methods cluster randomized controlled trial.

BACKGROUND: Humanistic nursing practice constitutes the cornerstone of the nursing profession. However, according to some authors, such practice tends to fade over time in favour of non-humanistic behaviours. To contrast this tendency, an educational intervention (EI) based on Watson's Theory of Human Caring was developed and tested in two pilot studies involving, respectively, rehabilitation nurses in Quebec (Canada) and haemodialysis (HD) nurses in Switzerland. In light of the positive results obtained in these, another study is being undertaken to examine more in depth the EI's effects on both HD nurses and patients in French Switzerland. The EI is expected to have positive effects on quality of nurse-patient relationship (NPR), team cohesion, nurse quality of working life (QoWL), and patient quality of life (QoL). METHODS/DESIGN: The study described in this protocol will use a mixed-method cluster randomised controlled trial design. For the quantitative component, nurse and patient data will be collected through questionnaires. The accessible population of 135 nurses and 430 patients will be clustered into 10 HD units. These units will be randomised into an experimental group (EG) and a waiting-list control group (WLCG). Measurements will be taken at baseline (pre-intervention) and repeatedly over time (post-intervention): immediately at EI completion and six and 12 months thereafter. For the qualitative portion of the study, 18 semi-structured interviews will be conducted with EG nurses picked at random two months after EI completion to explore perceived changes in nurse humanistic practice. Qualitative data will be analysed through the relational caring inquiry method, a phenomenological approach. Descriptive and inferential statistics will be computed from the quantitative data. DISCUSSION: The study described in this protocol will determine if and how the proposed EI promotes humanistic nursing practice and how this practice affects quality of NPR, nurse QoWL, and patient QoL. Moreover, it will lay the groundwork for offering the EI to nurses in other healthcare sectors. TRIAL REGISTRATION: This clinical study was registered with ClinicalTrials.gov [NCT03283891, 14/09/2017].

[Evidence of lack of agreement between hemodialysis patients and nurses on presence and severity of symptoms.] / Évidence d'un manque de concordance entre les patients hémodialysés et les infirmières sur la présence et la sévérité des symptômes.

Hemodialysis patients constitute a vulnerable population whose quality of life is affected by the many symptoms (e.g., pain, fatigue) they experience. The presence and severity of these symptoms are significantly under-assessed by health professionals. The purpose of this study was to describe and compare the symptoms perceived by hemodialysis patients versus those detected by nurses. A total of 123 patients and 70 nurses working in six hemodialysis centers were included in the study. The results show that participating nurses detected less than 50% of the symptoms perceived by patients. Agreement between hemodialysis patients and nurses regarding symptom presence and severity was slight to fair at best (kappa < 0.47). This suggests that improving the knowledge and skills of hemodialysis nurses for detecting the symptoms of the patients in their care could go a long way toward intervening more efficiently and improving the quality of the care they offer.

Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV.

This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.

[French scale validation of the Infant Behavior Questionnaire three months after birth]. / Validation en langue française de l'instrument Infant Behavior Questionnaire (IBQ) à trois mois de vie de l'enfant.

Breastfeeding is recognize to be the perfect food of mother and child's health. The child's temperament is one of the factors that may explain pursuing the breastfeeding. Few instruments are available in French to measure this factor. The objective of the study is to present and validate the French translation of the scale "Infant Behavior Questionnaire" (IBQ). The sample consists of 193 primaparous or multiparous women who gave birth in a maternity in Paris. The child's temperament questionnaire was sent by mail three months after the birth. The same questionnaire was sent to a sub-sample of 30 women 15 days later. Analyses were conducted to assess the temporal stability, internal consistency, construct validity and predictive. The different results tend to show a compliant validity to the french scale version. This first IBQ French-language validation is worth pursuing in order to confirm the scale factor structure and participate to studies supporting mothers in their breastfeeding project.

[Physiological ageing is not a disease]. / Le vieillissement physiologique n'est pas une maladie.

Physiological ageing is a slow process which brings about natural changes in the functioning of the organism. These changes are to be distinguished from the effects of diseases. Nurses, who care for more and more elderly people due to the ageing of the population, must be able to distinguish between these changes to adjust their practice.

[The nurse and the clinical examination of the nervous system]. / L'infirmière et l'examen clinique du système nerveux.

The clinical examination of the neurological system provides valuable information regarding a person's health status. The nurse, in her daily practice, must be able to identify certain signs which may reveal situations requiring urgent treatment. Others are regularly assessed to monitor the evolution of the patient's condition.

[The nurse faced with sudden cardiac arrest]. / Pratique infirmière en situation d'arrêt cardiaque.

The nursing intervention in a sudden cardiac arrest only comes as a continuation of the resuscitation procedures undertaken by the first person on the scene. Hence the importance of raising the awareness of and training the general public. In a healthcare facility, experts recommend putting in place an emergency procedure, a standard crash trolley and a dedicated life-threatening emergency response team.

[Clinical examination of respiratory function]. / L'examen clinique de la fonction respiratoire.

The physical pulmonary examination consists of four stages: inspection, palpation, percussion and auscultation. Rarely used in current practice by French nurses, it is nevertheless an important part of the clinical examination of the respiratory function.

[Recognition of nursing as an academic discipline in French-speaking Europe]. / La reconnaissance des sciences infirmières comme discipline académique en Europe francophone.

Nursing is recognized worldwide as an academic discipline. However, if we look at nursing training in Belgium, France, Luxembourg and Switzerland, this does not appear to be the case. Disparities persist not only in terms of initial training, but also in graduate and post-graduate training. This underlines the difficulties of establishing and recognizing nursing as an academic discipline in the French-speaking European area.

[The French version of Symptom Management Theory and its application]. / Version Française de la Théorie de Gestion des Symptômes (TGS) et son application.

Patients with chronic diseases remain a challenge for patient centered care in terms of symptom management. In advancing the nursing profession in this respect, organizing and providing such care in a structured and systematic way benefits from being grounded in a sound theoretical framework. Since 1994, University of California in San Francisco's Symptom Management Theory (SMT) holds promise to provide such theoretical foundation. This paper aims at presenting a French version of the SMT, the "théorie de gestion des symptômes (TGS)" as well as at discussing its application in research and practice. The paper illustrates how different concepts of SMT interrelate for different symptoms or symptom clusters in light of the current state of knowledge. Furthermore, a selection of symptom assessment scales available in French are presented to inform practice, education and research. We believe that providing a French version of the SMT will foster a systematic and structured development of symptom management in nursing practice and research in francophone regions or countries.

[Accidental hypothermia, not just a clinical sign, a social alarm bell]. / L'hypothermie accidentelle, plus qu'un signe clinique, une alerte sociale.

Accidental hypothermia, even slight, affects the physiological functioning of the body. It requires all the attention of the caregivers, both in terms of prevention among vulnerable people as well as its treatment. Two types of rewarming therapy, one external and passive, the other internal and active, can be envisaged depending on the seriousness of the hypothermia to be treated.

[Dyspnea, a symptom with multifactorial causes]. / La dyspnée, un symptôme d'origine multifactoriel.

Dyspnoea is a symptom which must not be trivialised. It corresponds very often to a severe functional disorder and can quickly place the patient's life under threat. Worrying for the patient, this symptom will be explored in detail by the nurse on a clinical level and quantified with the aid of assessment scales.

[Taking the temperature, a procedure which should not be trivialized]. / La prise de la température, un geste a ne pas banaliser.

Along with blood pressure, temperature is one of the fundamental parameters most frequently measured by nurses in their daily practice. Different sites of the body are suitable. They are reviewed here with their respective methodologies, advantages and disadvantages in order to adapt nurses' clinical practice as best as possible.

Relationship among symptoms, quality of life, and complementary and alternative medicines use among patients undergoing hemodialysis in French-speaking Switzerland.

BACKGROUND: Chronic renal disease is considered a main public health problem due to its high prevalence in the population. The solution of choice currently available is kidney transplantation but when this option is not available, blood purification treatments, notably haemodialysis (HD), are necessary. The presence of chronic renal disease combined with this demanding medical procedure leads to a hard symptomatology. To face this situation, HD patients often resort to complementary and alternative medicines (CAM) as they perceive that the healthcare professionals aren't paying enough attention to their quality of life. Given this background, we aim to describe the prevalence and the type of the CAM used among HD patients and their possible relations with patients' symptomatology and quality of life. METHODS: We interviewed 88 patients, undergoing hemodialysis in three hemodialysis centers in French-speaking Switzerland, about the presence of symptoms, their quality of life, and the possible use of CAM. Cluster analysis was used to create patients' profiles about CAM use and regression analysis to explore the links between symptoms' presence, patients' quality of life, and CAM use. RESULTS: Our results show a large use of CAM: almost two HD patients out of three uses at least one CAM. Using cluster analysis, we were able to identify five patients' profiles: non-users (37.5% of our sample), users of herbal medicine (20.5%), users of prayer-based practices (18.2%), people mainly using massages (9.1%), and a residual group including the users of other CAMs, with a predominance of meditation (14.8%). As expected, we observe a negative relation between the number of declared symptoms and patients' quality of life. Contrarily, we observe no relation between the use of CAM and the presence of symptoms. Our results show a positive relationship between the use of CAM and patients' overall perception of health as well as the psychological dimension of their quality of life. No relationship is observed with other dimensions of quality of life, notably the physical dimension. CONCLUSIONS: Our results suggests that CAMs aren't used as a substitute of official medicine but as a parallel support to HD patients' quality of life.

[A questioning method to guide the nursing clinical assessment]. / Une méthode de questionnement pour guider le jugement clinique infirmier.

Often minimised by patients, the symptoms they experience in the evolution of chronic diseases must be explored rigorously by healthcare professionals. The PQRST questioning method is a mnemonic tool which enables the nurse to cover the essential elements of the description of a symptom, thereby facilitating the clinical assessment.

[Assessment of oedema]. / L'evaluation de l'oedème.

Oedema signals a more or less significant disturbance of the capillary balance. Generalised or localised, it usually affects the lower parts of the body, notably the lower limbs. It can be a sign of heart failure which is why it is important for nurses to know how to spot, classify and above all assess the different types of oedema.