Nurse Resiliency and Health in Practicing Nurses Before and During COVID-19.

OBJECTIVES: The aim of this study was to compare the degree of resilience and self-perceived physical and mental health in nurses before and during the COVID-19 pandemic. BACKGROUND: Work-related stress among nurses is recognized as an antecedent of burnout, which in turn impacts resiliency and well-being. The work of nursing has long been noted as stressful. Although nurse resilience and perceived well-being have been shown to decrease during a period of usual stress (constant and chronic), the impact and significance of prolonged stress on nurse resilience and well-being illuminates throughout the literature. METHODS: Replicating a cross-sectional prepandemic study, nurses were resurveyed in 2020 during the COVID-19 pandemic. In both studies, the Connor-Davidson Resilience Scale and PROMIS Global Health was used to measure respondent's: 1) resilience level; 2) physical health status; and 3) mental health status, respectively. Independent 2-sample t tests were performed to compare the pre-and-post score differences in the 3 outcomes. To identify characteristics that were associated with the pre-and-post differences, comparison analyses were also performed within each level of the respondents' characteristic variables. RESULTS: A higher proportion of postsurvey respondents reported working more than 8 hours of overtime per week, had thoughts of quitting their current job, and thought their workload was too much compared with the presurvey respondents. Generally, the postgroup resilience scores and self-perceived physical and mental scores were statistically significantly lower compared with the pregroup scores, but those differences were only observed in certain subgroups defined by respondents' characteristics. CONCLUSIONS AND IMPLICATIONS: Self-perceived physical and mental health are significantly associated with the degree of resilience and worsened during the COVID-19 pandemic, especially in younger and older nurse cohorts. Engaged nurse leaders are key to implement interventions that build resilience and perceived well-being during periods of usual and prolonged stress.

Interprofessional Education in Psychology Doctoral Programs, Internships, and Postdoctoral Training: A Survey of Training Directors.

Interprofessional Education (IPE) is intended to prepare health professionals for teambased care. Little is known about IPE offerings for psychology trainees. The article reports on a survey of training directors (263) from graduate school, internship, and fellowship programs about IPE in a 39-item survey. Most programs have IPE activities across 17 types (e.g., classroom didactics, IP team care, Grand Rounds, simulations, etc.), though 34% reported no or poorly coordinated IPE. Barriers included limited funding/protected time and conflicting student schedules. Resources needed for implementing IPE included incorporating IPE into clinical settings, curricular materials, and evaluation tools. Only 15% felt institutional leadership considered IPE a high priority. Training directors need leadership engagement and support, protected time, and administrative support as well as faculty development for event design and facilitation skills. This study is an exploratory first step, more granular investigation of quality and quantity of IPE from training directors' perspectives is needed.

A Descriptive Study of Resiliency and Health in Practicing Nurses.

OBJECTIVES: The aim of this study was to identify the degree of resilience and self-perceived physical and mental health in practicing nurses. BACKGROUND: Stressors and challenges of everyday demands influence resilience and well-being in acute care nurses. METHODS: Nurses were surveyed using the Connor-Davidson Resilience Scale and PROMIS Global Health. One sample t test compared the study group to the general population mean of resiliency, physical and mental health scores. Linear regression analysis identified factors associated with resiliency. RESULTS: Of the 859 practicing nurses in the sample, most were female and White, had a BSN or associate of science in nursing degree (55.2%, 30.0%) and more than 10 years of experience (57.1%), and worked in direct patient care (77.0%). Nurses had low resiliency (P < .0001) and physical health (P = .0037). Well-being factors included 2 or more missed days/shifts in 3 months (P < .001), thoughts of quitting (P = .003), and perceptions that workload was too much (P < .001). CONCLUSIONS: Self-perceived physical and mental health was significantly associated with the degree of resilience.

Performance of Pediatric Systemic Inflammatory Response Syndrome and Organ Dysfunction Criteria in Late-Onset Sepsis in a Quaternary Neonatal Intensive Care Unit: A Case-Control Study.

OBJECTIVES: To evaluate accuracy of systemic inflammatory response syndrome (SIRS) criteria in identifying culture-proven late-onset neonatal sepsis and to assess prevalence of organ dysfunction and its relationship with SIRS criteria. STUDY DESIGN: This was a retrospective case-control study of patients in the Children's Hospital of Philadelphia level IV neonatal intensive care unit undergoing sepsis evaluations (concurrent blood culture and antibiotics). During calendar years 2016-2017, 77 case and 77 control sepsis evaluations were identified. Cases included infants who had sepsis evaluations with positive blood cultures and antibiotic duration ≥7 days. Controls were matched by gestational and postmenstrual age, and had sepsis evaluations with negative blood cultures and antibiotic duration ≤48 hours. SIRS criteria were determined at time of sepsis evaluation, and organ dysfunction evaluated in the 72 hours following sepsis evaluation. Statistical analysis included descriptive statistics, Mann-Whitney tests, and χ2 (Fisher exact) tests. RESULTS: At time of sepsis evaluation, 42% of cases and 26% of controls met SIRS criteria. Among infants of ≤37 weeks postmenstrual age, SIRS criteria were met in only 17% of sepsis evaluations (4 of 23 in both cases and controls). Test characteristics for SIRS at diagnosis of culture-proven sepsis included sensitivity 42% and specificity 74%. Cases had higher rates of new organ dysfunction within 72 hours (40% vs 21%); however, 58% of cases developing organ dysfunction did not meet SIRS criteria at time of sepsis evaluation. Of 6 deaths (all cases with organ dysfunction), 2 did not meet SIRS criteria at sepsis evaluation. CONCLUSIONS: SIRS criteria did not accurately identify culture-proven late-onset sepsis, with poorest accuracy in preterm infants. SIRS criteria did not predict later organ dysfunction or mortality.

Interventricular Septal Hematoma Complicating Ventricular Assist Device Placement in an Infant: Case Report and Review of the Literature.

Interventricular septal hematoma is a rare and life-threatening complication of pediatric cardiac surgery. Commonly seen following ventricular septal defect repair, it has also been associated with ventricular assist device (VAD) placement. Although conservative management is usually successful, operative drainage of interventricular septal hematoma occurring in pediatric patients undergoing VAD implantation should be considered.

Longitudinal Trends of Vascular Flow and Growth in Patients Undergoing Fontan Operation.

BACKGROUND: Single ventricle (SV) patients undergo multiple surgeries with subsequent changes in anatomy and hemodynamics. There are little cardiac magnetic resonance (CMR) data on serial changes in these patients. This study aimed to assess longitudinal changes of SV anatomy and hemodynamics in a large cohort. METHODS: Anatomy and flow in SV patients with serial CMRs performed between 2008 and 2019 at a single institution were retrospectively reviewed. Mixed-effects linear regression was used to estimate changes over time at 3 to 9 months, 1 to 5 years, and >5 years after Fontan. RESULTS: A total of 119 patients were included (51% with hypoplastic left heart syndrome; 77% underwent extracardiac Fontan). A total of 88 patients had 3 serial CMRs. Indexed right superior vena cava, inferior vena cava, neoaortic valve, and descending aorta area decreased over time (beta = -0.19, -0.44, and -0.23, respectively; P < .01), as did indexed right superior vena cava, neoaorta and native aorta, and descending aorta flow (beta = -0.49, -0.53, and -0.59, respectively; P < .0001). Inferior vena cava flow and its contribution to total caval flow increased (beta = 0.33; P < .0001). Indexed right and left pulmonary artery flow did not change; however, indexed left pulmonary artery area decreased (beta = -0.16; P = .0014) with time. Systemic-to-pulmonary collateral flow remained unchanged before and early after Fontan (beta = -0.54; P = .42) but decreased with time from Fontan (beta = -0.22; P < .0001). CONCLUSIONS: In this cohort of longitudinally followed SV patients, there are significant trends in vascular size and flow over time from Fontan. These findings can be used as a framework to interpret serial CMR data in the SV and noninvasively identify deviations from expected patterns before the development of clinical symptoms.