Impact of engagement factors on nurses' intention to leave hospital employment.

AIM: To determine the impact of workforce engagement factors on nurses' intention to leave their hospital. BACKGROUND: Nurse retention is important for safe patient care. It is unknown whether meaning and joy in work, occupational fatigue, job satisfaction and unprofessional behaviour experiences predict hospital nurse turnover intentions. METHOD: This cross-sectional study involved responses from 747 nurses from two south-western hospitals. Measures included surveys to capture meaning and joy in work, job satisfaction, occupational fatigue and unprofessional behaviour exposure/impact. RESULTS: Following correlational analyses, manifest variables significantly correlated with related latent factors. In structural equation modelling, greater chronic occupational fatigue was the strongest and meaning and joy at work (negative direction) the next strongest predictor of turnover intention. Although significant, job satisfaction and acute fatigue were weak predictors. Inter-shift recovery did not predict intent to leave. CONCLUSION: This is the first study to identify Chronic Fatigue and meaning and joy in work as significant predictors of hospital nurse turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Employing practices that decrease chronic fatigue and increase meaning/joy in work are recommended to improve nurse retention.

A work systems analysis approach to understanding fatigue in hospital nurses.

Occupational fatigue is an important challenge in improving health and safety in health care systems. A secondary analysis of cross-sectional data from a survey sample comprised 340 hospital nurses was conducted to explore the relationships between components of the nursing work system (person, tasks, tools and technology, environment, organisation) and nurse fatigue and recovery levels. All components of the work system were significantly associated with changes in fatigue and recovery. Results of a tree-based classification method indicated significant interactions between multiple work system components and fatigue and recovery. For example, the relationship between a task variable of 'excessive work' and acute fatigue varied based on an organisation variable related to 'time to communicate with managers/supervisors'. A work systems analysis contributes to increased understanding of fatigue, allowing for a more accurate representation of the complexity in health care systems to guide future research and practice to achieve increased nurse health and safety. Practitioner Summary: This paper explored the relationships between nursing work system components and nurse fatigue. Findings revealed significant interactions between work system components and nurses' fatigue and recovery. A systems approach allows for a more accurate representation of complexity in work systems and can guide interventions to improve nurse health and safety.

Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses.

AIMS: To identify fatiguing tasks and develop a model of sources of fatigue in nursing work. BACKGROUND: Research has identified multiple factors contributing to occupational fatigue; however, comprehensive consideration of diverse factors identified by nurses as contributing to fatigue in nursing work systems is lacking. METHODS: Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses. Responses from 100 registered nurses to questions related to the most fatiguing tasks in their work and factors that cause those tasks to be most fatiguing were analysed. RESULTS: Physically demanding patient care tasks, and organisation, management and logistics tasks, respectively, were listed as the most frequent physically and mentally fatiguing. Time and multitasking demands were listed frequently as sources of both fatigue dimensions. CONCLUSIONS: Registered nurses reported working in environments that include physically and mentally fatiguing tasks. They identified factors related to work content demands, including physical and mental task demands as well as time and multitasking demands, as most frequently contributing to fatigue. IMPLICATIONS FOR NURSING MANAGEMENT: This work and our conceptual model of sources of fatigue provide a framework to support nurses, nursing managers and administrators to develop strategies to reduce fatigue among RNs.

Venous thromboembolism knowledge among older post-hip fracture patients and their caregivers.

Patient education about venous thromboembolism (VTE) prevention is needed to prevent complications and costly re-hospitalization. Nurses are uniquely positioned to provide vital education as patients transition from the inpatient setting to after discharge. Still, little is known about patient knowledge deficits and those of their caregivers. The purpose of this study was to explore VTE prevention knowledge in a sample of older hip fracture patients and family caregivers. At the time of hospital discharge, surveys were completed by hip fracture surgery patients (≥65; n=30) and family caregivers (n=30). Participants reported needs for more prophylactic anticoagulation and side effects education. Mean education satisfaction was 3.49 out of 5 among patients and 3.83 among caregivers. Focused patient education regarding the wisdom of VTE prevention, potential risks involved, and patient and caregiver roles in advocating for better prevention measures is needed for these patients at risk for hospital readmission secondary to VTE.

Instrument validation: hospital nurse perceptions of their Behavioral Health Care Competency.

AIM: To report the development and psychometric testing of the Behavioral Health Care Competency survey, designed to measure hospital nurse perceptions of behavioral healthcare competency. BACKGROUND: Hospital nurses working in general or other non-psychiatric units may lack behavioral healthcare competency to manage disruptive behaviours associated with mental illnesses. DESIGN: Instrument development. METHOD: A nurse study team including clinical experts and nurse researchers from three community hospitals in southern California (USA) reviewed content validity of each item and the 31-item instrument and created a behavioral health care competency conceptual model based on the nursing process. Separate institutional review board permissions were obtained from each hospital. The study team collaborated in the timing of survey administration (November 2010), analysis of the results and survey validation. RESULTS: A total of 844 nurses completed the survey, representing approximately 23-41% of eligible nurses from each hospital. Using principal component analysis with varimax rotation, 23 items led to a factor structure with four components. Four subscales with adequate alpha coefficients were formed: Resource Adequacy, Patient Assessment, Practice/Intervention Competency, and Psychotropic Recommendation. CONCLUSION: The 23-item hospital nurse Behavioral Health Care Competency survey is an adequate and valid newly developed instrument. Further testing with diverse samples is needed to strengthen generalizability and address unique and specialized nursing care needs.

Nurse Health, Work Environment, Presenteeism and Patient Safety.

Presenteeism is linked to negative outcomes for patients, nurses, and health care organizations; however, we lack understanding of the relationships between nurse fatigue, burnout, psychological well-being, team vitality, presenteeism, and patient safety in nursing. Therefore, the two aims of this study were: (a) to examine the fit of a literature-derived model of the relationships between presenteeism, psychological health and well-being, fatigue, burnout, team vitality, and patient safety; and (b) to examine the role of presenteeism as a mediator between patient safety and the other model variables. Survey data were analyzed using Composite Indicator Structural Equation (CISE) modeling, a type of structural equation modeling. Model fit was acceptable with multiple significant relationships. Presenteeism due to job-stress mediated multiple relationships to patient safety. Our findings indicate that focusing on job-stress presenteeism may be relevant for this population and may offer additional insight into factors contributing to decreased nurse performance and the resulting risks to patient safety.

Interpretation of Hospital Nurse Fatigue Using Latent Profile Analysis.

There has been a lack of consensus in the literature related to the conceptualization, definition, and measurement of hospital nurse fatigue. Using latent profile analysis, the Hospital Nurse Force Theory provided a conceptual format to identify 3 profiles of nurse fatigue from subjective reports of hospital patient care nurses in a survey cohort. All fatigue and adaptation variables demonstrated significant inverse relationships. Describing nurse fatigue in profiles that include measures of acute, chronic, physical, and mental fatigue dimensions provided a new and expanded view of nurse fatigue to monitor trends comprehensively and evaluate fatigue risk management strategies.

Association Between Serum 25(OH)D Level and Nonspecific Musculoskeletal Pain in Acute Rehabilitation Unit Patients.

OBJECTIVE: Nonspecific musculoskeletal pain can be difficult to manage in acute rehabilitation unit (ARU) patients. We investigated whether vitamin D status is a potential modifiable risk factor for nonspecific musculoskeletal pain in ARU patients. MATERIALS AND METHODS: This cross-sectional study focused on 414 adults from an inpatient ARU in Mission Viejo, California, between July 2011 and June 2012. On ARU admission, all patients had serum 25-hydroxyvitamin D (25(OH)D) levels measured and were assessed for nonspecific musculoskeletal pain. We performed multivariable logistic regression to test the association of serum 25(OH)D level with nonspecific musculoskeletal pain while adjusting for clinically relevant covariates. RESULTS: Among these 414 patients, mean (SD) 25(OH)D level was 29 (12) ng/mL, and 30% had nonspecific musculoskeletal pain. After adjustment for age, sex, race, body mass index, Functional Independence Measure score, Deyo-Charlson Comorbidity Index, fractures, steroid use, history of osteoporosis/osteomalacia, and patient type (orthopedic, cardiac, neurological, spinal cord injury, or traumatic brain injury), serum 25(OH)D level was inversely associated with nonspecific musculoskeletal pain (odds ratio [OR] per 10 ng/mL, 0.67; 95% confidence interval [CI], 0.48-0.82). When 25(OH)D level was dichotomized, patients with levels <20 ng/mL had higher odds of nonspecific musculoskeletal pain (OR, 2.33; 95% CI, 1.23-4.17) compared with patients with levels ≥20 ng/mL. CONCLUSIONS: In adult patients, serum 25(OH)D level on admission to ARU was inversely associated with nonspecific musculoskeletal pain. These data support the need for randomized, controlled trials to test the role of vitamin D supplementation to improve nonspecific musculoskeletal pain in ARU patients.

Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing.

BACKGROUND: Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. OBJECTIVE: To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. METHODS: A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. RESULTS: Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. CONCLUSIONS: A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections.

Physical fitness training: outcomes for adult oncology patients.

Physical activity and exercise participation are important considerations in the study and management of acute and long-term care for cancer patients. Although excessive rest and lack of physical activity are related to diminished physical fitness, reduced functional status, impaired cognition, and diminished quality of life, exercise prescription is not a standard treatment support for patients or survivors of cancer. In this retrospective study, it was hypothesized that routine participation in exercise could improve physical fitness for adults recently completing months of cancer treatment. Forty-five cancer patients were able to make considerable fitness gains over an 8-week period. A fitness program coordinated by an exercise physiologist, certified trainers, and an advanced practice cancer nurse was an effective method of organizing referral, monitoring individual patient concerns, and avoiding unnecessary risks.

Evaluation of hospital nurses' perceived knowledge and practices of venous thromboembolism assessment and prevention.

Venous thromboembolism (VTE) is a preventable cause of hospital death. Bedside registered nurses (RNs) are a key group that can be the first to recognize risks of patients in acute care settings. The purpose of this study was to identify bedside hospital RNs' perceived knowledge of VTE, their assessment practices, their self-efficacy in conducting VTE prevention care, and their perceived barriers to performing VTE risk assessment. An anonymous web-based survey on VTE risk assessment and prevention was conducted with RNs who provided direct patient care at two hospitals. RNs who were not directly involved in bedside patient care such as managers and educators were excluded. A total of 221 RNs completed the survey. Most participants rated their overall knowledge of VTE risk assessment between "good" (44%) and "fair" (28%). VTE assessment frequencies performed by participants varied widely. Participants reported high confidence in their ability to educate patients and families about VTE symptoms, prevention, and treatments. Participants were least confident in their own ability to conduct a thorough VTE risk assessment. Greater self-reported VTE knowledge was associated with greater VTE assessment frequency and self-efficacy for VTE preventive care. The most common perceived barriers in performing VTE risk assessment were lack of knowledge (21%) and lack of time (21%). The findings demonstrate a substantial need for focused education about VTE prevention for hospital nurses and support for hospital systems to monitor VTE care. Despite the Joint Commission emphasis on VTE risk assessment in all hospitalized patients, there remains a gap between current, evidence-based recommendations for VTE prevention and reported nursing practices.

Hospital staff nurse perceptions of competency to care for patients with psychiatric or behavioral health concerns.

Disruptive behaviors are common among hospitalized patients with psychiatric and substance abuse behaviors. Nurses working on nonpsychiatric units, however, may lack competencies to care for patients with such behaviors. A survey was developed and administered to 844 nurses across three hospital settings that revealed a lack of nurse confidence to intervene in situations that require de-escalation techniques and crisis communication. This study provides direction for further research and interventions in hospital settings with similar professional development needs.

Hospital nurse force theory: a perspective of nurse fatigue and patient harm.

This article is focused on the primary finding of the 2010 Institute of Medicine report asserting that nurses practice to the full extent of their education and training. An evolving theoretical perspective for hospital nursing practice is proposed as a basis for reaching this goal. This article describes the background and current factors influencing professional hospital nursing practice, presents a theoretical model for future research designed to optimize the power of hospital nursing practice, using a newly evolved concept of "nurse force," and discusses the implications of nurse force theory on perspectives of hospital nurse fatigue and patient harm.

Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention.

PURPOSE/OBJECTIVES: To review and summarize the current state of the evidence for exercise as an intervention for cancer-related fatigue and to facilitate application to clinical practice. DATA SOURCES: Articles, abstracts, and practice guidelines published through October 2003. DATA SYNTHESIS: The strength of the evidence of effectiveness of exercise in managing cancer-related fatigue is growing. CONCLUSIONS: All patients with cancer should be encouraged to maintain an optimum level of physical activity during and following cancer treatment. Patients with breast cancer and other selected patients should receive recommendations for moderate exercise programs. Referrals to physical therapy and/or rehabilitation may benefit certain patients, including those with comorbidities or deconditioning. Published multidisciplinary evidence-based guidelines for exercise programs involving patients with cancer are needed. IMPLICATIONS FOR NURSING: Nurses may participate in implementing exercise interventions with patients with cancer in various roles depending on skill and knowledge--from encouraging physical activity to referring patients to physical therapy and/or rehabilitation programs to prescribing and monitoring exercise in certain patient populations.