Chronic Fatigue Predicts Hospital Nurse Turnover Intentions.

OBJECTIVE: The objective of this study was to determine the impact of workforce engagement factors on hospital nurse turnover intentions. BACKGROUND: Nurse turnover intentions are impacted by occupational fatigue and burnout, which are differentially impacted by fatigue, meaning and joy in work, and work-related resilience. METHODS: One hundred fifty-one nurses from a southwestern hospital completed online surveys. Path analyses evaluated relationships among variables. RESULTS: Chronic occupational fatigue was the only significant predictor of turnover intentions among nurses. Although strongly associated with emotional exhaustion and depersonalization (burnout components), burnout did not predict turnover intention. High levels of chronic fatigue predicted lower meaning and joy in work and lower work-related resilience. Although significantly correlated, meaning and joy in work and resilience did not predict total burnout scores when analyzed in causal models. CONCLUSIONS: Nurse administrators should focus efforts on factors such as chronic occupational fatigue that are likely to impact nurses' decisions to leave their positions.

Hospital Nurse Competency to Care for Patients With Behavioral Health Concerns: A Follow-Up Study.

Nonpsychiatric nurses care for hospital patients with behavioral health (BH) conditions. This study found BH care competencies of hospital nurses slightly changed from those 9 years earlier. On average, nurses reported moderate to strong perceived competence about assessing/intervening and accessing resources to care for BH patients. They perceived less competence in recommending psychotropic drugs for patients who may need them. Staff development programs that aim to enhance nurse BH care competencies are needed.

Impact of Affect Balance on Cognitive and Physical Function in Adults With and Without Fibromyalgia.

OBJECTIVE: To identify the potential benefits of heightened levels of affect balance in older adults with and without chronic pain on various cognitive domains, physical performance, and perceived cognitive and physical health. METHOD: Ninety-one older adults, some with and some without fibromyalgia (FM) participated. Objective tests included cognitive (immediate and delayed recall, delayed recognition-CERAD 10-item word list) and physical measures (Fullerton Advanced Balance Scale; lower body strength-30-s chair stand; gait velocity-30-ft. walk). Self-report measures were problems with forgetting, activities of daily living (perceived function), and affect (Positive and Negative Affect Scale [PANAS]). Affect balance was calculated as positive minus negative affect from the PANAS. RESULTS: Hierarchical regression analyses revealed that-regardless of FM status-higher affect balance was associated with better episodic memory performance (immediate recall, delayed recognition), better balance, enhanced lower body strength (more chair stands), and healthier gait (30-ft. walk), as well as less forgetfulness and better perceived functional health. CONCLUSION: Increased affect balance was associated with better objective and subjective health in older adults both without and with chronic pain. Positive psychology treatments which increase affect balance are easy to administer, cost effective, and may add an important, additional treatment modality for maintaining health in normal aging adults as well as those with chronic pain. CLINICAL RELEVANCE: In order to help patients with healthy aging, nurses need to be aware of the potential long-term effect of emotional state on overall function and be able to counsel patients regarding potential treatments to enhance positive global emotions such as resilience.

Knowledge and Attitudes of Maternity Nurses and Ancillary Team Members about Substance Addiction during Pregnancy and Postpartum.

OBJECTIVE: To describe knowledge and attitudes of maternity nurses and other ancillary direct caregivers about addictive substance use by pregnant women and new mothers and to evaluate their perceptions of role preparation, resources available, and educational needs. STUDY DESIGN METHODS: We surveyed maternity nurses and ancillary members of the maternity care team to assess knowledge and attitudes about caring for women with addictive substance use. Data were analyzed using descriptive, parametric, and nonparametric statistics. RESULTS: Respondents (N = 109) from a southwestern Magnet community hospital were 100% female, predominantly nurses (89%), and worked mostly on mother-baby or labor and delivery units. They had high average knowledge scores and most had positive attitudes. When asked about preparation to care for pregnant women and new mothers with addictive substance use, some perceived that they were not able to carry out their role due to lack of knowledge. CLINICAL IMPLICATIONS: Findings suggest most maternity nurses have the knowledge and skills they believe are needed to care for women who use addictive substances during pregnancy and postpartum. Most have positive attitudes, but approximately one third may need interventions to encourage and further support empathy and acceptance. Education and skill-building for maternity nurses and other team members related to caring for women using addictive substances may be worth consideration; however, there is minimal evidence of their efficacy. Evaluations of these types of programs are needed in maternity settings.

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.

Effects of Transport on Oral Temperature of Postsurgical Patients Transported from PACU to Nursing Units.

PURPOSE: To determine the impact of transport from the postanesthesia care unit (PACU) to inpatient nursing units on postsurgical patient temperature. DESIGN: Exploratory correlational study. METHODS: PACU discharge oral temperatures of postsurgical adult patients were compared with oral temperature at unit transfer. FINDINGS: Temperatures on PACU discharge ranged from 97.3°F to 100.0°F (mean [M], 98.1 [0.5]), whereas those on unit arrival ranged from 97.3°F to 99.8°F (M, 98.0 [0.5]). Temperature differences between arrival and discharge ranged from -1.5°F to 0.9°F (M, -0.05 [0.34]); most showed decreases (n = 49; 52.7%). Correlations between temperature change and other variables (transport time, age, and gender) were less than 0.10 and nonsignificant. CONCLUSIONS: Transfers from the PACU to other hospital units may not clinically impact oral temperatures in postsurgical patients. However, post-transfer temperature should be monitored to assure that hypothermia does not occur.

Teaching Father-Infant Massage during Postpartum Hospitalization: A Randomized Crossover Trial.

PURPOSE: The purpose of this study was to evaluate acceptability and impact of infant massage video instruction on fathers' behaviors in early postpartum. METHODS: A randomized crossover design was used. Participants were fathers of healthy term infants born at a Magnet hospital in Southern California. Measures included a demographic survey, Father-to-Infant Bonding Scale, Father-Infant Observation Scale, and postdischarge phone interview. Study nurses observed father-infant interactions for 5 minutes. Fathers were randomized to one of two groups: fathers in group 1 saw the massage video before they were observed with their infants and fathers in group 2 saw the video after. Fathers completed the Bonding Scale at baseline in person and again within a week of discharge by phone. Statistics were descriptive and comparative. Responses to interview questions were categorized and described. RESULTS: Ninety-eight fathers aged 18 to 44 years participated. Over half of fathers identified as Hispanic and the majority spoke English at home. Most fathers had positive responses to infants on individual Bonding Scale items. Fathers differed significantly in observed interactions with infants depending upon timing of massage instruction; fathers observed immediately after the video had more total interactions, specifically fingertip touching. Poststudy evaluations were predominantly positive. CLINICAL IMPLICATIONS: We found a brief infant massage instruction offered by video was well accepted by fathers and increased observed father-infant interactions.

A Picture Is Worth a Thousand Words: Pictographs to Improve Understanding of Discharge Instructions.

INTRODUCTION: Poor comprehension of ED discharge instructions has been reported. Discharge instructions often include written information. Identification of home-care practices that were different from recommended discharge instructions among multiple clients led nurses at a community emergency department to evaluate health literacy among specific clients. METHODS: A bilingual translator administered the Newest Vital Sign-a 6-item validated scale that assesses health care literacy-to 150 English and Spanish-speaking parents of pediatric patients admitted to the fast-track area. RESULTS: Although mean scores for both groups indicated participants were, on average, "at risk" for health literacy problems, English speakers had a significantly higher mean total score (3.82, standard deviation [SD] = 1.60) than did Spanish speakers (2.61, SD = 1.71), indicating better literacy. DISCUSSION: Study findings of low levels of health literacy in many parents led to a practice change of using nurse-developed pictographs, along with discharge instructions, for specific common ED diagnoses. Postdischarge calls to parents or patients receiving the pictographs documented positive postdischarge client feedback. The pictograph strategy is transferable to other institutions.

Instrument Validation: Hospital Nurse Perceptions of Meaning and Joy in Work.

BACKGROUND AND PURPOSE: When workers experience meaning and joy in work (MJW), job satisfaction and retention are enhanced. No measure for MJW among nurses exists. The purpose of this work was to develop/test the MJW Questionnaire (MJWQ). METHODS: The initial MJWQ was piloted with a convenience sample of post-licensure nursing students. Factor analyses established MJWQ subscales for the MJWQ: "value /connections," "meaningful work," "caring." Subsequently, 463 employed nurses validated MJWQ psychometrics. RESULTS: The MJWQ demonstrated acceptable construct validity and internal consistency (α = .94). Scores were significantly associated with job satisfaction (r = .686). CONCLUSIONS: Initial testing supports adequate measurement of MJW for hospital nurses in varying roles. Testing in other settings, evaluation of sensitivity in determining intervention effectiveness, and inclusion in multivariate analyses of workforce engagement are suggested.

Supportive Care Nursing Clinical Protocol Incorporates Holism in a Public Acute Care Hospital.

The Supportive Care Nursing Clinical Protocol (SCNCP) was developed to guide holistic nursing care for seriously ill hospitalized patients. The SCNCP uses national guidelines and evidence-based interventions as its foundation. Seriously ill patients may require palliative care, which is synonymous with supportive care. Acute care nurses may not be proficient in providing holistic supportive care for patients with life-limiting illness. At a 670-bed public acute care hospital, palliative care consultation requires a physician order and palliation may arrive late in an illness. Independent nursing interventions can contribute to the alleviation of suffering. Evidence-based interventions used in the SCNCP include using computer applications for breathing exercise (relaxation and mindfulness), topical applications for alleviating thirst, and hand-held fans for dyspnea. The SCNCP is projected for implementation (Spring 2017). The SCNCP will be evaluated for effectiveness after 6 months of implementation. Key indicators for successful implementation include increased nursing knowledge of supportive care and the frequency of protocol implementation as evidenced in the electronic health record. Eventually, the SCNCP will be implemented as the standard for supportive care of the seriously ill for all hospitals in the health system network.

Barriers to medication error reporting among hospital nurses.

AIMS AND OBJECTIVES: The study purpose was to report medication error reporting barriers among hospital nurses, and to determine validity and reliability of an existing medication error reporting barriers questionnaire. BACKGROUND: Hospital medication errors typically occur between ordering of a medication to its receipt by the patient with subsequent staff monitoring. To decrease medication errors, factors surrounding medication errors must be understood; this requires reporting by employees. Under-reporting can compromise patient safety by disabling improvement efforts. DESIGN: This 2017 descriptive study was part of a larger workforce engagement study at a faith-based Magnet® -accredited community hospital in California (United States). METHODS: Registered nurses (~1,000) were invited to participate in the online survey via email. Reported here are sample demographics (n = 357) and responses to the 20-item medication error reporting barriers questionnaire. Using factor analysis, four factors that accounted for 67.5% of the variance were extracted. These factors (subscales) were labelled Fear, Cultural Barriers, Lack of Knowledge/Feedback and Practical/Utility Barriers; each demonstrated excellent internal consistency. RESULTS: The medication error reporting barriers questionnaire, originally developed in long-term care, demonstrated good validity and excellent reliability among hospital nurses. Substantial proportions of American hospital nurses (11%-48%) considered specific factors as likely reporting barriers. Average scores on most barrier items were categorised "somewhat unlikely." The highest six included two barriers concerning the time-consuming nature of medication error reporting and four related to nurses' fear of repercussions. CONCLUSIONS: Hospitals need to determine the presence of perceived barriers among nurses using questionnaires such as the medication error reporting barriers and work to encourage better reporting. RELEVANCE TO CLINICAL PRACTICE: Barriers to medication error reporting make it less likely that nurses will report medication errors, especially errors where patient harm is not apparent or where an error might be hidden. Such under-reporting impedes collection of accurate medication error data and prevents hospitals from changing harmful practices.

Does Changing Newborn Bath Procedure Alter Newborn Temperatures and Exclusive Breastfeeding?

PURPOSE: This evidence-based practice project evaluated effects of changing timing/character of initial newborn baths on infant temperatures and breastfeeding status. BACKGROUND: The hospital protocol for initial bathing procedures was updated: immersion baths; 12 hours postpartum; family included. METHODS: Staff nurse champions provided staff training. The evaluation included three seven-week periods (2016-2017) and three measures: adherence, temperature stabilization, and exclusive breastfeeding. RESULTS: Of 1,205 38-week healthy newborns, 322 were born preimplementation (Pre), 486 after (Post), and 397 during maintenance (M). Adherence to bath timing increased and was maintained: 28 percent Pre; 83 percent Post; 85 percent M. Almost 100 percent of newborns had stable temperatures. Breastfeeding exclusivity rates did not change (ps greater than or equal to .05): baths less than 12 hours: 79 percent Pre, 74 percent Post, and 68 percent M; baths 12 hours: 68 percent Pre, 71 percent Post, and 73 percent M. IMPLICATIONS: Changing bath time/character for healthy newborns maintained thermoregulation and exclusive breastfeeding rates. Nurses changed practice quickly, maintaining adherence over time.

Effect of Concentrated Psychiatric Education on Perceived Competence to Care for Behavioral Health Patients.

CONTRIBUTION TO EMERGENCY NURSING PRACTICE: ABSTRACT INTRODUCTION: Increasing numbers of behavioral patients are presenting to emergency departments, where competency of staff to care for this group is unknown. METHODS: This pre-post study measured the effects of a 7-hour conference on perceived competency of nurses and allied health professionals to care for behavioral health (BH) patients, as measured by the 23-item Behavioral Health Care Competency (BHCC) survey. RESULTS: Of 102 participants, most were emergency nurses (72%), acute care nurses and case managers (20%), and allied health personnel (trauma technicians and paramedics) (8%). Before the conference, participants had moderate average perceived competency in caring for BH patients. BHCC scores differed significantly by job category, with emergency nurses scoring higher than did nonemergency nurses and allied health personnel. Overall competence of participants increased significantly after the conference. The effect size, as reflected by partial eta squared, was 0.265. Significant increases in scores from before to after the conference occurred for the total BHCC and 2 competencies: practice/intervention and resource adequacy. DISCUSSION: This study provides needed research demonstrating improved perceived competency of nurses and allied health professionals to care for BH patients in emergency departments after brief concentrated education. Improvements occurred despite the fact that participants had initial baseline competencies that were higher than those of general hospital nurses from a historical sample.

Aging well: Processing speed inhibition and working memory related to balance and aerobic endurance.

AIM: The present study explored whether certain physical performance measures could be linked to specific cognitive domains in healthy older adults. METHOD: A total of 50 adults (mean age 69.5 years, SD 8.1) were evaluated on physical performance using measures of balance (Fullerton Advanced Balance Scale), functional mobility (8-ft up-and-go), lower body strength (30-s chair stand), gait (30-ft walk velocity) and aerobic endurance (6-min walk). Cognitive measures included Stroop Color-Word Test, Digit Span Backward, Trail Making Tests, Everyday Problems Test, Digit Symbol Substitution and a Brown-Peterson test. Principal component analyses reduced cognition to domains of processing speed, inhibition and working memory. RESULTS: Hierarchical regression analyses were carried out with age and each physical measure as potential predictors of the three cognitive domains. The balance scale and 6-min walk were specifically associated with processing speed, inhibition and working memory. CONCLUSIONS: Better dynamic balance and aerobic endurance predicted enhanced processing speed, inhibition and working memory in older adults, with these last two domains considered components of executive function. Geriatr Gerontol Int 2017; 17: 108-115.

Patient Satisfaction With Anesthesia Care: What Do We Know?

This evidence review aimed to conceptualize patient satisfaction with anesthesia care (PSAC), which has been linked to reimbursement, competency evaluations, and litigation; to describe factors affecting PSAC; and to develop provider recommendations to enhance PSAC. The search for systematic reviews, survey reports, qualitative studies, and consumer satisfaction reports within the last 20 years excluded pediatric and obstetric articles. The search yielded 27 quantitative, 7 qualitative, and 9 consumer satisfaction articles. High levels of PSAC are reported using a variety of methods. Studies evaluating patient perioperative experiences document that fear and anxiety with prior patient experiences have an impact on anticipatory anxiety. Patients reported desiring positive experiences and emotional connections with anesthesia providers. Modifiable dissatisfiers included anxiety, inadequate explanation of anesthesia, postoperative pain and nausea or vomiting, long surgeries or wait times, and anesthesia complications. Besides providing preoperative information with reasonable expectations (eg, for nausea and vomiting) and treating discomfort, anesthetists must engage emotionally with patients. Measures of PSAC should include the emotional component of PSAC. Future research addressing patient experiences with differing anesthesia methods would be helpful for providers trying to understand and facilitate patient coping.

CE: Preventing Contrast-Induced Acute Kidney Injury.

: Diagnostic radiographic imaging scans using intravascular iodinated contrast media can lead to various complications. The most salient of these is contrast-induced acute kidney injury (CI-AKI) or contrast-induced nephropathy, a potentially costly and serious patient safety concern. Prevention strategies are the cornerstone of evidence-based clinical management for patients receiving contrast agents. These include preprocedure screening, stratification of patients based on risk factors, and protective interventions, the most important of which is hydration both before and after the radiographic imaging scan. There is a gap, however, between best evidence and clinical practice in terms of exact hydration protocols. Nurses play an important role in nephropathy prevention and need to be familiar with CI-AKI as a potential complication of radiographic imaging scans. In order to ensure safe, high-quality care, nurses must be involved in efforts to prevent CI-AKI as well as interventions that minimize patients' risk of kidney injury.

Magnet® Facility Nurses: Pursuing a Baccalaureate Degree in Nursing.

UNLABELLED: The aim is to explore factors that motivate and obstacles that impede nurses from pursuing baccalaureate education when employed by a Magnet® organization. BACKGROUND: In the Future of Nursing (2011), the Institute of Medicine concluded that the baccalaureate should be the minimum education for nurses. Magnet organizations are encouraged to meet the Institute of Medicine goal of 80% of nurses with a baccalaureate by 2020. METHOD: In February 2014, a 15-item on-line survey was sent to nurses at a western Magnet-designated hospital to assess factors that motivate registered nurses to achieve a baccalaureate. Descriptive statistics and a general thematic analysis were completed. RESULTS: A 20% response rate (N = 191) was achieved. Most respondents (78%) entered nursing as associate degree/diploma graduates, and most (84%) either had a baccalaureate or master's degree or were currently enrolled in school. Encouragement from other nurses was the factor most frequently selected as facilitating return to school. Impeding factors included age and family responsibilities. A minority of nurses reported that they did not believe that a baccalaureate would make them a better nurse. IMPLICATIONS: Findings suggest that peer and leadership support play a larger role in facilitating baccalaureate completion more than previously reported. Additional research is needed to explore the role of registered nurse to registered nurse encouragement in facilitating educational advancement.

Heterogeneity in fibromyalgia based upon cognitive and physical performance and psychological symptomology.

PURPOSE: This study sought to investigate the existence of subgroups within a fibromyalgia (FM) sample based on physical and cognitive performance measures, as well as self-report psychological measures. A multisystem disorder characterized by widespread musculoskeletal pain and co-morbid conditions, FM can lead to declines in cognitive functioning and difficulty with psychological health. DATA SOURCES: Community participants (n = 57 women) recruited from support groups and university center databases provided documentation of having met the criteria for diagnosis of FM. Measures included validated performance and self-report instruments. Analysis was completed using hierarchical cluster analysis; a four cluster solution was chosen for its level of interpretability. The resulting model identified four distinct subgroups based upon patterns of performance and symptomology. Significant group differences were found on pain, fatigue, stiffness, and level of physical activity. CONCLUSIONS: Study results support the existence of subgroups among the FM population based on levels of cognitive and physical performance and psychological symptoms. IMPLICATIONS FOR PRACTICE: Nurse practitioners aware of potential subgroups within FM should be better prepared to recommend treatment options for patients that target subgroup characteristics (e.g., high vs. low levels of psychological symptoms).

Polysomnography with quantitative EEG in patients with and without fibromyalgia.

PURPOSE: Characterize the polysomnographic (PSG) and quantitative EEG (qEEG) features of fibromyalgia and determine whether fibromyalgia patients differ in these measures when compared with a control sleep disorder population. METHODS: All undergoing all-night PSG for evaluation of a sleep disorder were evaluated for fibromyalgia. The PSGs were interpreted for routine sleep measures, and qEEG was performed to measure the delta and alpha frequency power during non-rapid eye movement sleep. Measures and qEEG were analyzed according to fibromyalgia diagnosis. SETTING: Community-based sleep medicine center. PATIENTS: All patients undergoing PSG over a 2-year period. INTERVENTIONS: None. RESULTS: Of the 385 patients in the study population, 133 had fibromyalgia according to American College of Rheumatology criteria. The population's average Epworth Sleepiness Score was 10.5, the average sleep efficiency was 78%, and the Periodic Limb Movement disorder prevalence was 15%. None of these sleep measures differed significantly between the fibromyalgia and non-fibromyalgia groups. Obstructive sleep apnea was present in 45% of the fibromyalgia group. Significant differences were present in the qEEG ratio of delta to alpha frequency power, which was 95% specific for fibromyalgia when ≤1. A qEEG ratio ≤10.5 was 85% sensitive for fibromyalgia, and a qEEG ratio >10.5 had an 89% negative predictive value for fibromyalgia. Among patients with fibromyalgia who were not taking a benzodiazepine or benzodiazepine agonist, a qEEG ratio ≤10.5 was 84% specific and had a 78% positive predictive value. CONCLUSIONS: Sleep disorders identified by routine PSG, including obstructive sleep apnea, are common in fibromyalgia, but periodic leg movement disorder and poor sleep efficiency are not. A qEEG low delta/alpha ratio during non-rapid eye movement sleep can differentiate patients with fibromyalgia from others who are referred for PSG. Consideration of benzodiazepine and benzodiazepine agonist use is important when interpreting the delta/alpha ratio.

Blood culture accuracy: discards from central venous catheters in pediatric oncology patients in the emergency department.

INTRODUCTION: Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn. METHODS: During 2009-2011, 62 pediatric oncology patients with CVCs and orders for blood cultures to determine potential sepsis were enrolled during ED visits. Trained study nurses aseptically drew blood and injected the normally discarded first 5 mL and the second specimen (usual care) into separate culture bottles. Specimens were processed in the microbiology laboratory per hospital policy. RESULTS: Positive cultures were evaluated to assess agreement between specimen results and to determine that the identified pathogen was not a contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive results. In all positive-positive matches, the normal discard specimen contained the same organism as the usual care specimen. In 4 matches, the normally discarded specimen demonstrated notably earlier time to positivity (4 to 31 hours) compared with the usual care specimen, which resulted in earlier initiation of definitive antibiotics. DISCUSSION: These findings support the accuracy of the specimen that is normally discarded and suggest the need to reconsider its use for blood culture testing.