Changes in the diagnosis of depression among nursing professionals during the COVID-19 pandemic: A longitudinal study.

AIMS: To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic. DESIGN: An observational and longitudinal study. METHODS: Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021. RESULTS: 13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs CONCLUSIONS: There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge. IMPACT: What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic. What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload. Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Systemic relations among the variables involved in occupational accidents of the nursing team in a psychiatric hospital.

BACKGROUND: The occupational activities carried out in hospital environments pose occupational risks to professionals. In psychiatric hospitals, due to the characteristics of the patients treated, professionals are also subjected to other risks, such as physical aggression. OBJECTIVE: This research aimed to identify the systemic context, highlighting the cause-and-effect relationships that culminate in occupational accidents that occurred with the nursing staff in a psychiatric hospital in Brazil. METHODS: The current study is an applied research and was divided into three stages. First, the collection of data related to the case study was made and accidents were analyzed and occupational hazards were identified. In the second stage, from the collected information, occupational safety indicators were defined. Lastly, in the third stage, the qualitative aspect of System Dynamics was applied to perform the systemic analysis and to identify how the different variables were related. RESULTS: The results showed that physical aggression was the main cause of accidents. Regarding safety indicators, while both the level of use of Personal Protective Equipment (PPE) by professionals and the high level of PPE protection were positive aspects, the level of training of professionals to use PPE was a negative aspect. The Causal Link Diagram (CLD) showed that the perception of risk influenced the level of use of PPE and those organizational measures influenced the accident rate. CONCLUSION: In conclusion, the systemic analysis of the system dynamics can optimize the diagnostic process of occupational accidents in psychiatric hospitals, and especially help to identify the cause and effect among the variables involved.

Does affiliation to a cross-sectorial lung team impact well-being, health-related quality of life, symptoms of anxiety and depression and patient involvement in patients with COPD? A randomised controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease causing limitations in daily life. A cross-sectorial lung team was established for COPD patients at risk of hospitalisation due to exacerbation of COPD. AIMS: To investigate the impact of affiliation to a cross-sectorial lung team on well-being, health-related quality of life, symptoms of anxiety and depression and patient involvement in patients with severe COPD. METHODS: A randomised controlled trial was conducted from September 2017 to March 2020. In total, 109 patients were included for analysis in the study: 53 patients were affiliated to a cross-sectorial lung team and 56 patients received usual care. The patients were included for 1 year. Data were collected at baseline and at follow-up after 1 year. Data were collected using COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), EuroQol 5-Dimensions (EQ-5D) and Patient Assessment of Chronic Illness Care (PACIC). RESULTS: The questionnaire response rate was between 84% and 96%. No statistically significant differences were detected between patients affiliated to the cross-sectorial lung team and patients receiving usual care, in either patient's well-being, health-related quality of life, symptoms of anxiety and depression, or patient involvement. However, CAT-total score decreased with -0.21(95%CI: -1.63; 1.20) for patients affiliated to the cross-sectorial lung team and increased with 1.44(95%CI; -0.11; 3.00) for patients receiving usual care. CONCLUSION: Affiliation to the cross-sectorial lung team seems safe as it did not deteriorate the patients' well-being, symptoms of anxiety and depression, health-related quality of life or patient involvement. Further research is needed and interviewing patients to obtain more knowledge on their experiences might be preferable.

Nursing work environment and accreditation: Is there a relationship?

BACKGROUND: The association between Magnet recognition and nursing work environment is well established; however, little is known about hospital accreditation and its relationship to the nursing work environment. OBJECTIVE: To describe the Brazilian nurses' perceptions of the work environment and their relationship with hospital accreditation. METHODS: A cross-sectional survey study was carried out in three Brazilian hospitals. Nurses who delivered direct patient care and worked for at least 6 months were invited to participate. Those who were on vacation or leave for any reason during data collection were excluded. The participants were asked to fill out the personal and professional characterization form and the Brazilian version of the Revised Nursing Work Index. RESULTS: The work environment was evaluated as favourable by Brazilian nurses. Linear regression analysis evidenced that hospital accreditation is associated with the nursing work environment, affecting the nurse-physician relationship (OR = 0.266, p < .001), organisational support (OR = 0.256, p < .001), control over the practice setting (OR = 0.229, p < .001) and autonomy (OR = 0.227, p < .001). CONCLUSION: The findings suggest that there is a positive influence of hospital accreditation on nurses' perceptions of the work environment concerning autonomy, nurse-physician relationship, control over the practice setting and organisational support. IMPLICATION FOR NURSING MANAGEMENT: Nurse managers can apply the recommendations of certification programmes in practice settings to improve the nursing work environment.

Mixed methods quality evaluation of structured interprofessional medical ward rounds.

BACKGROUND: Standardised structure and content of interdisciplinary medical ward rounds can promote patient safety and patient-centred teamwork. AIMS: To evaluate interdisciplinary ward rounds using a Structured Interdisciplinary Bedside Rounding (SIBR) intervention. METHODS: The study involved multi-method, repeat measures with a non-equivalent control group. Non-participant observations were collected at: 1 and 6 months, on an intervention ward that introduced SIBR; and a control ward that continued traditional rounds. Focus group and survey data were also collected on the intervention ward. Participants were clinicians (medicine, nursing and allied health) working in two general medicine wards at a tertiary hospital in Melbourne, Australia. RESULTS: Seventy-eight patient rounds were observed at Time 1, and 239 at Time 2. The SIBR ward rounds had all clinician disciplines represented, whereas allied health and nurses were present for less than 20% of non-SIBR rounds. Interdisciplinary participation and frequency of desired clinician behaviours increased, and variability in duration of time per patient decreased, on the SIBR rounds. Longitudinal data reflected decreased performance of some SIBR behaviours in the intervention ward, while some desired behaviours increased in the control ward. Qualitative survey and focus group data indicated many positive views, but fit with broader ward routines impacted SIBR implementation. CONCLUSIONS: The overall recommendation by staff was that SIBR should continue. The results provide insights into the adoption of SIBR behaviours and illustrated diffusion of behaviours across wards. Highlighting successes and identifying barriers can help meet challenges for ongoing improvement.

[Skill mix of nurses and primary health care professionals: a systematic review]. / Combinação de tarefas do enfermeiro e de outros profissionais na atenção primária em saúde: uma revisão sistemática.

OBJECTIVE: To evaluate the effectiveness of the strategy of skill mix of nurses and other health care professionals in primary health care. METHODS: Systematic review of the literature aligned with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), including observational and intervention studies. No restrictions were established for period or country of publication; studies published in Spanish, English and Portuguese were included. The search was carried out in MEDLINE, CINAHL, LILACS, EMBASE and Web of Science electronic databases. RESULTS: Eighteen studies were analyzed, including 6 from the United States; 3 from the Netherlands; 2 from the United Kingdom; 1 each from Australia, South Africa, South Korea, Scotland, Haiti and Japan; and 1 study with a prospective observational design from 8 countries. The studies reported that the skill mix among health professionals enables a better use of material resources; optimizes time spent on care; improves adhesion to treatment, quality of care and commitment and satisfaction with the work; and reduces the level of psychological distress in nursing professionals. CONCLUSIONS: The expansion of tasks of nurses and other health care professionals, and the skill mix as well as the development of interprofessional teams, are strategies that help to face a scarcity and poor distribution of human resources in urban and non-urban areas with improvement of the health care of the population and satisfaction of professionals and clients.

Factors associated with absenteeism of nursing professionals in university outpatient clinics in Brazil.

OBJECTIVE: To analyse the sociodemographic, occupational and health profile of nursing professionals working in university outpatient services and their relationship with absenteeism. BACKGROUND: The organisation and working conditions in outpatient services may be directly related to the illness and absenteeism in the nursing profession. METHOD: Analytical cross-sectional study was conducted in 11 outpatient clinics in the city of Rio de Janeiro/Brazil with nursing professionals. A self-applicable data collection tool was used for sociodemographic, occupational and health characterization. The analyses were performed using chi-square tests, odds ratio calculation and a 95% confidence interval. RESULTS: Absenteeism due to illness in the previous 12 months was reported by 35.9% of workers. Sociodemographic and occupational characteristics were not significantly associated with absenteeism, having a positive association only among workers who had two or more jobs. In health-related variables, self-rated health was significantly associated with long absenteeism. Individuals with four or more chronic diseases had a 187% higher chance of being absent for more days. CONCLUSION: The analysis of factors associated with absenteeism must take into account the context of outpatient nursing work and its consequences for the health-disease process. IMPLICATIONS FOR NURSING MANAGEMENT: This allows for rethinking proposals for interventions based on the reality of workers' health.

The importance of the nurse leader's proactivity and intellectual stimulation in the nursing team workload-learning relationship: A cross-sectional study.

AIMS: To test the role of the nursing team leader's (nurse leader) proactivity in attenuating the adverse effect of the nursing team's workload on the team learning and subsequent performance and to consider the role of intellectual stimulation by the nurse leader in this moderated mediation effect. DESIGN: A cross-sectional design. METHODS: Data on 63 nursing teams were collected from various healthcare organizations by having 455 nursing team members and 63 nurse leaders complete validated questionnaires during 2016-2017. RESULTS: As was hypothesized, the nurse leader's proactivity significantly attenuated the adverse effect of nursing team workload on both nursing team learning and intellectual stimulation. Furthermore, intellectual stimulation significantly predicted nursing team learning. Overall, when the nurse leader's proactivity was low, there was a significant indirect effect of nursing team workload on nursing team performance mediated successively by intellectual stimulation and nursing team learning. When the nurse leader's proactivity was high, however, this indirect effect faded. CONCLUSIONS: Proactive nurse leaders attenuate the adverse effect of nursing team workload on nursing team learning and subsequent performance. While less proactive nurse leaders demonstrate lower levels of intellectual stimulation under high nursing team workloads, the highly proactive nurse leaders sustain its level and thus maintain nursing team learning. IMPACT: This study addresses the nursing team workload-learning relationship. It was found that the indirect negative effect of nursing team workload on team performance, which is mediated by intellectual stimulation, followed by team learning, is substantially reduced when the nurse leader's proactivity is high rather than low.

Effectiveness of an Interdisciplinary, Nurse Driven In-Hospital Code Stroke Protocol on In-Patient Ischemic Stroke Recognition and Management.

BACKGROUND: In-hospital strokes account for up to nearly 1 in 5 strokes. Clinical outcomes, such as length of stay, disability, and mortality are worse for in-hospital strokes than for those that occur in the community. For a variety of reasons, stroke can be more difficult to recognize and treat in hospitalized patients. Earlier recognition of stroke results in better clinical outcomes, presumably due to faster diagnosis and subsequently, prompt treatment. METHODS: This investigation was a retrospective, interrupted time series, observational study of all in-hospital stroke patients between 2008 and 2017. This investigation was a quality improvement project, and a waiver was granted from the institutional review board. We used Lean methodologies to standardize our stroke protocol and optimize skill-task alignment to improve the time from onset of symptoms to brain imaging (primary outcome). RESULTS: Overall, we observed significant improvement in the time from onset of symptoms to brain imaging from a median of 69 minutes to 37 minutes (P = .002). CONCLUSIONS: If successfully implemented, this approach may be useful in other care settings with potential to improve stroke outcomes, and decrease associated complications of stroke.

Psychometric properties evaluation of the Psychological Empowerment Instrument in a Brazilian context.

AIM: To evaluate the psychometric properties of the Psychological Empowerment Instrument among Brazilian nurses. BACKGROUND: The Psychological Empowerment Instrument-Brazil is a structured questionnaire that aims to measure the psychological empowerment in the work environment. METHOD: A methodological study involving 219 nurses. Confirmatory factor analysis was conducted to evaluate the factor structure validity of the Psychological Empowerment Instrument-Brazil. Model fit indices and saliences of factor loadings were assessed. The convergent validity was estimated using the average variance extracted and composite reliability. The correlational analysis was verified using the Spearman Correlation between the Psychological Empowerment Instrument-Brazil and other specific tools. Discriminant validity, internal consistency, test-retest and floor/ceiling effects were also assessed. RESULTS: Factor structure indices of the second-order hierarchical model were [λ = 0.47-0.84; χ2 /df = 1.84, GFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06 (90% CI = 0.04-0.08)]. Model refinement was not required. All subscales presented suitable average variance extracted, composite reliability and Cronbach's alpha, except the Impact subscale (0.39; composite reliability = 0.65, α = 0.63). All correlations between Psychological Empowerment Instrument-Brazil and the other questionnaires were significant. CONCLUSION: Psychometric properties of the Psychological Empowerment Instrument-Brazil were suitable when applied to Brazilian nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Psychological Empowerment Instrument-Brazil supports the evaluation of the empowerment level, as well as the applicability of the psychological empowerment in the work environment of Brazilian nurses.

["I thank the universe for my donor."] / « Avant, pendant, après le chemin est long ¼.

High-risk acute myeloid leukaemia: the diagnosis is established. Although rough and strewn with worries, Martine's care pathway is also rich in human encounters. Cared for with compassion and professionalism by the whole nursing team and supported by her family, she is making her way with determination through this very specific time in her life… towards recovery. Here, she shares her story.

[Learning to live with haemophilia]. / Apprendre à vivre avec l'hémophilie.

Highlighting the importance and quality of the support provided by the nursing team to her young son with moderate haemophilia, a mother expresses how this care is essential in terms of the family's quality of life, her son's happiness and in ensuring his autonomy as an adult.

[Nursing co-ordination and partners around the patient]. / Coordinations infirmières et partenaires autour du patient.

To meet today's challenges and prepare for the future, our health system's "My Health 2022" strategic plan recommends development of prevention and health promotion and better access to quality care. This requires development of co-ordinated exercise between professionals and support structures and further development of digital and e-health.

The moderating role of team resources in translating nursing teams' accountability into learning and performance: a cross-sectional study.

AIMS: The aim of this study was to test the moderated-mediation model suggesting that nursing teams' accountability affects team effectiveness by enhancing team learning when relevant resources are available to the team. BACKGROUND: Disappointing evidence regarding improvement in nurses' safe and quality care elevate the need in broadening our knowledge regarding the factors that enhance constant learning in nursing teams. Accountability is considered as crucial for team learning and quality of care but empirical findings have shown mixed evidence. DESIGN: A cross-sectional design. METHODS: Forty-four nursing teams participated in the study. Data were collected in 2013-2014: Head nurses completed validated questionnaires, regarding team resources for learning (time availability, team autonomy and team performance feedback), and nursing teams' effectiveness; and nurses answered questionnaires regarding teams' accountability and learning (answers were aggregated to the team level). The model was tested using a moderated-mediation analysis with resources as moderating variables, and team learning as the mediator in the team accountability-team effectiveness link. RESULTS: The results of a mixed linear regression show that, as expected, nursing teams' accountability was positively linked to nursing teams' learning, when time availability, and team autonomy were high rather than low, and team performance feedback was low rather than high. CONCLUSIONS: Nurturing team accountability is not enough for achieving team learning and subsequent team effectiveness. Rather there is a need to provide nursing teams with adequate time, autonomy, and be cautious with performance feedback, as the latter may motivate nurses to repeat routine work strategies rather than explore improved ones.

Nursing teams: behind the charts.

AIMS: To examine the nature and characteristics of both received and provided mutual support in a social network within an acute care hospital unit. BACKGROUND: Current evidence regarding the social network in the health care workforce reveals the nature of social ties. Most studies of social network-related support that measured the characteristics of social support used self-reported perception from workers receiving support. There is a gap in studies that focus on back-up behaviour. METHODS: The evaluation included a social network analysis of a nursing unit employing 54 staff members. A 12 item electronic survey was administered. Descriptive statistics were calculated using the Statistical Package for the Social Sciences. Social network analyses were carried out using ucinet, r 3.2.3 and gephi. RESULTS: Based on the study findings, as providers of mutual support the nursing staff claimed to give their peers more help than these peers gave them credit for. Those who worked overtime provided more mutual support. CONCLUSION: Mutual support is a key teamwork characteristic, essential to quality and safety in hospital nursing teams that can be evaluated using social network analysis. IMPLICATIONS FOR NURSING MANAGEMENT: Because of a discrepancy regarding receiving and providing help, examining both receiver and provider networks is a superior approach to understanding mutual support.

[Analysis of records and professionalisation of care]. / Analyse des écrits et professionnalisation des soins.

A hospital has initiated a nursing research project to support the nursing teams in their professional development. Record closing, a method involving the critical reading of patients' records when they are discharged, reinforces professional identity and contributes to the development of individual and collective competencies.

Interpersonal relationships of the nursing team in the work environment according to nursing students: A qualitative study.

AIM: To explore the perceptions of nursing students from Brazilian universities about the interpersonal relationship of the nursing team in the work environment. BACKGROUND: Healthcare institutions are complex entities where diverse professionals from different educational backgrounds work together to provide high-quality care to the population. The effective coordination of services within these institutions is closely linked to the interpersonal relationships among these different healthcare professionals. Nurses play a crucial role as members of the multidisciplinary healthcare team, acting as fundamental links between other professionals and patients. DESIGN: This is a descriptive study with a qualitative approach. METHODS: An online, open-ended questionnaire was used. A total of 30 nursing students participated in the study. RESULTS: Data were organized in two themes: (1) Interpersonal relationships of the nursing team and (2) Improving interpersonal relationships of the nursing team. Also, eight sub-themes were identified: Conflict dynamics within the nursing team, Hierarchical issues, Lack of communication, Impact of workplace interpersonal relationships on nursing students, Valuing the profession, Understanding role boundaries, Training in effective communication and conflict management, and Curricular reform. CONCLUSIONS: Blurred boundaries between professional roles, lack of respect, ineffective communication, hierarchical issues, and conflicts, were identified. Of particular concern was the limited interaction observed between the nursing team and multidisciplinary/support teams. Inadequate interpersonal relationships between members of the health team reflect negatively on nursing students during their clinical placements. These findings underscore the urgent need for interventions aimed at improving interpersonal relationships within nursing teams.

Impact of Nurse Manager's Attributes on Multi-Cultural Nursing Teams: A Scoping Review.

BACKGROUND: As global migration increases, nurse managers' effectiveness in multi-cultural nursing work environments is crucial due to the rising cultural diversity within healthcare teams. Despite the increasing international recruitment of qualified nurses to address the worldwide nursing shortage, no studies have synthesised the impact of nurse managers' attributes on nurses in multi-cultural nursing teams. Therefore, it was conducted a literature review aimed to synthesise the available literature on how nurse managers' personality traits, competencies, behaviours, and leadership styles influence nurse outcomes in multi-cultural nursing teams. METHODS: Scoping review conducted according to the Joanna Briggs Institute guidelines to map the relationship or influence of nurse managers' personality traits, competencies, behaviours, and leadership styles on the outcomes of nurses in multi-cultural settings across various clinical environments. Searches were conducted across electronic databases such as CINAHL and MEDLINE, along with grey literature. RESULTS: This review included 39 studies, highlighting 29 personality traits, 9 competencies, 115 behaviours, and 5 leadership styles that impact nurses' outcomes. Key findings emphasise the importance of nurse managers being supportive, culturally competent, and effective communicators, with transformational leadership style being particularly beneficial. CONCLUSIONS: These findings provide insights for planning and developing training programmes to equip current and future nurse managers with skills to effectively lead in multi-cultural care settings.

Strategy actions to include students in a private hospital's nursing teams: A qualitative study.

Background: Student nurse education focusses on preparing competent professionals integral to nursing teams. Aim: To develop strategic actions to include student nurses within the nursing team. Setting: A private healthcare group in South Africa. Methods: A qualitative approach in three phases was used. Thirty purposively sampled participants recorded reflective journals in phase one. Tesch's eight steps were utilised for analysis. Phase two involved non-probability volunteer sampling of 11 participants for the nominal group technique analysis. In phase three, total population sampling recruited nine panellists for an e-Delphi technique that provided data that were open coded. Results: Phase one identified themes, including perceptions of responsibilities, support needs, recognition, conflict and communication issues. Phase two revealed five strategic actions: fair treatment, aligned work allocation, active participation, respect and acknowledgement of contributions. Phase three validated 19 strategic statements underpinning the strategic actions. Conclusion: Unit managers play a key role in fostering inclusivity, impacting student nurse retention. Contribution: Enhancing team cohesion can improve workplace wellness and patient outcomes while aiding in retention and recruitment efforts.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia.

BACKGROUND: Severe pneumonia is a common severe respiratory infection worldwide, and its treatment is challenging, especially for patients in the intensive care unit (ICU). AIM: To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU. METHODS: We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1, 2021 and December 31, 2023. We compared and analyzed the respiratory mechanical indexes [airway resistance (Raw), mean airway pressure (mPaw), peak pressure (PIP)], blood gas analysis indexes (arterial oxygen saturation, arterial oxygen partial pressure, and oxygenation index), and serum inflammatory factor levels [C-reactive protein (CRP), procalcitonin (PCT), cortisol (COR), and high mobility group protein B1 (HMGB1)] of all patients before and after treatment. RESULTS: Before treatment, there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups (P > 0.05). However, after treatment, the respiratory mechanical indexes of patients in both groups were significantly improved, and the improvement of Raw, mPaw, plateau pressure, PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group (P < 0.05). The serum CRP and PCT levels of patients were significantly decreased, and the difference was statistically significant compared with that of nursing group alone (P < 0.05). The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups. CONCLUSION: The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators, blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.