Latent class analysis of the sleep quality of night shift nurses and impact of shift-related factors on the occupational stress and anxiety.

AIMS: The objective of this study is to explore the various latent categories within the sleep quality of night shift nurses and to investigate whether shift-related factors predispose nurses to higher levels of occupational stress and anxiety. DESIGN: This is a cross-sectional study. METHODS: From November to December 2020, registered nurses from 18 tertiary hospitals and 16 secondary hospitals in Chongqing were selected through convenience sampling for this study. Latent class analysis was used to investigate the sleep quality of nurses working night shifts. Furthermore, univariate analysis and logistic multivariate analysis were utilized to identify the contributing factors to occupational stress and anxiety. RESULTS: The four latent categories of Pittsburgh Sleep Quality Index for night shift nurses were identified as 'Low Sleep Disorder Group' (56.34%), 'Moderate Sleep Disorder Group' (37.27%), 'High Sleep Disorder Non-Reliant on Sleeping medication Group' (4.89%) and 'High Sleep Disorder Reliant on Sleeping medication Group' (1.50%). The results showed that having a night-shift frequency of 3-4 times per month, night-shift durations of 9-12 h, sleep time delay after night shift (≥2 h), total sleep time after night shift less than 4 h were shift-related factors that increased the levels of occupational stress and anxiety. CONCLUSION: The sleep quality of night shift nurses demonstrates heterogeneity and can be classified into four latent categories. Higher frequency of night shifts, extended work hours and insufficient rest time are all associated with increased levels of occupational stress and anxiety. IMPACT: By identifying the four latent categories of sleep quality among night shift nurses, this study sheds light on the relationship between sleep patterns and levels of occupational stress and anxiety. These findings have important implications for healthcare institutions in the management of nurse well-being and work schedules. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

RETRACTED: Safety climate, quality of care, adherence to and compliance with standard precautions among nurses: Structural equation modeling.

AIMS: The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs). BACKGROUND: Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines. DESIGN: Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines. METHODS: Participant nurses were recruited using convenience sampling (n = 870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis. RESULTS: The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs. CONCLUSIONS: Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance. IMPLICATIONS FOR NURSING POLICY AND PRACTICE: Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance.

Occupational fatigue, compassion competence and caring behaviours of intensive care nurses: A structural equation modelling approach.

BACKGROUND: No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses. AIM: We studied the direct effect of participating nurses' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables. STUDY DESIGN: This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model. RESULTS: Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, ß = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, ß = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, ß = .241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R2 = 0.350). CONCLUSIONS: This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care.

Critical success factors for the successful initiation of Lean in public hospitals in KwaZulu-Natal: a factor analysis and structural equation modelling study.

BACKGROUND: Lean thinking is one of several operations-management techniques which have yet to be fully embraced in the South African health care sector. In most health care managers' service delivery mandates, what needs to be done might be known, but it is how it should be done which might be alien to most managers. In order to recognise the "how", one needs to know the critical success factors for Lean initiation. METHODS: The research took the form of an observational descriptive study with quantitative methods. The objectives were to identify the key variables for the successful initiation of Lean and then to conduct factor analysis and structural equation modelling (SEM) on these variables leading to the identification of critical success factors (CSFs) for Lean initiation. Simple random sampling was applied to select the participants from various categories of 500 senior managers across 73 KwaZulu-Natal (KZN) public hospitals. The sample size was 218, with a response rate of 96.8% (n = 211). For the purpose of identifying key variables for the successful initiation of Lean and then of conducting factor analysis and SEM on these variables, a self-administered, structured questionnaire was used. Data were reduced using exploratory factor analysis (EFA) to identify latent constructs. Confirmatory factor analysis (CFA) was used to determine the reliability and validity of these factors. Structural equation modelling (SEM) fit indices were then applied to assess acceptability of the measurement model. RESULTS: Certain variables were eliminated during EFA if they cross-loaded onto more than one factor, since this caused discriminant validity problems. In addition, if variables loaded weakly onto a factor, they were not retained. Three critical success factors (CSFs) were identified in this study: strategic leadership and organisational attitude; integration of Lean elements, tools, and techniques; and basic stability in operational processes. All reliability and validity conditions have been met (RMSEA = 0.085; CFI = 0.956 and χ2/df = 2.513), consequently rendering the model reliable and valid. CONCLUSION: None of the three CSFs can be viewed in isolation, as they all have significance at different dimensions of capability within the organisation. The use of these CSFs and the context, content, application, and outcome of Lean should be viewed in light of the organisation's strategic, technical, structural, and cultural environment. Further research in the effectiveness of these CSFs for the rollout of Lean in South African hospitals would be of benefit to the Lean body of knowledge.

Structural Equation Modeling Analysis on Associations of Moral Distress and Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of Healthcare Professionals.

OBJECTIVE: Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)-perceived psychological safety, ethical climate, patient safety-and healthcare professionals' perception of moral distress. DESIGN: Cross-sectional survey. SETTING: Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States. PARTICIPANTS: Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study. MAIN OUTCOME MEASURES: Three dimensions of OCHC were measured using validated questionnaires: Olson's Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality's Patient Safety Culture Survey, and Edmondson's Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM). RESULTS: Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (ß= -0.357, p <.001) and patient safety culture (ß = -0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (ß = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82). CONCLUSIONS: We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations.