Cancer nurses have experienced ‘moral injury' due to the pandemic

First, a Happy New Year to you all. I hope you enjoyed the festive break. In this issue, our cover article (evidence and practice, page 21) explains how emotional labour can lead to exhaustion and burnout, which contributes to a high turnover in the nursing workforce. It examines the differences in resilience and coping strategies of less experienced nurses compared with their more experienced counterparts.

Understanding Challenges to Wellbeing among Medical and Nursing Staff Working in Paediatric Critical Care: An Enhanced Critical Incident Technique Study

BACKGROUND AND AIM: Staff working in paediatric critical care (PCC) experience high levels of burnout, compassion fatigue and symptoms of post-traumatic stress. We aimed to identify critical incidents inside or outside work which challenged staff's wellbeing, what hindered and helped;to identify successful strategies for maintaining workplace wellbeing. METHOD(S): Using the Enhanced Critical Incident Technique, individuals were asked to reflect on situations which challenged their wellbeing and to provide wish list items that would improve their workplace wellbeing RESULTS: Seven themes were identified (n=53): Covid-19 represented a significant challenge to wellbeing, yet it stimulated positive conversations about vulnerability. Shiftwork was experienced as challenging, especially with an Ageing workforce. Being older though brought self-awareness of one's limits and successful wellbeing strategies. Clinical investigations were distressing, sometimes worsened by opaque procedures. Yet support from seniors was available and highly valued. Frustration with Leadership was expressed, but PCC were described as quick to innovate and act. Patient outcomes sometimes led to moral distress, but news about patients' successes post discharge was rewarding. Facilities were described as unsatisfactory, except for some well-maintained quiet spaces. Finally, personal circumstances (e.g. bereavement, relationship breakdown) impacted staff's ability to work productively, but friends and family provided much-needed respite. Wishlist items included: self-rostering, recognising the impact of ageing and menopause, transparent investigation protocols, psychological support, communication training, comfortable spaces. CONCLUSION(S): Threats to wellbeing are multifaceted, but largely predictable. Knowing this, we need to develop protocols, support packages, and training to better equip staff to manage wellbeing prior to crisis.

Evolution of work ability, quality of life and self-rated health in a police department after remodelling shift schedule.

BACKGROUND: There exists a great diversity of schedules concerning the way shift work is organized and implemented with ample agreement regarding recommendable features of a shift system. In order to adapt the shift schedule of a metropolitan police department to current recommendations, a remodelled shift schedule was introduced in 2015. The aim of this study was to evaluate the potential associations between the remodelled shift schedule and work ability, quality of life and self-rated health after one and five years. METHODS: A controlled before-and- after study was conducted during the piloting phase (2015-2016) as well as a 5-year follow-up using paper questionnaires. Outcome parameters included work ability, quality of life and self-rated health. RESULTS: Work ability, quality of life and self-rated health improved after the first year of the newly implemented shift schedule among police officers working in the piloting police stations compared to those working according to the former schedule. In 5-year follow-up differences between indicators diminished. CONCLUSIONS: The implementation of a remodelled shift schedule including more 12-h shifts accompanied by more days off and a coherent weekend off duty was not associated with detrimental effects to work ability, quality of life or self-reported health among police officers.

Abuse from patients is affecting nurses’ well-being

I used to love my job, but recently I have had to brace myself before starting a shift, as I wonder 'how much abuse am I going to suffer today?'.

A Cross-Sectional, Exploratory Study on the Impact of Night Shift Work on Midwives' Reproductive and Sexual Health.

BACKGROUND: Shift work is the basis for health care system functioning. The non-standard schedules enforce abrupt changes in the timing of sleep and light-dark exposure. It can contribute to the increased risk of various medical conditions, including reproductive and sexual health issues. The purpose of the study was to assess the impact of shift work with night shifts on midwives' reproductive and sexual health. METHODS: This cross-sectional, exploratory study included 520 midwives. A descriptive questionnaire was distributed in person (414) and online (106) from July 2019 to May 2020. We used the Female Sexual Function Index (PL-FSFI) standardized questionnaire and proprietary research tools (applicable to demographic and social data and reproductive health). All statistical calculations were performed with the IBM SPSS 23 statistical package. RESULTS: Shift work affects midwives' reproductive and sexual health. Midwives working night shifts are more likely to experience reproductive problems and sexual dysfunctions. The most pronounced differences are observed in the experience of infertility and the number of miscarriages. PL-FSFI results clearly showed the adverse impact of working shifts including night shifts on functioning in various dimensions of sexual health. CONCLUSION: Shift work negatively affects reproductive and sexual health and causes work-life conflict experience. It is necessary to develop procedures that minimize shift rotation and implement work schedules that allow for recuperation or rest and ensure proper family and social life.

Perceived stigma, substance use and self-medication in night-shift healthcare workers: a qualitative study.

BACKGROUND: Many risk factors related to altered circadian rhythms impact the health of night-shift hospital workers (NSHW), resulting in mental and somatic disorders. Easy access to psychoactive substances (PS) may facilitate addictive behaviors in NSHW. They are also exposed to a stressful work environment, which may further affect sleep quality. This study aimed to explore the link between sleep deprivation, work-related psychosocial stress and psychoactive substance use as a self-medication response in NSHW. METHODS: Qualitative study to verify the plausibility of the self-medication theory applied to addictive behaviors. Semi-structured interviews (N = 18 NSHW) and thematic analysis, following consolidated criteria for reporting qualitative research recommendations. RESULTS: Stigma against NSHW was a primary element of a stressful work environment. The stressful and stigmatizing environment, together with night-shift work, further affected NSHW sleep and their mental and physical health. The use of PS appeared to be for self-medication, encouraged by social and professional environments, source(s) of stress, discrimination, and isolation. The work environment, through aggravated sleep disorders, led NSHW to use non-prescribed sleeping pills. Alcohol after work and smoking were used as a social break but also as a means to reduce stress. CONCLUSION: Anti-stigma interventions in the healthcare setting and screening of mental/somatic disorders in NSHW can help reduce harmful self-medication behaviors and improve hospital care in the COVID-19 era.

Post COVID-19 Fatigue Management for ATCOs

In the context of the outbreak of COVID19 and its effect on the aviation industry, air traffic controllers (ATCOs) have seen both their working and living conditions significantly affected. These effects may increase the risk of fatigue, especially when traffic increases again, with potential consequences for flight safety and the ATCOs’ health and well-being. This paper reviews the main risk factors of the pandemic on ATCO fatigue and proposes some recommendations to manage this risk. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.