Impact of Work Motivation on Occupational Health in Healthcare Workers.

OBJECTIVES: The present cross-sectional study investigated, in a group of Italian healthcare workers (HCWs), the association between work motivation and occupational health and the impact of socio-demographic and job-related variables on this association. METHODS: A total of 656 subjects (nurses, technicians, midwives and physiotherapists) completed the survey. Linear regression models were used to correlate motivation types (by Scale of Motivation At Work) with health indicators (general health, depression, professional exhaustion, satisfaction and turnover intention) and burnout's subscales (emotional exhaustion, depersonalization and reduced professional achievement). FINDINGS: Autonomous motivation correlated positively with general health and work satisfaction and negatively with depression, exhaustion and turnover intention. Scoring high on intrinsic/integrated regulation was associated with better health and job satisfaction and with turnover intention, depression and emotional exhaustion. Controlled motivation, demotivation and external regulation nourished burnout's indicators, while autonomous motivation was protective. Operating in intensive care or surgical areas negatively affected general health; working as a nurse manager or midwife increased one's depressive risk and reduced satisfaction; being older than 60 increased emotional exhaustion and turnover intention; having a master's degree protected from exhaustion and depression. IMPLICATIONS: Collectively, our findings extend evidence on the role of work motivation in shaping occupational health and underline the importance for healthcare organizations of promoting actions to reinforce autonomous motivation at work.

COVID-19 isolation/quarantine rules in home care patients.

The spread of Severe Acute Respiratory Syndrome Coronavirus 2 new variants increased the number of subjects in home isolation and quarantine. The aim of this study was to assess the compliance with coronavirus disease 2019 home isolation rules for 32 subjects in home care in Marche Region, Italy. The results showed that subjects in home isolation were better informed about isolation rules (P = 0.007) than those who were in quarantine. They had lower educational level (P < 0.001) and none/single income (P < 0.001) and higher rate of clinical manifestation. The education for a safe quarantine should be strengthened widely, especially among disadvantaged subjects.

Recognising undernutrition in a community hospital: the nursing judgement is insufficient.

INTRODUCTION: Standardised nutritional screening methods improve the rate of recognising older patients with undernutrition, which is strongly encouraged in hospitals and residential settings. Therefore, our study compared the rates of identifying undernutrition before and after introducing the Mini Nutritional Assessment (MNA®) in a community hospital. METHODS: This was a single-centre, retrospective, observational before-after study. Participants were subjects aged 65 years or older, admitted to a community hospital from May 2018 to December 2020. The nursing assessment at admission included the MNA® from January 2020. The prevalence of undernutrition gathered by nursing diagnoses from 2018 to 2019 was compared with data obtained using the MNA® in 2020. Then, a confirmatory analysis was conducted to compare the prevalence of undernutrition in 2020 when both nursing diagnoses and the MNA® were used. RESULTS: We analysed data of approximately 316 patients (238 before and 78 after introducing the MNA®). Overall, results showed that 47.1% (n = 149) of the patients were undernourished. As observed, the prevalence of undernutrition was 38.6% (n = 92) in 2018-2019 and 73.1% (n = 57) in 2020 (p < 0.001). In 2020, however, 38.5% of patients (n = 30) were identified as undernourished using the MNA® but not using nursing diagnoses. Therefore, the correlation between these two methods was poor (Pearson's correlation 0.169, p = 0.14). CONCLUSION: Identifying elderly patients with undernutrition significantly increased after introducing the MNA®. Undernutrition is a common condition that should be systematically screened using a validated tool to activate personalised nutritional interventions promptly.

Predictors of adverse outcomes using a multidimensional nursing assessment in an Italian community hospital.

BACKGROUND: There is growing evidence about the role of nurses in patient outcomes in several healthcare settings. However, there is still a lack of evidence about the transitional care setting. We aimed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during community hospital stay. METHODS: A retrospective observational study was performed on patients consecutively admitted to a community hospital (CH) in Loreto (Ancona, Italy) between January 1st, 2018 and May 31st, 2019. The nursing assessment included sociodemographic characteristics, functional status, risk of falls (Conley Score) and pressure damage (Norton scale), nursing diagnoses, presence of pressure sores, feeding tubes, urinary catheters or vascular access devices and comorbidities. Two logistic regression models were developed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during CH stay. RESULTS: We analyzed data from 298 patients. The mean age was 83 ± 9.9 years; 60.4% (n = 180) were female. The overall mean length of stay was 42.8 ± 36 days (32 ± 32 days for patients who died and 33.9 ± 35 days for patients who had an acute hospitalization, respectively). An acute hospitalization was reported for 13.4% (n = 40) of patients and 21.8% (n = 65) died. An increased risk of death was related to female sex (OR 2.25, 95% CI 1.10-4.62), higher Conley Score (OR 1.19; 95% CI 1.03-1.37) and having a vascular access device (OR 3.64, 95% CI 1.82-7.27). A higher Norton score was associated with a decreased risk of death (OR 0.71, 95% CI 0.62-0.81). The risk for acute hospitalization was correlated with younger age (OR 0.94, 95% CI 0.91-0.97), having a vascular access device (OR 2.33, 95% CI 1.02-5.36), impaired walking (OR 2.50, 95% CI 1.03-6.06) and it is inversely correlated with a higher Conley score (OR 0.84, 95% CI 0.77-0.98). CONCLUSION: Using a multidimensional nursing assessment enables identification of risk of nearness of end of life and acute hospitalization to target care and treatment. The present study adds further knowledge on this topic and confirms the importance of nursing assessment to evaluate the risk of patients' adverse outcome development.

Cortisol, chronotype, and coping styles as determinants of tolerance of nursing staff to rotating shift work.

Hypothalamo-pituitary-adrenal axis activity and cortisol patterns are likely to play a role in shift work tolerance, i.e., ability to adapt to shift work without suffering stress-related consequences. Yet, the evidence is scanty. Here, salivary cortisol output during night shifts and leisure days was assessed in fast-forward rotating shift work nursing staff (N = 30), and possible links with a series of variables - gender (30% male), age (M = 39.6, SEM = 1.57 y), years of service (M = 12.43, SEM = 1.48 y), BMI (M = 23.29, SEM = 0.66 Kg/m2), self-rated chronotype, sleep quality, and psycho-behavioral factors - were investigated. Main results show that cortisol output during night shifts: i) is larger in morning-oriented chronotypes, thus affected by the circadian misalignment between biological and working rhythms; ii) associates with dysfunctional coping styles at work; iii) positively correlates with diurnal cortisol secretion on leisure days, i.e., individuals with larger cortisol output during shifts display higher cortisol secretion on non-working days. Chronotype and psycho-behavioral factors explain most of the correlational weight linking cortisol output during the night shift and off-days. In conclusion, we confirm salivary cortisol testing as a suitable objective marker of occupational stress and propose it as a valuable index for monitoring shift work tolerance, in combination with chronotype. Moreover, we emphasize the importance of evaluating psycho-behavioral factors in professional settings, because these modifiable variables can be addressed with tailored psychological interventions to ameliorate poor job satisfaction, reduce work-related distress, and avoid chronic cortisol excess experienced by shift workers.

Enhanced recovery after thoracic surgery: patient information and care-plans.

Many studies have confirmed that the implementation of enhanced recovery after surgery (ERAS) protocols has the advantages of reducing the potential complications after thoracic surgery and the length of hospital stay. The ERAS program involves a multidisciplinary team, aimed at integrating evidence-based knowledge into clinical practice in order to reduce the patient's stress response to the surgical procedure and improve the response to stress, guaranteeing a combination of better outcomes and cost savings. All this would not be possible without the improvement of minimally invasive surgical techniques, progression of anesthesia, pain control, and careful patient preparation. In this setting, a preoperative personal counselling may play a key role to reduce stress, fear or anxiety and improve the morbidity of patients, enabling them to achieve functional and psychological compensatory mechanisms more quickly. Preoperative patient counselling, performed using verbal, written or multimedia materials, is crucial in order to achieve the goal of the ERAS project: making the patient a potentially active participant and the main character of his recovery, able to positively impact himself throughout the surgical and healing process. This report is aimed at evaluating patient information and care-plans in thoracic surgery, reviewing the available evidence on ERAS pathways, and demonstrating our ideal program as discussed and shared among the Italian Thoracic Surgery Units accredited in the video-assisted thoracic surgery (VATS) group.

Work-engaged nurses for a better clinical learning environment: a ward-level analysis.

AIM: To correlate workgroup engagement in nursing teams and the clinical learning experience of nursing students. BACKGROUND: Work engagement plays a pivotal role in explaining motivational dynamics. Nursing education is workplace-based and, through their clinical placements, nursing students develop both their clinical competences and their professional identity. However, there is currently a lack of evidence on the role of work engagement related to students' learning experiences. METHODS: A total of 519 nurses and 519 nursing students were enrolled in hospital settings. The Utrecht Work Engagement Scale (UWES) was used to assess work engagement, and the Clinical Learning Environment and Supervision plus nurse Teacher (CLES+T) scale was used to assess students' learning experience. A multilevel linear regression analysis was performed. RESULTS: Group-level work engagement of nurses correlated with students' clinical learning experience (ß = 0.11, P < 0.001). Specifically, the 'absorption' and 'dedication' factors mostly contributed to enhancing clinical learning (respectively, ß = 0.37, P < 0.001 and ß = 0.20, P < 0.001). CONCLUSIONS: Nursing teams' work engagement is an important motivational factor to enhance effective nursing education. IMPLICATION FOR NURSING MANAGEMENT: Nursing education institutions and health-care settings need to conjointly work to build effective organisational climates. The results highlighted the importance of considering the group-level analysis to understand the most effective strategies of intervention for both organisations and nursing education.

Nurses' knowledge of evidence-based guidelines on the prevention of peripheral venous catheter-related infections: a multicentre survey.

AIMS AND OBJECTIVES: To evaluate nurses' knowledge of guidelines for preventing infections associated with peripheral venous catheters. BACKGROUND: Guidelines for the prevention of intravascular catheter-related infections are an important tool to help healthcare professionals minimise the risk of infection. However, they are not always applied by nurses. The literature on this topic is limited, and no study examined this matter for peripheral venous catheters. DESIGN: This cross-sectional study was carried out from November 2011-June 2012. METHODS: The nurses' knowledge of peripheral venous catheter guidelines and its association with gender, experience, education and the ward membership was assessed using a validated questionnaire. RESULTS: Sixteen hospitals from six regions of Italy participated, and 933 questionnaires were collected. Most participants were female (70·1%), undergraduate (51·8%), worked in medical (35·8%) and surgical departments (28·0%), and had >10 years of experience (55·0%). The median score on 10 questions was 6 of 10. A majority of nurses knew it is recommended to replace peripheral venous catheters routinely (90·0%), to perform an aseptic technique during connecting/disconnecting the infusive lines (55·2%), and to replace the administration set <24 hour when lipid emulsions have been infused (88·4%). Of note, 52·6% of nurses advocated the use of steel needles, a potentially dangerous practice. In multivariate analysis, a higher level of education and the area of work were associated with better test scores. CONCLUSION: The sample of nurses' knowledge to some recommendations is frequently low. This could be a potential risk factor for patient safety. The results should sensitise healthcare managers to improve nursing training and education, according to clinical risk management perspectives. RELEVANCE TO CLINICAL PRACTICE: These data request for more emphasis on international guidelines in infection prevention initiatives.