Chronic stress, behavioral tendencies, and determinants of health behaviors in nurses: a mixed-methods approach.

BACKGROUND: Nurses experience high, and often chronic, levels of occupational stress. As high-quality care requires a healthy workforce, individualized stress-alleviating interventions for nurses are needed. This study explored barriers and resources associated with health behaviors in nurses with different stress levels and work-related behavioral tendencies and identified health behavior determinants based on the Health Action Process Approach (HAPA) model. METHODS: Applying a mixed methods transformative triangulation design, n = 43 nurses filled out chronic stress (SSCS) and work-related behavior and experience patterns (German acronym AVEM) questionnaires, and participated in semi-structured interviews. With content analysis, categories of health behavior-related barriers and resources emerged. Behavior determinants (self-efficacy, outcome expectancies), health behavior, and barriers and resources were quantified via frequency and magnitude coding and interrelated with SSCS and AVEM scores to link level of health behavior with potential influencing factors. Nonparametric tests explored differences in quantified variables for SSCS and AVEM scores and 4-step-hierarchical regression analysis identified predictors for health behavior. RESULTS: Eighty-four percent of the nurses were chronically stressed while 49% exhibited unhealthy behavioral tendencies at the workplace. 16 personal and organizational themes (six resources, ten barriers) influenced health behaviors. Stress was associated with resource frequency (p = .027) and current health behaviors (p = .07). Self-efficacy significantly explained variance in health behaviors (p = .003). CONCLUSION: Health promotion related barriers and resources should be considered in designing nurse health promotion campaigns. Practitioners need to individualize and tailor interventions toward stress and behavioral experiences for sustainable effects on adherence and health.

[Personal Resources of Geriatric Nursing Staff - Results of a Cross-Sectional Study]. / Gesundheitsressourcen von Altenpflegepersonal ­ Ergebnisse einer Querschnittsstudie.

OBJECTIVES: Geriatric nursing staff are exposed to high workloads, which often lead to stress, incapacity to work and early retirement. Personal resources can help deal with work demands and can have a positive effect on health. To design tailored interventions, this study aims to identify personal resources of staff and its impact on stress levels. MEASURES: Data on 195 geriatric nurses (87.4% female, 40.1±12.2 years) were collected using a set of validated questionnaires consisting of Slesina questionnaire, Nordic Questionnaire, SF-12, personal resources (according to WHO criteria), AVEM questionnaire and the SSCS scale of the TICS questionnaire. According to the SSCS scale, nursing staff were divided into stressed and non-stressed. To further investigate potential factors influencing the development of stress, a four-step regression analysis was carried out. RESULTS: Non-stressed geriatric nursing staff felt less burdened by work-related stress factors, had fewer physical complaints, had higher physical (p<0.001) and mental well-being (p <0.001), better personal resources and healthier work-related behavior and experience. The regression analysis showed that personal resources such as satisfaction with health status, nutritional behavior, frequency of being calm and relaxed, frequency of being full of energy as well as the stress level can improve physical and mental well-being, but cannot decrease the emergence of stress in case of unhealthy work coping behavior (R²=0.760). CONCLUSION: When developing stress prevention interventions, the focus should be on strengthening personal resources. In addition, individual work-related behavior and experience patterns should be taken into account.

Interventions to promote physical and mental health of nurses in elderly care: A systematic review.

This systematic review focuses on the current evidence on interventions to promote physical and mental health in elderly care nurses. The literature was identified through the electronic databases Medline, PsycINFO and CINAHL using a combination of synonyms of the terms "elderly care nurses", "physical activity", "stress management", "occupational stress", "musculoskeletal diseases" and "incapacity to work". The search was performed in January 2020 and repeated in November 2020. N = 6 randomized controlled studies were included investigating the effect of physical activity interventions, cognitive-behavioral interventions, organizational interventions and multicomponent interventions on physical and mental health in elderly care nurses. Both, the content of the interventions and the used outcome measures were heterogeneous. Four of the included studies had a high quality. They scored same or higher than seven (out of a maximum quality score of 14) with low risks of performance and attrition bias. Results suggest that cognitive-behavioral and multicomponent interventions seem to have an influence on physical and mental health factors such as job satisfaction, burnout, mental health symptoms and neck complaints. This systematic review demonstrated the potential of health promotion programs in elderly care nurses. Nevertheless, high quality randomized controlled trials are needed. Further research should consider the bottom-up approach for planning programs as well as recommended and standardized outcome measures and interventions.

Definition and Contextual Factors of Nursing Home Residents' Mobility in a Holistic View: A Delphi Study.

Background and Objectives: Current definitions of older adults' mobility do not cover the full range of influencing factors and do not consider nursing home residents. The present study reports expert ratings from a Delphi study regarding factors influencing the mobility of long-term nursing home residents. Research Design and Methods: We invited 129 professionals with expertise in a field relevant to research on mobility in older adults such as health care, medicine, or human movement science to participate in a Delphi study comprising 3 rounds of online questionnaires. Up to 40 experts participated in each round. In the first round, we used open-ended questions to solicit possible definitions, contextual factors, and assessment tools. In the second round, the participants used Likert scales (1-10) to rate their suitability. In the final round, we presented a definition based on consensus as well as the top-rated contextual factors and assessment tools from the first 2 rounds for a final rating of agreement. Results: The experts showed broad agreement on the final version of the mobility definition, with 8.9 ± 1.4 (mean ± standard deviation) out of 10 points. The experts also showed broad consensus on the selected contextual factors, with 8.4 ± 1.8 points to 8.9 ± 1.2 points (out of 10 points). This was also the case for the top 3 assessment tools selected from results of previous rounds, which showed an agreement of 7 or more points (out of 10 points) by 81.6% to 100% of all experts in the different categories. Discussion and Implications: Given that an interdisciplinary group of experts considered various hitherto neglected contextual factors as relevant, the Delphi survey and its results imply the need for an updated interdisciplinary and holistic understanding of mobility in nursing home residents and can provide a basis for putting it into practice.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships.

BACKGROUND: According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately. OBJECTIVE: Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships. DESIGN, SETTING, AND PARTICIPANTS: An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'. METHODS: The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling. RESULTS: The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern. CONCLUSIONS: Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241); August 9, 2018. TWEETABLE ABSTRACT: Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project.

BACKGROUND: Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. METHODS: The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). RESULTS: Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. DISCUSSION AND CONCLUSION: Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance. TRIAL REGISTRATION: Trial registration number: DRKS00014957.

Dataset of single nucleotide polymorphisms of immune-associated genes in patients with SARS-CoV-2 infection.

The SARS-CoV-2 pandemic has affected nations globally leading to illness, death, and economic downturn. Why disease severity, ranging from no symptoms to the requirement for extracorporeal membrane oxygenation, varies between patients is still incompletely understood. Consequently, we aimed at understanding the impact of genetic factors on disease severity in infection with SARS-CoV-2. Here, we provide data on demographics, ABO blood group, human leukocyte antigen (HLA) type, as well as next-generation sequencing data of genes in the natural killer cell receptor family, the renin-angiotensin-aldosterone and kallikrein-kinin systems and others in 159 patients with SARS-CoV-2 infection, stratified into seven categories of disease severity. We provide single-nucleotide polymorphism (SNP) data on the patients and a protein structural analysis as a case study on a SNP in the SIGLEC7 gene, which was significantly associated with the clinical score. Our data represent a resource for correlation analyses involving genetic factors and disease severity and may help predict outcomes in infections with future SARS-CoV-2 variants and aid vaccine adaptation.

Multicomponent exercises to prevent and reduce back pain in elderly care nurses: a randomized controlled trial.

BACKGROUND: Sports science is making an important contribution to health services research and supports the development of tailored interventions, e.g., in nursing settings. Working in elderly care is associated with a high prevalence of low back pain (LBP). Due to the diverse requirements and high strains, multicomponent programs are essential to address all relevant factors. This randomized controlled trial investigated the effects of a tailored ten-week ergonomics and twelve-week strength training on lifting behavior, strength endurance, LBP, functional impairment and adherence. METHODS: n = 42 nurses were randomly assigned to the intervention (IG; n = 20) or control group (CG; n = 22). They were eligible for participation if they were active in residential care and if they provided written informed consent. Other employees were excluded. The data were collected at baseline, at ten weeks (after ergonomics training), at 22 weeks (after strength training), and at 34 weeks (follow-up). The analysis combined physical tests with questionnaires (Progressive Isoinertial Lifting Evaluation, PILE-Test; Biering-Sørensen-Test; Visual Analog Scale Pain, VAS; Oswestry Disability Index, ODI; self-developed questionnaire for adherence). Group differences were analyzed by Chi2-Tests, ANOVA, and Linear Mixed Models. RESULTS: The IG showed an improved lifting performance (PILE-Test; 95% CI 1.378-7.810, p = .006) and a reduced LBP compared to the CG (VAS; 95% CI - 1.987 to 0.034, p = .043) after ergonomics training (PILE-Test, F(1,34) = 21.070, p < .001; VAS, F(1,34) = 5.021, p = .032). The results showed no differences concerning the Biering-Sørensen-Test and the ODI. Positive adherence rates were observed. CONCLUSIONS: This approach and the positive results are essential to derive specific recommendations for effective prevention. The study results can be completed in future research with additional strategies to reduce nurses' burden further. TRIAL REGISTRATION: The trial was registered at DRKS.de (DRKS00015249, registration date: 05/09/2018).

Physical activity and health promotion for nursing staff in elderly care: a study protocol for a randomised controlled trial.

INTRODUCTION: Nursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness. METHODS AND ANALYSIS: A randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20-30 min) and subsequently, back-fitness training (12 weeks, once a week for 45-60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up). ETHICS AND DISSEMINATION: The study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241).

Work-Related Burdens and Requirements for Health Promotion Programs for Nursing Staff in Different Care Settings: A Cross-Sectional Study.

Nursing staff in all settings have multiple work-related problems due to patient handling and occupational stressors, which result in high stress levels and low back pain. In this context the importance of health promotion becomes apparent. The aim of this study is to analyse whether nursing staff (in elderly care, hospitals, home care, or trainees) show different levels of work-related burdens and whether they require individualized components in health promotion programs. N = 242 German nurses were included in a quantitative survey (Health survey, Screening Scale (SSCS) of Trier Inventory for Chronic Stress, Slesina). The differences were tested using Chi2-Tests, Kruskal-Wallis Test and one-way ANOVA. Nurses differed in stress loads and were chronically stressed (F(3236) = 5.775, p = 0.001). Nurses in home care showed the highest SSCS-values with time pressure as the most important straining factor. The physical strains also placed a particular burden on nurses in home care, whereas they still reported higher physical well-being in contrast to nurses in elderly care (Chi2 = 24.734, p < 0.001). Nurses in elderly care and home care preferred strength training whereas nurses in hospitals and trainees favoured endurance training. Targeted programs are desirable for the reduction of work-related burdens. While nurses in elderly care and home care need a combination of ergonomic and strength training, all nurses require additional stress management. Planning should take into account barriers like perceived additional time consumption. Therefore, health promotion programs for all settings should be implemented during working time at the work setting and should consider the working schedule.

The effect of physical activity interventions on occupational stress for health personnel: A systematic review.

BACKGROUND: High occupational stress and its implications on health in people who are working in the healthcare sector are well-documented. However, less is known about beneficial effects physical activity interventions might have on occupational stress in healthcare settings. OBJECTIVE: This systematic review aims to identify the current evidence on the effect of physical activity interventions on stress outcomes in health personnel. DESIGN: A systematic review with quality assessment. METHOD: PsycINFO, Medline and CINAHL databases were searched in February 2018 using a combination of synonyms of the terms "health personnel", "physical activity" and "occupational stress". The search was repeated in March 2019. RESULTS: N = 18 experimental studies were included, representing three specified physical activity intervention types (yoga, tai chi and qigong) and different non-specific worksite training programs. Nine studies conducted a multi component intervention with a minor part being physical activity. A total of n = 9 studies investigated the effect of a single component physical activity intervention on stress (seven RCTs, two pre-post intervention studies). Stress measurements used were heterogeneous and only five studies specifically assessed occupational stress. None of the nine studies were considered to be of high quality. All of the included studies scored lower than seven (out of a maximum quality score of 14) with risks of performance and attrition bias. Results suggest a stress reducing effect of yoga and qigong interventions, whereas general workplace physical activity programs and tai chi did not show significant effects. CONCLUSIONS: The present review indicates that yoga and qigong might be an effective way of reducing stress in health personnel and could be incorporated into health promotion in the healthcare sector. Nevertheless, further research with appropriate planning and detailed descriptions of the conducted interventions (duration, frequency and intensity) is needed to determine the effect of physical activity interventions on occupational stress.

Identifying Individual Stressors in Geriatric Nursing Staff-A Cross-Sectional Study.

Background: Nurses in geriatric care are exposed to various burdens in the workplace that result in high stress levels. The perceived stress may result in a lack of professional caring and burnout. Objectives: The study aim was to identify work-related and personal factors that determine stress levels to design tailored interventions. Research design: cross-sectional study. Subjects:N = 195 geriatric nursing staff members. Measures: The survey included validated questionnaires (Trier Inventory for Chronic Stress (TICS), Health Survey Short form 12 (SF-12), Nordic Questionnaire) to identify work-related burdens, resulting stress levels and work-related behavior (AVEM). According to the limits of the Screening Subscale for chronic stress (SSCS) of the TICS, nurses were classified as stressed or non-stressed. With four-step regression analysis, main predictors for the stress level were identified. Results: The analysis revealed body postures, handling heavy loads, time pressure, deadlines and pressure to perform as the main burdens of the participants. Chronically stressed nurses showed different work patterns in comparison to nurses with lower stress levels. The regression analysis showed significance for the models including the work-related patterns and resilience aspects (step three (F (3.42) = 4.168; p = 0.010) and four (F (7.35) = 4.194; p = 0.002). Pattern B was a main factor for determining stress. The stress level determined the perceived burdens. Conclusions: Experiencing and managing stressors depends on the individual's perception, while coping patterns-especially pattern B-can be decisive. The tailored interventions to reduce stress in geriatric nurses should focus on personal patterns.