The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night.

BACKGROUND: Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care. OBJECTIVE: The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night. METHODS: A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations. RESULTS: Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient-RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care. DISCUSSION: This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety.

The State of Rest Break Practices Among 12-Hour Shift Hospital Nurses in the United States.

OBJECTIVE: This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses. BACKGROUND: Nurses often miss, skip, or take interrupted breaks. To improve the quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them. METHODS: Survey data from 806 nurses were collected between October and November 2021. RESULTS: Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks. CONCLUSION: Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.

Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States.

AIMS AND OBJECTIVES: To describe the levels of insomnia, fatigue and intershift recovery, and psychological well-being (burnout, post-traumatic stress and psychological distress), and to examine differences in these measures based on work-related characteristics among nursing staff during COVID-19 pandemic in the United States. BACKGROUND: The COVID-19 pandemic has created a major physical and psychological burden on nursing staff in the United States and worldwide. A better understanding of these conditions will lead to tailored support and resources for nursing staff during and after the pandemic. DESIGN: Cross-sectional study. METHODS: Hospital nurses and nursing assistants (N = 587) were recruited online between May-June 2020. The survey included measures on insomnia (Insomnia Severity Index) fatigue and intershift recovery (Occupational Fatigue and Exhaustion Recovery-15), burnout (Maslach Burnout Inventory-Human Services Survey), post-traumatic stress (Short Post-Traumatic Stress Disorder Rating Interview) and psychological distress (Patient Health Questionnaire-4), and questions on work and demographics. The STROBE checklist was followed for reporting. RESULTS: The sample had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue and low-to-moderate intershift recovery. The sample experienced increased emotional exhaustion and depersonalisation, increased personal accomplishment, moderate psychological distress and high post-traumatic stress. Nurses who cared for COVID-19 patients had significantly scored worse on almost all measures than their co-workers. Certain factors such as working hours per week and the frequency of 30-min breaks were significant. CONCLUSION: Nursing staff experienced poor sleep, fatigue and multiple psychological problems during the COVID-19 pandemic. Moreover, staff who were involved in the care of COVID-19 patients, worked more than 40 h per week and skipped 30-min breaks showed generally worse self-reported outcomes. RELEVANCE TO CLINICAL PRACTICE: Nursing administration is recommended to monitor for fatigue and distress on nursing units, re-visit current scheduling practices, reinforce rest breaks and provide access to mental health and sleep wellness resources with additional support for their front-line nursing groups.

Hospital staff nurse perceptions of resources and resource needs during the COVID-19 pandemic.

BACKGROUND: There is a knowledge gap related to the resource needs of hospital nurses working during the Coronavirus disease 2019 (COVID-19) pandemic. PURPOSE: To investigate nurses' perceptions of organizational resources and support needs approximately 18 months after the COVID-19 pandemic began. METHOD: Cross-sectional survey of a convenience sample of 2,124 U.S. hospital nurses from July to September 2021 FINDINGS: There were some misalignments between what resources were provided to nurses and what was perceived as helpful to them. Nurses reported increased staffing, compensation, and management and leadership support most frequently as resources that could help them continue to provide safe and quality care during and after the pandemic. These were also the resources nurses most frequently reported that they wanted to be provided by their hospitals during the pandemic but were not. DISCUSSION: The findings offer valuable insights into how organizations can prepare to ensure workforce resilience during future crises.

Nonpharmacologic Interventions and Seizure Frequency in Patients With Psychogenic Nonepileptic Seizures: An Integrative Review.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices. AIM: To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES. METHODS: An integrative review guided by the Whittemore and Knafl approach. RESULTS: The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies). CONCLUSIONS: Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses.

PURPOSE: This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care. DESIGN: The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States. METHODS: Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models. FINDINGS: Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent. CONCLUSION: These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care. CLINICAL RELEVANCE: Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Occupational fatigue, workload and nursing teamwork in hospital nurses.

AIMS: To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue. DESIGN: This cross-sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021. METHODS: Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used. RESULTS: All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue. CONCLUSION: Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: Fatigue is negatively associated with the health and safety of hospital nurses and patients. Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue. WHAT WERE THE MAIN FINDINGS?: Greater nursing teamwork is significantly associated with lower acute and chronic fatigue. The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study.

BACKGROUND: Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts. PURPOSE: To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress. DESIGN: Cross-sectional. METHODS: Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting. RESULTS: Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices. CONCLUSION: Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices. RELEVANCE TO CLINICAL PRACTICE: Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

"Was Definitely Different Because They Were Kids": Caring for Patients From a School Shooting.

BACKGROUND: Trauma nurses may experience secondary traumatic stress, compassion fatigue, and burnout as their clinical roles expose them to patients with traumatic injuries. Because traumatic events described as being most stressful for nurses involve sudden death or children and adolescents, multicasualty, school-associated shooting events are likely to be particularly stressful for nurses who care for the affected patients. OBJECTIVE: This research examined the psychosocial effects of caring for patients in an inpatient trauma unit following a multicasualty, school-associated shooting event. METHODS: This research was guided by a qualitative case series approach, a theory of secondary traumatic stress, and the compassion fatigue resilience model. Registered nurses who provided care in the trauma unit of a Level I trauma center to patients who were injured during a multicasualty, school-associated shooting event in the Southeastern United States were invited to participate. RESULTS: The three themes identified by this research were (a) innocence of the patients, (b) trajectories of increased emotions, and (c) processing emotional stressors. Nurses reported the benefits of peer support and provided recommendations to increase the efficacy of formal debriefing sessions. CONCLUSIONS: Nurses value self-care routines and peer support as coping mechanisms to foster well-being following exposure to traumatic events. Hospitals should encourage active participation in timely critical incident stress debriefings and promote the use of employee assistance services to support nursing staff after these events.

Longitudinal Moderated Mediation Analysis in Parallel Process Latent Growth Curve Modeling in Intervention Studies.

BACKGROUND: Intervention studies are used widely in nursing research to explore the efficacy of intervention programs for changing targeted health outcomes. However, the analyses of such studies have focused predominantly on their main intervention effects; most studies ignore the mechanisms underlying how the intervention programs work partly because of lack of application details of the longitudinal mediation analysis techniques. OBJECTIVES: The aim of this study was to illustrate an application of parallel process latent growth curve modeling (PP-LGCM) to examine longitudinal moderated mediation effects. METHODS: Longitudinal data from an online bone health intervention study were used to demonstrate the step-by-step application of PP-LGCM with Mplus statistical software. RESULTS: With modification indices, we were able to achieve adequate model fit for PP-LGCM in our data. The mediation effects of self-efficacy on the intervention effects on exercise were nonsignificant for the entire sample. However, the conditional indirect effect showed the mediation effects were moderated by age group. DISCUSSION: PP-LGCM provides an efficient way to analyze and explain the underlying mechanisms for the intervention effects in a trial, especially when the intervention program is guided by a theory.

Insomnia symptoms, fatigue, and future job exit in American older adults.

BACKGROUND: As older adults prolong working life and face age-related health changes, insomnia symptoms and fatigue may jeopardize their ability to stay in the labor force. Our study explored the relationships between insomnia symptoms, fatigue, and job exit in workers aged 65 years and older. METHODS: Data from the National Health and Aging Trends Study were used (2011-2017). The sample included 953 Medicare beneficiaries with paid work at the time of the interview. Workers were followed annually for 6 years to the time of job exit. Insomnia measures included the number and type of symptoms, and fatigue (measured as low energy). Crude and adjusted odds ratios and 95% confidence intervals were estimated within discrete-time survival analysis. Models were adjusted for health, lifestyle, and sociodemographic characteristics. RESULTS: At baseline, approximately 49% of workers had either one or two insomnia symptoms. Difficulty falling asleep and difficulty maintaining asleep were prevalent in 35% and 37% of the sample. Fatigue was common in <30% of the sample. Workers with difficulty falling asleep were 1.29 times at higher odds to have job exit when compared with workers with no insomnia (p = 0.033). Conversely, fatigued workers were 0.73-0.77 times at lower odds to have job exit when compared with nonfatigued workers (p < 0.05). CONCLUSION: Difficulty falling asleep negatively affects future work status, unlike feeling fatigued. Healthcare providers are encouraged to assess for insomnia and discuss treatments with workers, and workplaces should be flexible with the start of workdays to support worker longevity.

Did rest breaks help with acute fatigue among nursing staff on 12-h shifts during the COVID-19 pandemic? A cross-sectional study.

AIM: This study aimed to explore whether 30-min rest breaks were as effective at lowering acute fatigue among 12-h shift hospital nursing staff who cared for patients with COVID-19 as among those who did not. DESIGN: The study was cross-sectional in design. METHODS: Data from the SAFE-CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12-h shifts, and providing direct patient care in hospitals was used in this study. Data on socio-demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID-19 patient care. RESULTS: The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID-19, and 71% reported taking rest breaks 'sometimes', 'often' or 'always'. In the group that cared for patients with COVID-19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010). CONCLUSION: Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within-work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID-19 pandemic. IMPACT: Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID-19, other co-workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.

Prevalence of type II workplace violence among home healthcare workers: A meta-analysis.

BACKGROUND: Home healthcare workers (HHWs) provide medical and nonmedical services to home-bound patients. They are at great risk of experiencing violence perpetrated by patients (type II violence). Establishing the reliable prevalence of such violence and identifying vulnerable subgroups are essential in enhancing HHWs' safety. We, therefore, conducted meta-analyses to synthesize the evidence for prevalence and identify vulnerable subgroups. METHODS: Five electronic databases were searched for journal articles published between 1 January 2005 and 20 March 2019. A total of 21 studies were identified for this study. Meta-analyses of prevalence were conducted to obtain pooled estimates. Meta-regression was performed to compare the prevalence between professionals and paraprofessionals. RESULTS: Prevalence estimates for HHWs were 0.223 for 12 months and 0.302 for over the career for combined violence types, 0.102 and 0.171, respectively, for physical violence, and 0.364 and 0.418, respectively, for nonphysical violence. The prevalence of nonphysical violence was higher than that of physical violence for professionals in 12 months (0.515 vs 0.135) and over the career (0.498 vs 0.224) and for paraprofessionals in 12 months (0.248 vs 0.086) and over the career (0.349 vs 0.113). Professionals reported significantly higher nonphysical violence for 12-month prevalence than paraprofessionals did (0.515 vs 0.248, P = .015). CONCLUSION: A considerable percentage of HHWs experience type II violence with higher prevalence among professionals. Further studies need to explore factors that can explain the differences in the prevalence between professionals and paraprofessionals. The findings provide support for the need for greater recognition of the violence hazard in the home healthcare workplace.

Acute fatigue predicts sickness absence in the workplace: A 1-year retrospective cohort study in paediatric nurses.

AIMS: To examine the relationship between fatigue and sickness absence in nurses from a paediatric hospital over 12 months of follow-up. A secondary aim was to identify other work and personal factors that predict sickness absence. BACKGROUND: Sickness absence is often related to worker-fatigue, yet few studies have explored this relationship in nurses despite documented high fatigue levels. DESIGN: The study used retrospective cohort design. METHODS: Baseline data on 40 nurses from an intervention study were linked to absence data using the hospital's attendance records (2012-2013). A total of 6,057 work shifts were studied of which 5.2% were absence episodes. Fatigue was measured by the Occupational Fatigue Exhaustion Recovery scale. The questionnaire included instruments assessing sleep disturbances, workload and personal characteristics. Generalized linear mixed models were used to test the associations between fatigue, work, personal factors and sickness absence, while accounting for non-independency of repeated measures. RESULTS: With 1SD increase in acute fatigue scores, nurses were 1.29 times more likely to be absent from work. Factors such as intershift recovery, perceived workload, obstructive sleep apnoea and marital status also predicted sickness absence, that is, with 1SD increase in workload scores, nurses were 1.23 times more likely to be absent from work. Nurses with obstructive sleep apnoea had two times higher odds of sickness absence. CONCLUSION: Sickness absence is related to acute fatigue in paediatric nurses and to workload. Nursing leaders can monitor these factors to reduce sickness absence and screen for sleep apnoea and assist nurses in receiving the appropriate treatments.

Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study.

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current personal health record and patient portal implementation process. Further studies are needed using larger samples in other settings to ascertain if these results are generalizable to other populations.

Validation of the Arabic version of the EORTC quality of life questionnaire among cancer patients in Lebanon.

PURPOSE: The objective of this article was to evaluate the psychometric properties of the translated Lebanese Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 in a sample of adult cancer patients in Lebanon. METHODS: The EORTC QLQ-C30 was translated into Lebanese Arabic and administered to a convenient sample of 200 adult patients diagnosed with cancer at a tertiary care center in Lebanon between 2009 and 2010. The psychometric indices assessed were reliability, multitrait scaling analysis, construct validity, and confirmatory factor analysis. RESULTS: Six out of nine subscales had Cronbach's alpha coefficients above 0.70. Multitrait scaling analysis showed that all item-scale correlation coefficients met the set standards of convergent validity with the exception of item 5 only (95.8 %). In addition, 79.7 % of the item-scale correlation coefficients met the criterion for discriminant validity. In inter-scale correlations, all conceptually related scales had correlation coefficients of ≥ 0.40 with the exception of role functioning and fatigue scales having an undesirable correlation coefficient of -0.76. In known-groups comparison, the instrument differentiated significantly between some of the subscales with respect to education, employment, and age. CFA showed an almost good fit (GFI = 0.87) with respect to our current data set. CONCLUSION: The translated Lebanese Arabic version of the EORTC QLQ-C30 is a reliable and valid instrument that can be used to assess the quality of life of Lebanese cancer patients.

Quality of palliative care in children with cancer in Lebanon.

OBJECTIVE: There is a growing research interest in pediatric palliative care in Lebanon. To date the existing studies have focused on the perspective of parents of children with cancer. The purpose of this study was to evaluate the quality of life (QoL), symptom prevalence and management, functional ability, and the quality of care among children with cancer at the Children's Cancer Center of Lebanon. METHODS: A cross-sectional survey design was used. A convenience sample of 85 patients on therapy aged 7 to 18 years participated in the study between 2010 and 2011. Using face to face interviews, a combination of four instruments were administered in Arabic. RESULTS: The mean age of the participants was 12.5 years, with the majority having leukemia. Overall, the children had satisfactory health-related QoL, with the exception of the nausea and worry subscales, had no limitations in functional abilities, and were satisfied with the care that they received. In children between 7 to 12 years, the most common symptoms were lack of appetite, pain, and nausea, while adolescents between 13 to 18 years experienced lack of energy, irritability, and pain. Pain and nausea were the most frequently treated symptoms. CONCLUSION: Although the participants reported satisfactory QoL, yet symptom management was inadequate and mainly focused on treating the physical symptoms. It is recommended to provide both pharmacological and psychological interventions in order to alleviate symptom burden and hence improve QoL in children with cancer.

Nurses' Rest Breaks and Fatigue: The Roles of Psychological Detachment and Workload.

BACKGROUND: Rest breaks have been shown to reduce acute fatigue, yet not all nurses who take rest breaks report lower fatigue. Psychological detachment-letting go of work-related thoughts-during rest breaks and workload may be key factors in explaining this phenomenon. OBJECTIVE: To examine the mediating role of psychological detachment during rest breaks and determine how workload moderated that pathway to lower acute fatigue among hospital nurses. METHODS: In this cross-sectional study, data were collected from 1861 12-hour shift nurses who answered an online survey between July and September 2021. The survey included measures of occupational fatigue, psychological detachment from work, workload, and questions on breaks, work, health, and demographics. Structural equation modeling was used in Mplus 8.9 software to estimate the direct and indirect effects of rest breaks on acute fatigue at 3 levels of workload. RESULTS: Nurses, on average, reported high acute fatigue, rarely experienced psychological detachment during rest breaks, and reported heavy workloads. Around 60% were able to sit down for a break on their last shift but with patient-care responsibilities. The relationship between taking a rest break and acute fatigue was fully mediated by psychological detachment from work. However, this relationship only held in the context of manageable workloads. CONCLUSION: Our findings showed that within-shift recovery is possible when nurses can psychologically detach from work during rest breaks. However, this within-shift recovery mechanism was disrupted for nurses with heavy workloads.

Nurses' Short-Term Sickness Absences Before and After the Implementation of a Brief Napping Opportunity During Night Shifts.

BACKGROUND: Nurses who work at night have used naps to alleviate their sleepiness and fatigue. Research has shown night shifts, sleepiness, and fatigue predict nurses' missed workdays. Thus, nighttime napping may have a beneficial consequence of reducing nurses' sickness absences. The purpose of this brief report was to describe the difference in rates of short-term sickness absence before and after implementation of a 30-min nap opportunity in one U.S. hospital for 12-hr shift nurses. METHODS: The study was a retrospective pre-post evaluation design. Eight units provided nap opportunities for the nurses. Full-time nurses were classified into night and rotating shifts based on their 2 years of scheduling patterns. Absence data were extracted from the hospital's timekeeping system and annual absence rates were computed. A single linear mixed model with rank transformed data was conducted for each group. Median estimates, minimum and maximum, and p-values were reported. FINDINGS: The median absence rates for night shift nurses were 4.3% and 4.0% for the pre-napping and post-napping implementation periods, respectively; however, this difference was not statistically significant (p = .241). The median absence rates for rotating shift nurses were 2.0% and 3.9% for the pre-napping and post-napping implementation periods, respectively; and the difference increase was statistically significant (p < .001). CONCLUSION/APPLICATION TO PRACTICE: A nap policy which provides nurses with the opportunity to take nighttime naps did not benefit their sickness absence rates. Future research needs to examine the actual napping process on sickness absences, as well as explore other sickness management avenues.