Effects of consecutive bed bathing with weak versus ordinary pressure on skin barrier recovery of hospitalised older adults: A within-person randomised controlled trial.

AIM: Wiping pressure (WP [mmHg]) during bed baths is essential to maintain skin integrity and care quality for older adults. However, effects of different wiping pressures on skin barrier recovery over multiple days remain unclear. This study evaluated and compared the effects of consecutive bed bathing with weak pressure and that with ordinary pressure on skin barrier recovery of hospitalised older adults. METHODS: This within-person, randomised, controlled trial involved 254 forearms (127 patients) and was conducted at a general hospital. Forearms were blinded and randomly assigned a site and sequence of two bed bathing sessions: wiping three times with weak (10≤WP<20) and ordinary pressure (20≤WP<30) once per day for 2 consecutive days. The skin barrier was assessed daily based on transepidermal water loss (TEWL) and stratum corneum hydration (SCH) before and 15 min after the interventions. Dry skin was assessed using the overall dry skin score. RESULTS: A linear mixed model showed that the time courses of TEWL and SCH differed significantly between groups. Impaired skin barrier function caused by ordinary pressure on the first day did not recover to baseline values the next day, whereas weak pressure did not cause significant changes. During subgroup analyses, TEWL of patients with dry skin was more likely to increase with ordinary pressure. CONCLUSIONS: Despite decreased skin barrier recovery experienced by older adults, our findings suggest the safety of weak pressure and highlight the importance of WP during bed baths. Weak pressure is particularly desirable for patients with dry skin. TRIAL REGISTRATION: UMIN000048838.

Health Management of Working Pregnant Nurses: A grounded theory study.

AIM: To explore the recognition of pregnant nurses on how they managed their health conditions to examine safe working strategies. DESIGN: A qualitative study with a grounded theory approach. METHODS: Twenty-one nurses engaged in work during their pregnancy were recruited and interviewed using a semi-structured questionnaire from January to June 2021. The data were analysed using a constant comparative method. RESULTS: The core category 'duelling roles' and the four other categories emerged. Pregnant nurses understand the 'weight of one' of being a professional in the workplace. Therefore, despite their health concerns, they struggle to complete their work as one team member to avoid inconveniencing others. However, through experiencing various nursing situations, they 'perceive one's limits' of working as they had done before pregnancy and protect their health and patients. Nevertheless, interactions with patients and their colleagues bring 'delight in nursing', which encourages them to continue working. Pregnant nurses thus develop a 'prioritizing the foetus' working style to continue being nurses while protecting their health. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: These results provide meaningful guidance in considering safe job retention strategies for pregnant nurses. Sharing and developing the 'prioritizing the foetus' mindset and management skills gained by the participants may be beneficial for the appropriate health management of pregnant nurses. The study may also facilitate nursing managers' understanding of the experiences of pregnant nurses and encourage them to consider reviewing nursing practices. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Studies checklist was used to ensure the quality of research reporting. PATIENT OR PUBLIC CONTRIBUTION: Members of the nursing team were involved in the design, conduct and interpretation of the data in this study.

Risk factors of skin barrier dysfunction in older adults: A systematic review.

AIM: Skin barrier dysfunction can trigger various skin disorders in older adults. Skin barrier assessment is essential for nurses and caregivers to prevent skin disorders; however, the evidence available for clinical assessment is limited. This systematic review aimed to clarify the risk factors of skin barrier dysfunction in older adults. METHODS: This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The four databases were searched using multiple terms related to "aged" and "skin barrier." The search was initially run on April 19, 2023, and rerun on October 12, 2023. Peer-reviewed quantitative studies in English were included, with no publication time limit being set. Two reviewers assessed the risk of bias in a blinded and independent manner using JBI tools. Owing to the heterogeneity of the results, a narrative synthesis was performed. RESULTS: Among the database-identified 4833 studies, 20 studies were included. The extracted factors were categorized as demographic characteristics, functional characteristics, chronic diseases, nutritional status, skin condition, and environmental factors. However, owing to high risk of bias and inconsistent results across studies, only chronic kidney disease and dry skin were considered risk factors for skin barrier dysfunction in older adults. CONCLUSIONS: Assessment of chronic kidney disease and dry skin in daily skin care may guide the development of personalized skincare programs to maintain skin integrity in older adults. Furthermore, cohort studies that consider confounding factors and the reliability of measurements are needed for an in-depth investigation into skin barrier dysfunction and more risk factors.

Utility of salivary cortisol profile as a predictive biomarker in nurses' turnover risk: a preliminary study.

BACKGROUND: Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs. METHODS: This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months. RESULTS: Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R2 of 0.529 (ΔR2 = 0.114). CONCLUSIONS: This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.

Venous dilation effect of hot towel (moist and dry heat) versus hot pack for peripheral intravenous catheterization: a quasi-experimental study.

BACKGROUND: Heat application before peripheral intravenous catheterization is recommended for venous dilation. Hot pack application enlarges the venous diameter in healthy adults; however, hot towels (moist and dry heat) are used often in some medical cases. However, it is unclear whether hot towel application promotes venous dilation better than hot pack application. This study compared the venous dilation effect of using a hot towel (moist and dry heat) to a hot pack before applying the tourniquet at an access site for peripheral intravenous catheterization. METHODS: Eighty-eight healthy females aged 18-29 years were recruited for this quasi-experimental study. They underwent three types of heat applications (hot pack, moist hot towel, and dry hot towel [moist hot towel wrapped in a dry plastic bag], all of which were warmed to 40 ± 2 °C and performed for 7 min) to their forearm and tourniquet application for 30 s after each heating. Venous diameter and depth were measured using ultrasonography, and venous palpability and visibility (venous assessment score) was observed as venous dilatation effects. In addition, the skin temperature, stratum corneum hydration, and subjective evaluation of the warmth were measured. RESULTS: There were no significant differences in venous diameter and assessment scores after intervention between the dry hot towel and the hot pack groups, and the effect size was negligible (Cohen's d < 0.20). However, these measurements were significantly lower for the moist hot towel than for the other two heat applications (P < .001). Although there was no significant difference in skin temperature and warmth rating score between the dry hot towel and the hot pack, these were significantly lower for the moist hot towel than for the other two heat applications (P < .001). The amount of change in stratum corneum hydration of the dry hot towel was not significantly different from that of the hot pack; however, that of the moist hot towel was significantly larger than that of the other two heat applications (P < . 001.) CONCLUSIONS: A method in which a towel warmed in hot water is wrapped in a dry barrier may be an alternative to a hot pack. TRIAL REGISTRATION: This study was registered with University Hospital Medical Information Network in Japan (Registration No.: UMIN000048308. Registered on July 7, 2022).

Human pathogenic bacteria on high-touch dry surfaces can be controlled by warming to human-skin temperature under moderate humidity.

Healthcare-associated infections have become a major health issue worldwide. One route of transmission of pathogenic bacteria is through contact with "high-touch" dry surfaces, such as handrails. Regular cleaning of surfaces with disinfectant chemicals is insufficient against pathogenic bacteria and alternative control methods are therefore required. We previously showed that warming to human-skin temperature affected the survival of pathogenic bacteria on dry surfaces, but humidity was not considered in that study. Here, we investigated environmental factors that affect the number of live bacteria on dry surfaces in hospitals by principal component analysis of previously-collected data (n = 576, for CFU counts), and experimentally verified the effect of warming to human-skin temperature on the survival of pathogenic bacteria on dry surfaces under humidity control. The results revealed that PCA divided hospital dry surfaces into four groups (Group 1~4) and hospital dry surfaces at low temperature and low humidity (Group 3) had much higher bacterial counts as compared to the others (Group 1 and 4) (p<0.05). Experimentally, warming to human-skin temperature (37°C with 90% humidity) for 18~72h significantly suppressed the survival of pathogenic bacteria on dry surfaces, such as plastic surfaces [p<0.05 vs. 15°C (Escherichia coli DH5α, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and blaNDM-5 E. coli)] or handrails [p<0.05 vs. 15~25°C (E. coli DH5α, S. aureus, P. aeruginosa, A. baumannii)], under moderate 55% humidity. Furthermore, intermittent heating to human-skin temperature reduced the survival of spore-forming bacteria (Bacillus subtilis) (p<0.01 vs. continuous heating to human-skin temperature). NhaA, an Na+/H+ antiporter, was found to regulate the survival of bacteria on dry surfaces, and the inhibitor 2-aminoperimidine enhanced the effect of warming at human-skin temperature on the survival of pathogenic bacteria (E. coli DH5α, S. aureus, A. baumannii) on dry surfaces. Thus, warming to human-skin temperature under moderate humidity is a useful method for impairing live pathogenic bacteria on high-touch surfaces, thereby helping to prevent the spread of healthcare-associated infections.

Effects of Exercise on Functional Recovery in Patients with Bipolar Depression: A Study Protocol for a Randomized Controlled Trial.

Treatment of bipolar disorder is prone to prolongation despite various treatments, including medication. The efficacy of exercise treatment (i.e., interventions involving physical exercise and sports intervention) for major depressive disorders has been reported for depressive symptoms, cognitive function, and sleep disturbances. However, its efficacy for bipolar disorder has yet to be established. We designed a randomized, controlled, double-blind clinical trial that includes 100 patients with bipolar disorder aged 20-65 years. This will be a cluster-randomized, two-group trial that will be conducted in ten psychiatric hospitals. The hospitals will be randomly assigned to an exercise intervention + treatment as usual (exercise) group or a placebo exercise intervention (stretching) + treatment as usual (control) group. Patients will be assessed using an extensive battery of clinical tests, physical parameters, sleep status, biological parameters (cytokines, neurotrophic factors), and genetic parameters (DNA and RNA) at baseline after a 6-week intervention period, at 10-week follow-up, and at 6-month follow-up. This innovative study may provide important evidence for the effectiveness of exercise in the treatment of bipolar depression based on clinical, biological, genetic, and physiological markers.

Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases.

BACKGROUND: The indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with reduced ovarian reserve has also been questioned. Progestin-primed ovarian stimulation can improve the controlled ovarian stimulation (COS) protocol, but there is limited data on the efficacy of FP with progestin-primed ovarian stimulation. METHODS: We conducted a prospective study of 43 women with cancer or autoimmune diseases before and after gonadotoxic treatment at the reproductive unit of Keio University Hospital, counselled between 1 January 2018 and 31 December 2021. After counselling, informed consent was obtained for FP from 43 patients, with those who underwent gonadotoxic treatment of the primary disease being prioritised. Gonadotropin-releasing hormone analogue or progestin was used to suppress luteinising hormone in COS before or after gonadotoxic treatment. The number of cryopreserved mature oocytes was the primary outcome. RESULTS: Forty-three patients and 67 assisted reproductive technology cycles were included in the analysis. The median age at entry was 32 [inter quartile range (IQR), 29-37] years. All patients in the post-gonadotoxic treatment group had their oocytes frozen. Gonadotoxic treatment resulted in fewer oocytes [median 3 (IQR 1-4); pre-gonadotoxic treatment group: five patients, 13 cycles] vs. median 9 (IQR 5-14; pre-gonadotoxic treatment group: 38 patients, 54 cycles; P < 0.001). Although anti-Müllerian hormone levels were lower in the post-gonadotoxic treatment group (n = 5, 13 cycles, median 0.29 (IQR 0.15-1.04) pg/mL) than in the pre-gonadotoxic treatment group (n = 38, 54 cycles, median 1.89 (IQR 1.15-4.08) pg/mL) (P = 0.004), oocyte maturation rates were higher in the post-gonadotoxic treatment group [median 100 (IQR 77.5-100) %] than in the pre-gonadotoxic group [median 90.3 (IQR 75.0-100) %; P = 0.039]. Five patients in the pre-gonadotoxic treatment group had their cryopreserved embryos thawed, of which three had live births. CONCLUSIONS: Oocytes obtained for FP from women with cancer or autoimmune disease for FP are of satisfactory quality, regardless of whether they are obtained post-gonadotoxic treatment or COS protocols.

Meaning of hygiene care for patients as perceived by clinical nurses through an interactive care process: A grounded theory approach.

AIM: This study aimed to explore the meaning of hygiene care for patients from the perspective of nurses, who provide them with care through an interactive process. METHODS: Sixteen registered nurses working in general wards for over 5 years were selected through purposive and snowball sampling. Individual semi-structured interviews were conducted between May and August 2021. Data were analyzed using a grounded theory approach, and the Consolidated Criteria for Reporting Qualitative Research was used to ensure quality and transparency. RESULTS: The participants recognized the core category "realizing oneself alive here," where hygiene care energized patients and promoted their realization of "feeling alive." Hygiene care created "time of relief, temporarily forgetting the illness," and "restoring a sense of oneself." A situation of care also created an "opportunity to treat each other as unique individuals," "opportunity to face self," and "encouraging the recovery and disease-fighting process." CONCLUSIONS: This study highlights the value of hygiene care provided by nurses to patients. The meaning of hygiene care conceptualized in this study should help build a conceptual framework for understanding the patient's experience and reaffirming the value of hygiene care.

Do Tapping and Massaging during Tourniquet Application Promote Dilation of Forearm Cutaneous Veins? A Pilot Quasi-Experimental Study.

Successful insertion of a peripheral intravenous catheterization requires that veins be sufficiently dilated. This study aimed to clarify the venous dilation effect of including tapping or massaging to the application of a tourniquet at the cutaneous veins of healthy adults' forearms. This was a quasi-experimental study of 30 healthy adult volunteers. Each participant underwent all three venous dilation procedures, which included the tourniquet application (Control condition), the tourniquet application and tapping the participant's forearm (Tapping condition), as well as the tourniquet application combined with massaging the participant's forearm (Massage condition). To clarify the venous dilation effects, venous indices were measured, namely the venous diameter (mm), depth (mm), and palpation score. After applying all venous dilation procedures, the venous diameter and palpation score significantly increased. However, no significant difference was observed between the control condition and each intervention condition. The depth in the control and tapping conditions decreased significantly in contrast to the Massage condition. Moreover, a subgroup (nine participants with a venous diameter less than 3 mm after the control condition) had similar results. This study found that additional tapping or massaging after tourniquet application could be less effective in promoting dilation in the forearm veins of healthy adults. Future studies should examine the efficacy and effectiveness of venous dilation in a wide target population while considering intervention methods.

Minimum wiping pressure and number of wipes that can remove dirt during bed baths using disposable towels: a multi-study approach.

BACKGROUND: Friction irritation by wiping increases the risk of skin problems. In bed baths with cotton towels, wiping three times with weak pressure (10-20 mmHg ≈ 1333-2666 Pa) can remove dirt while maintaining skin barrier function. However, few studies have examined the appropriate frictional irritation with disposable towels. This study aimed to analyse the wiping pressure and number of wipes currently applied by nurses when using disposable towels during bed baths and propose the minimum values for removing dirt from the skin. METHODS: This multi-study approach consisted of cross-sectional and crossover design components. In Study 1, 101 nurses in two hospitals were observed by recording the wiping pressure and number of wipes when using both disposable (nonwoven) and cotton (woven) towels. Wiping pressure and number of wipes by towel materials were analysed using a linear mixed model. In Study 2, 50 adults received oily and aqueous dirt on their forearms, which were wiped six-times with disposable towels, applying randomly assigned pressure categories. We used colour image analysis and a linear mixed model to estimate the dirt removal rate for each combination of wiping pressure and number of wipes. RESULTS: Study 1 showed that although wiping pressure did not differ by towel material, the number of wipes was significantly higher for disposable wipes than cotton wipes. Approximately 5% of nurses applied strong wiping pressure or wiped too often. In Study 2, wiping three times with disposable towels at least 5-10 mmHg achieved dirt removal rates of ≥80%. CONCLUSIONS: Some nurses excessively wiped using disposable towels, which might cause skin problems. However, excessive wiping is not required to adequately remove dirt, regardless of the towel material used in various clinical situations. We recommend wiping at 10-20 mmHg of pressure (just like stroking gently) at least three times to improve the quality of bed baths. These findings highlight the need to develop skin-friendly bed bath educational programmes, particularly using appropriate frictional irritation to reduce the risk of skin problems.

Validity and reliability of the Japanese version of the Nursing Performance Instrument.

AIM: Work performance of nurses is a critical aspect that concerns the safety of both nurses and patients, but also secondarily influences nurses' turnover due to serious fatigue and burnout. Monitoring nursing performance as well as fatigue is important for appropriate safety management of patients and nurses, and the development of a monitoring tool is essential. The Nursing Performance Instrument (NPI) can provide comprehensive and brief monitoring of nursing performance. This study aimed to verify the validity and reliability of a Japanese version of the NPI (NPI-J). METHODS: A cross-sectional study was conducted on nurses who work in inpatient care across five Japanese hospitals. We considered appropriate factor numbers with parallel analysis and the Velicer's minimum average partial test. The construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis (CFA), and Pearson's correlation analysis. Cronbach's alpha was calculated for the internal consistency. RESULTS: A three-factor model eventually showed acceptable fit indices in the CFA. Moreover, the correlation results among the three factors indicated discriminant validity comparable to the original NPI. The correlation results with acute fatigue, chronic fatigue, and burnout verified convergent validity. Internal consistency was insufficient. CONCLUSION: The NPI-J demonstrated acceptable construct validity. This instrument can assess nurses' perceptions of their performance by measuring each item. Future work on the reliability of the sub-concepts will require additional items or reliability testing based on generalizability theory and item response theory.

Cognitive changes with psychomotor skill acquisition through blended learning among nursing students: A qualitative study.

AIM: This study described nursing students' cognitive changes as they acquire psychomotor skills through blended learning. BACKGROUND: Deliberate practice, including feedback from teachers, is vital for acquiring psychomotor skills. Blended learning, a program that allows students to deepen their learning and improve their skills even when students and faculty are physically separated has attracted significant attention in recent years. Although blended learning has been used for learning in the cognitive domain, no study has examined its effectiveness in the acquisition of psychomotor skills. Understanding how students' cognition changes as they acquire skills in a blended learning environment could be a valuable resource for effective teaching. DESIGN: An inductive, qualitative description approach was adopted. METHODS: The program involved a basic nursing skill: making an occupied bed. Eleven second-year nursing students participated. The participants attended face-to-face lectures and e-learning courses comprising self-study content that was designed for easy and frequent reference. Students practiced for a skill test, which was conducted one month after the first lecture. Two interviews were conducted approximately one month apart. Before each interview, the participants' current practices were videotaped. During the interviews, they explained their thought processes and conscious awareness of their actions as they watched the videos. This study was conducted between April and May 2019. RESULTS: Six categories related to changes in participants' cognitive processes while acquiring the skill of making an occupied bed were identified: "feeling that it is easy to acquire," "practicing without much thought," "realizing the difficulty in translating thoughts into practice," "experiencing a sense of purpose in each technique," "gaining a perspective to evaluate one's skills," and "developing one's unique approach." CONCLUSIONS: In a blended learning environment, where a practice environment and audiovisual materials were provided, students could practice and improve their skills at their own pace even without the instructor's frequent advice. The findings show that metacognitive skills are essential to the development of psychomotor skills in a blended learning program because this program requires practicing while monitoring one's skills. Metacognitive skills affect the development of psychomotor skills and the ability to provide care. Therefore, initiatives that address the development of metacognitive skills, such as the current program, during the early stages of basic education programs can contribute to the development of nursing students' practical skills.

Explicit and implicit attitudes toward smoking: Dissociation of attitudes and different characteristics for an implicit attitude in smokers and nonsmokers.

Smoking is a global health risk for premature death and disease. Recently, addictive behaviors, like smoking, were considered to be guided by explicit and implicit processes. The existence of a dissociation between the two attitudes in nonsmokers and the causes of the differences in implicit attitudes toward smoking have not been fully investigated. We investigated the explicit and implicit attitudes toward smoking via a self-reported scale and the single category implicit association test (SC-IAT), respectively, among undergraduate and graduate health sciences students. In addition, we applied the drift-diffusion model (DDM) on the SC-IAT and examined the behavioral characteristics that caused differences in implicit attitude toward smoking between smokers and nonsmokers. The results showed the existence of a dissociation between explicit and implicit attitudes toward smoking among nonsmokers. In addition, nonsmokers had a higher decision threshold than smokers and a higher drift rate in the condition where negative words were associated with smoking. Nonsmokers engaged in SC-IAT with more cautious attitudes and responded more easily in a negative condition since it was consistent with their true attitudes. Conversely, smokers did not show a significant difference in the drift rate between the conditions. These results suggested that the differences in an implicit attitude between smokers and nonsmokers were caused by differences in evidence accumulation speed between the positive and negative conditions. The existence of dissociation between implicit and explicit attitudes toward smoking may indicate the difficulty of measuring true attitude in nonsmokers in a questionnaire survey. Additionally, the DDM results explained the difference of implicit attitude between smokers and nonsmokers; it may provide information on the mechanisms of addictive behaviors and a basis for therapy. However, whether these results are affected by cultural differences requires further investigation.

Salivary Biomarker Profiles and Chronic Fatigue among Nurses Working Rotation Shifts: An Exploratory Pilot Study.

Although nurses' fatigue affects their well-being and patient safety, no effective objective measurements exist. We explored the profiles of salivary biomarkers associated with nurses' chronic fatigue across several shifts. This longitudinal study involved 45 shiftwork nurses and collected their saliva samples before two night and two day shifts for a month. Chronic fatigue was measured using the Cumulative Fatigue Symptom Index before the first night shift. Biomarker profiles were analyzed using hierarchical cluster analysis, and chronic fatigue levels were compared between the profiles. Cortisol profiles were classified into high- and low-level groups across two day shifts; the low-level group presented significantly higher irritability and unwillingness to work. Secretory immunoglobulin A (s-IgA) profiles across the four shifts were classified into high- and low-level groups; the high-level group had significantly higher depressive feelings, decreased vitality, irritability, and unwillingness to work. Cortisol (two day shifts) and s-IgA (four shifts) profiles were combined, and (i) cortisol low-level and s-IgA high-level and (ii) cortisol high-level and s-IgA low-level groups were identified. The former group had significantly higher chronic fatigue sign and irritability than the latter group. The profiles of salivary cortisol and s-IgA across several shifts were associated with nurses' chronic fatigue.

Effects of 90 Min Napping on Fatigue and Associated Environmental Factors among Nurses Working Long Night Shifts: A Longitudinal Observational Study.

For nurses working long night shifts, it is imperative that they have the ability to take naps to reduce fatigue, and that an appropriate environment is prepared where such naps can be taken. We verified the effects of 90 min napping on fatigue and the associated factors among nurses working 16-h night shifts. We investigated 196-night shifts among 49 nurses for one month. Wearable devices, data logging devices, and questionnaires were used to assess nap parameters, fatigue, and environmental factors such as the napping environment, ways of spending breaks, and working environment. Nurses who nap at least 90 min on most night shifts had more nursing experience. Multivariable logistic regression analysis showed that the environmental factors significantly associated with total nap duration (TND) ≥ 90 min were noise, time spent on electronic devices such as cellphones and tablets during breaks, and nap break duration. The night shifts with TND ≥ 90 min showed lower drowsiness after nap breaks and less fatigue at the end of night shift compared to those with TND < 90 min. Nurses and nursing managers should recognize the importance of napping and make adjustments to nap for at least 90 min during long night shifts.

Post-Work Recovery from Fatigue and Sleep Episodes among Nurses Who Are Engaged in 16-Hour Night Shifts: A Prospective Observational Study.

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

Psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery Scale among shift-work nurses.

OBJECTIVES: Shift-work nurses are at a higher risk of inadequate recovery from fatigue and developing maladaptive fatigue with significant health consequences. Therefore, it is necessary to monitor fatigue and recovery levels with a reliable scale. We investigated psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery scale (OFER-J) for shift-work nurses. METHODS: Japanese shift-work nurses responded to self-administered questionnaires at baseline (n = 942) and one month later (n = 334). The confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to verify the structural validity and the correlation analysis and one-way analysis of variance were conducted to test the construct and discriminative validity. Cronbach's alpha coefficient, intra-class correlation coefficient (ICC), and smallest detectable change (SDC) were calculated to assess reliability. RESULTS: The CFA showed high correlations between the factors and whilst the goodness-of-fit of the three-factor model was suboptimal, it was in an acceptable range. Most modifications included the error covariance of the Acute Fatigue (AF) and Intershift Recovery (IR) items. The EFA showed that Chronic Fatigue (CF) and AF were not clearly separated, indicating that the two AF items dropped out. Construct and discriminative validity were also well indicated. Cronbach's alpha coefficients were 0.75-0.85. Only CF showed sufficient reproductivity (ICC = 0.74). The SDC for CF, AF, and IR was 14.0, 17.1, and 18.7, respectively. CONCLUSIONS: The validity and reliability of the OFER-J were verified as acceptable for shift-work nurses. The OFER-J could contribute to a data-based approach to fatigue management in nursing management practice.

Accuracy of the Data of Biochemical Parameters in Blood Collected Above the Infusion Insertion Site.

The authors aimed to investigate the possibility of collecting blood samples from above patient intravenous infusion sites by temporarily stopping the infusions while collecting the blood. A hypotonic infusion solution was administered to 5 male patients through the cephalic veins in the forearms of their left upper limbs. The biochemical data of blood collected from the median cubital veins of both patients' arms were compared. The results showed that infusions could change some biochemical test parameters, such as potassium and glucose, to higher levels, even if the infusion was interrupted temporarily during the blood collection from above the insertion site. Blood counts remained unchanged under the same conditions. If the evaluation is performed solely to assess blood counts, using a blood collection site above the insertion site by temporarily interrupting the infusion is feasible.