Development of a nurse-manager dualistic intervention program to alleviate burnout among nurses based on the appreciative inquiry.

Aims: To develop a feasible and effective nurse-manager dualistic intervention program to support nurses coping with burnout symptoms. Background: Person-organization combined interventions were recommended as the most effective approach for reducing burnout symptoms. However, few interventions have been developed in the nursing field. Methods: The Medical Research Council, United Kingdom (MRC UK), Framework for Development and Evaluation of Complex Interventions, was employed for nurse-manager dualistic intervention program development. The following three steps were followed for developing the dualistic intervention program: (1) identifying the evidence base by conducting extensive reviews of the relevant literature and a mixed study; (2) identifying/developing a theory by selecting the job demands-resources model and proposing the theoretical framework for intervention development; and (3) modifying the process and outcomes of the nurse-manager dualistic intervention program. Results: The intervention program consists of six group sessions over 9 weeks. Researchers/managers are supposed to deliver the program. The main contents of the intervention are (1) inception (session 1); (2) discovery (session 2); (3) dream (session 3); (4) design (session 4); (5) destiny (session 5); and (6) keep (session 6). The emphasis of the intervention is on helping nurses dealing with burnout symptoms. Conclusion: Following the guidance of the MRC framework, a feasible and potentially effective nurse-manager dualistic intervention program was developed for nurses coping with burnout. Future studies are needed to model the intervention and assess the effects and replicability of the intervention.

Associations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units: A multicentre survey.

AIMS: To explore whether perceived overqualification increases the risk of burnout and whether transformational leadership negatively moderates this relationship. BACKGROUND: Perceived overqualification might contribute to burnout and lead to poor experience of transformational leadership, and transformational leadership might be associated with burnout. However, these relationships have not yet been confirmed. METHODS: A multicentre cross-sectional study. A total of 321 nurses from intensive care units were recruited from six tertiary hospitals. Scale of Perceived OverQualification, Transformational Leadership Questionnaire and emotional exhaustion subscale of the Maslach Burnout Inventory-General Survey were employed to collect the data. Hierarchical multiple regression and bootstrap resampling were applied to analyse the data. RESULTS: Burnout was positively associated with perceived overqualification and negatively associated with transformational leadership (each p < 0.05). Transformational leadership significantly mediated the relationship between perceived overqualification and burnout (b = -0.6389, 95% confidence interval: -0.8706, -0.4072). CONCLUSION: Our findings indicated that perceived overqualification and transformational leadership directly or indirectly affect burnout among nurses from intensive care units. IMPLICATIONS FOR NURSING MANAGERS: Personal and organizational-oriented interventions utilizing nurses' overall qualifications and implementing transformational leadership should be employed by nurse managers to alleviate burnout and promote the work performance of nurses from intensive care units.

Associations between perceived overqualification, organisational commitment and work passion of nurses: A multicentre cross-sectional study.

AIM: To investigate the associations between perceived overqualification, organisational commitment and work passion of nurses. BACKGROUND: Few studies have considered the effects of perceived overqualification and organisational commitment on work passion of nurses, especially in developing countries. METHODS: This is a multicentre cross-sectional study. A total of 4511 nurses from eight tertiary hospitals were recruited. The Scale of Perceived OverQalification (SPOQ), the Organizational Commitment Scale (OCS) and the Work Passion Scale (WPS) were used to collect the data. Hierarchical multiple regression were employed. RESULTS: Perceived overqualification and organisational commitment were the main predictors for both harmonious and obsessive passions (each p < .001). The unique effect of organisational commitment (ßharmonious  = .608, ßobsessive  = .556) on work passion were six to eight times larger than these of perceived overqualification (ßharmonious = -.079, ßobsessive = .085). CONCLUSION: Our findings indicate that high perceived overqualification clearly reduces nurses' harmonious passion and increases their obsessive passion, whereas high organisational commitment significantly promotes nurses' harmonious and obsessive passions. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should distinguish the different effects of perceived overqualification and organisational commitment on work passion. Effective intervention should be developed to release nurses' potential abilities and improve their organisational commitment and work passion. Chinese Clinical Trial Registry: ChiCTR2100047974.

Quality of life in cancer patients with different preferences for nurse spiritual therapeutics: The role of psychological capital.

AIM: To explore the status of quality of life and psychological capital and analyse the different effects of psychological capital on the quality of life of cancer patients with different preferences for nurse spiritual therapeutics. DESIGN: A cross-sectional survey was used. METHODS: Two hundred and eight cancer patients were recruited using convenience sampling from a tertiary Chinese hospital, between March and July 2019. Data on preferences for nurse spiritual therapeutics (PNST), psychological capital (PsyCap) and quality of life (QoL) were collected using paper questionnaires. Hierarchical multiple regression was employed to investigate the different influences of PsyCap on QoL of cancer patients with various levels of PNST. RESULTS: Compared with patients having high PNST, patients with mild-moderate PNST experienced lower self-efficacy, hope, optimism, PsyCap and social/family well-being. PsyCap significantly explained the variance on QoL of patients with various levels of PNST. Age, gender, presence of caregiver were significant factors influencing physical, social/family and emotional well-being of patients with high PNST. CONCLUSION: The present study demonstrates disparities in PsyCap and QoL between cancer patients with mild-moderate and high PNST. It is essential to be aware of the positive influences of PsyCap on QoL and develop effective interventions for patients to improve their QoL, especially for those with mild-moderate PNST. IMPACT: It is necessary to realize the benefits of PsyCap on QoL of cancer patients with various levels of PNST. Appropriate training for nurses needs to be developed to promote their spiritual care competencies. Moreover, supportive interventions should be developed for cancer patients to improve their PsyCap and QoL.

Association between psychological capital and spiritual care competencies of clinical nurses: A multicentre cross-sectional study.

AIMS: To investigate the status of spiritual care competencies among clinical nurses and their relationships with psychological capital. BACKGROUND: Limited knowledge is about the influence of positive personal characteristics on nurses' spiritual care competencies. METHODS: A multicentre cross-sectional study. A total of 1717 nurses were recruited from nine separate Chinese hospitals. Online questionnaires were delivered through a local nursing association to assess socio-demographics, spiritual care competencies and psychological capital of nurses. RESULTS: Nurses had mild-to-moderate levels of spiritual care competencies and moderate levels of psychological capital. Psychological capital and its two metrics (self-efficacy and hope), spiritual care education, professional qualification and shift work were the main predictors of spiritual care competencies (each p < .05). CONCLUSION: The findings of the study show a positive relationship between psychological capital and spiritual care competencies of clinical nurses. Strengthening nurses' psychological capital could improve their spiritual care competencies. IMPLICATIONS FOR NURSING MANAGERS: Nurse managers and hospital administrators should better understand the value of psychological capital for nurses' capacity development. Effective interventions need to be implemented separately or combined with spiritual care education programmes to improve nurses' psychological capital and spiritual care competencies.

Impact of WeChat-based 'three good things' on turnover intention and coping style in burnout nurses.

BACKGROUND: Few studies have considered functions of nurses' positive personality and behaviours on addressing their turnover intention. AIMS: To explore the effects of WeChat-based 'three good things' (3GT) on burnout nurses' turnover intention and coping styles. METHODS: A randomized controlled trial. 73 nurses were included in the intervention group (n = 33) and the control group (n = 40). The intervention group received WeChat-based 3GT. Turnover intention and coping style were measured before and after the intervention. RESULTS: WeChat-based 3GT effectively reduced turnover intention and negative coping style (each p < .05). Positive coping style was promoted after the intervention (p < .05). Time effects as well as intervention and time interactions were significant in turnover intention and negative coping style (each p < .05). CONCLUSION: Benefits of WeChat-based 3GT on turnover intention and coping style in burnout nurses were found. Nurses experienced lower levels of turnover intention and negative coping style and increased the usage of positive coping style after the intervention. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should incorporate 3GT intervention with popular social communication programmes to improve nurses' coping strategies towards clinical issues and maintain the stability of nursing teams.

Psychometric Testing of the Chinese Simple Version of the Simulation Learning Effectiveness Inventory: Classical Theory Test and Item Response Theory.

BACKGROUND: High-fidelity simulation (HFS) has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, there are few evidence-based instruments that validate the effectiveness of simulation learning in mainland China. METHODS: The Simulation Learning Effectiveness Inventory (SLEI) was adapted and validated for use in this study. Psychometric evaluation, incorporating classical test theory and item response theory (IRT) methods, was performed with 533 third-year undergraduate nursing students who were recruited from May 2017 to July 2018. RESULTS: The findings of exploratory and confirmatory factor analyses revealed that the simplified Chinese version of the SLEI (SLEI-SC) was composed of six factors, namely, course arrangement, equipment resource, debriefing, clinical ability, problem solving, and confidence, which explained 60.84% of the total variance. The Cronbach's α, MIIC, marginal reliability, and test-retest reliability values obtained for the total scale were 0.88, 0.38, 0.96, and 0.88, respectively. Furthermore, the difference between the total scores for learning effectiveness pre- and post-course was statistically significant (t = 2.59, p < 0.05, Cohen's d = 0.60). IRT analysis showed that the SLEI-SC discriminates well between students with high and low levels of learning effectiveness and offers information about a broad range of learning effectiveness measures. The relationship between final course grade and total score on the SLEI-SC was statistically significant (r = 0.63, p < 0.05). CONCLUSION: We demonstrated initial psychometric evidence and support for the 31-item SLEI-SC as a developmentally appropriate instrument for assessing the learning effectiveness of all phases of HFS use with nursing students.

A WeChat-based "Three Good Things" positive psychotherapy for the improvement of job performance and self-efficacy in nurses with burnout symptoms: A randomized controlled trial.

AIM: To evaluate the effects of a WeChat-based "Three Good Things" on job performance and self-efficacy of clinical nurses with burnout symptoms. BACKGROUND: Few studies have valued the impact of nurses' personal strengths and positive work environment on job performance, particularly in developing countries. METHODS: A randomized controlled trial. The intervention group (n = 33) participated in WeChat-based Three Good Things, while the control group (n = 40) did not. Data were collected prior to and immediately after the intervention. WeChat, a popular social software, provides several communicating and recording functions. RESULTS: The main intervention effects and interactions between time and intervention on job performance and self-efficacy were significant (each p < .05). The main time effects on self-efficacy were also significant (p < .05). The post-intervention scores for job performance and self-efficacy between the two groups were statistically different (each p < .05). The scores for job performance and self-efficacy of the intervention group were statistically different before and after the intervention (each p < .05). CONCLUSION: Three Good Things could significantly improve job performance and self-efficacy of nurses with burnout. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are recommended to include Three Good Things into their management systems to improve nurses' physical and mental health and work outcomes over the long term.

An evaluation of a positive psychological intervention to reduce burnout among nurses.

This quasi-experimental study aimed to evaluate the positive psychological intervention of recording three good things on alleviating nurses' burnout. Eighty-seven nurses with burnout were recruited. Nurses in the study group recorded three good things using communication tool WeChat for six months, no records were made in the control group. After intervention, the score of exhaustion decreased considerably for nurses in the study group. Nurses recording three good things on average twice a week returned the lowest score of exhaustion. This intervention combined with appropriate surveillance and encouragement is recommended to reduce nurses' burnout and create a positive work environment.

The effects of resilience and turnover intention on nurses' burnout: Findings from a comparative cross-sectional study.

AIMS AND OBJECTIVES: To investigate burnout among nurses from Australia and China and explore the effects of resilience and turnover intention on nurse burnout between the two countries. BACKGROUND: Nursing shortages and burnout have become serious problems worldwide in recent years. In both developed and developing countries, such as Australia and China, nurse burnout levels are high and therefore attract concern from nurse managers, hospital administrators, nurse educators and researchers. However, few studies have been conducted exploring the differences in burnout and its predictors between Australian and Chinese nurses, particularly investigating the differences in the effect sizes of the predictors. DESIGN: A comparative cross-sectional design was employed. METHODS: A total of 100 Australian nurses and 197 Chinese nurses participated in the study. Australian participants completed an online questionnaire, while Chinese participants completed a hardcopy questionnaire. Burnout, resilience and turnover intention were measured. RESULTS: Burnout was worse for Australian participants than Chinese participants. Only having turnover intention significantly predicted burnout in Australian participants, while low resilience, having turnover intention and low level of regular exercise strongly predicted burnout in Chinese participants. The effect size of turnover intention on burnout in the Australian group was almost twice that of the Chinese group. CONCLUSION: The findings of this study show that there are differences in burnout between Australian and Chinese nurses. The effects of resilience and turnover intention on burnout between the two groups are also identified. RELEVANCE TO CLINICAL PRACTICE: The differences in nurse burnout and the effects of resilience and turnover intention on burnout should be better understood by nurse managers from Australia and China. Moreover, developing effective strategies relevant to their own country to reduce nurse burnout is recommended.

Burnout and its association with resilience in nurses: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate the prevalence and extent of burnout on nurses and its association with personal resilience. BACKGROUND: With the worldwide shortage of nurses, nurse burnout is considered one of the main contributing factors and has been the focus of studies in recent years. Given the well-documented high level of burnout among nurses, resilience is expected to be a significant predictor of nurse burnout. The association between burnout and resilience has not previously been investigated extensively. DESIGN: A cross-sectional survey design was selected. METHODS: A total of 1,061 nurses from six separate three-level hospitals in Hunan Province, China, returned self-reported questionnaires from March-June 2015. Data were collected using a socio-demographic sheet, Maslach Burnout Inventory-General Survey and the Connor-Davidson Resilience Scale. RESULTS: Nurses experienced severe burnout symptoms and showed a moderate level of resilience. Three metrics of burnout had significantly negative correlations with the total score and following variables of resilience. Linear regression analysis showed resilience, especially strength, demographic characteristics (exercise, alcohol use and marital status) and job characteristics (income per month, ratio of patients to nurses, shift work and professional rank) were the main predictors of the three metrics of burnout. CONCLUSION: The findings of this study may help nurse managers and hospital administrators to have a better understanding of nurse burnout and resilience. The significantly negative relationship between burnout symptoms and resilience has been demonstrated, and this informs the role of resilience in influencing burnout. RELEVANCE TO CLINICAL PRACTICE: Adaptable and effective interventions for improving resilience are needed to relieve nurses' burnout and reduce workplace stress. Moreover, nurse managers and hospital administrators should establish an effective management system to cultivate a healthy workplace and adopt positive attitudes and harmonious relationships.

Exploring resilience in Chinese nurses: a cross-sectional study.

AIMS: To explore the state of resilience and its predictors among nurses in mainland China. BACKGROUND: Resilience is considered as an important ability to influence the prevention of job dissatisfaction and burnout. There are few studies on resilience in Chinese nurses, particularly investigating the predictors of resilience. METHODS: A cross-sectional survey was employed and 1061 nurses from six three-level hospitals in Hunan responded to participate in the study. Data were collected using self-reported questionnaires. RESULTS: Nurses experienced moderate levels of resilience and self-efficacy and tended to use a positive coping style. Multiple linear regression showed that a high level of self-efficacy and education, having a positive coping style rather than a negative coping style, exercising regularly and not using cigarettes predicted a high level of resilience (P < 0.01). CONCLUSION: This study shows a moderate level of resilience among nurses and suggests that a high level of self-efficacy and education, as well as having a positive coping style and choosing a healthy lifestyle may increase nurses' resilience. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital administrators and nursing managers need to explore the resilience state among nurses and understand the predictors of resilience. Then, scientific and evidence-based interventions for improving resilience should be adopted.

Positive psychotherapy for depression and self-efficacy in undergraduate nursing students: A randomized, controlled trial.

Nursing students across the globe experience depressive symptoms, and many interventions have been used to alleviate their depression. However, few interventions focus on students' personal strengths and advantages. The aim of the present study was to explore the effects of an 8-week group positive psychotherapy (PPT) programme on depression and self-efficacy in full-time undergraduate nursing students. A randomized, controlled trial was conducted for 76 nursing students (34 in the experimental group, 42 in the control group). The Beck Depression Inventory-II and the General Self-Efficacy Scale were used to collect data prior to, immediately after PPT, 3 months', and 6 months' post-PPT. Repeated-measures analysis of variance indicated that the intervention significantly alleviated depression and improved self-efficacy (each P < 0.05); the effect of time and time-group interaction was also significant (each P < 0.05). The findings suggest that PPT could significantly relieve depressive symptoms and improve self-efficacy. We recommend that PPT is effective in alleviating depression and improving self-efficacy in undergraduate nursing students. Academic mental health nurses should appreciate the value of PPT and consider incorporating it in psychological support methods in order to facilitate nursing students' mental health.

IncA/C plasmid-mediated spread of CMY-2 in multidrug-resistant Escherichia coli from food animals in China.

OBJECTIVES: To obtain a broad molecular epidemiological characterization of plasmid-mediated AmpC ß-lactamase CMY-2 in Escherichia coli isolates from food animals in China. METHODS: A total of 1083 E. coli isolates from feces, viscera, blood, drinking water, and sub-surface soil were examined for the presence of CMY-2 ß-lactamases. CMY-2-producing isolates were characterized as follows: the blaCMY-2 genotype was determined using PCR and sequencing, characterization of the blaCMY-2 genetic environment, plasmid sizing using S1 nuclease pulsed-field gel electrophoresis (PFGE), PCR-based replicon typing, phylogenetic grouping, XbaI-PFGE, and multi-locus sequence typing (MLST). RESULTS: All 31 CMY-2 producers were only detected in feces, and presented with multidrug resistant phenotypes. All CMY-2 strains also co-harbored genes conferring resistance to other antimicrobials, including extended spectrum ß-lactamases genes (blaCTX-M-14 or blaCTX-M-55), plasmid-mediated quinolone resistance determinants (qnr, oqxA, and aac-(6')-Ib-cr), floR and rmtB. The co-transferring of blaCMY-2 with qnrS1 and floR (alone and together) was mainly driven by the Inc A/C type plasmid, with sizes of 160 or 200 kb. Gene cassette arrays inserted in the class 1 or class 2 integron were amplified among 12 CMY-2 producers. CMY-2 producers belonged to avirulent groups B1 (n = 12) and A (n = 11), and virulent group D (n = 8). There was a good correlation between phylogenetic groups and sequence types (ST). Twenty-four STs were identified, of which the ST complexes (STC) 101/B1 (n = 6), STC10/A (n = 5), and STC155/B1 (n = 3) were dominant. CONCLUSIONS: CMY-2 is the dominant AmpC ß-lactamase in food animals and is associated with a transferable replicon IncA/C plasmid in the STC101, STC10, and STC155 strains.