Determinants of social loneliness among older adults in job retirement and the role of emotional expressivity.

OBJECTIVES: The study examined the possibility that a mediating role of positive and negative emotional expressivity may contribute to understanding the associations between social loneliness and its previously identified predictors (i.e. health, age, sex, and social living situation). METHOD: Self-reported assessments were collected from community-dwelling Swedish residents (aged 65 and above) in job retirement. Structural equation modeling with manifest variables was applied to cross-sectional data (N = 601) to analyze two competing models; one main-effect regression model, examining the predictive effect of emotional expressivity (along with health and sociodemographics) on social loneliness, and one mediation model, examining the mediating effect of emotional expressivity (using the bootstrapping technique provided in Mplus). RESULTS: The results indicated that the mediation model fit the data considerably better than the main-effect regression model (Δχ2 [Δdf = 8] = 72.69, p < 0.00001), and demonstrated a good fit on its own, with CFI = 0.986 and RMSEA = 0.030. This suggests that emotional expressivity contributes to the understanding of the connection between social loneliness and its previously identified predictors. CONCLUSION: Recognizing the significance of emotional expressivity has the potential to enhance our understanding of loneliness in older adults, both in theory and in practice.

Patients' Self-Reported Recovery After an Environmental Intervention Aimed to Support Patient's Circadian Rhythm in Intensive Care.

BACKGROUND: Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients' recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health. AIM: To evaluate patients' self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery. METHOD: An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) × 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) × 2(intervention room, ordinary room) ANCOVA. RESULTS: Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room (M = 8.88, SD = 4.07) compared to the ordinary room (M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months' postdischarge. CONCLUSIONS: A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.

Job demands and functional resources moderating assistant and Registered Nurses' intention to leave.

AIMS: To investigate how job demands and resources interact with each other to predict intention to leave among assistant nurses and Registered Nurses. DESIGN: Longitudinal study. METHODS: Questionnaire data were collected yearly during three years (October 2012-December 2014) from Registered Nurses (RN) and assistant nurses (N = 840) employed in Swedish hospitals. Associations and interaction effects of demands and resources were assessed with correlation analyses and regression models. RESULTS: Job demands predicted assistant nurses' intentions to leave, while resources predicted RNs' intention to leave. For RNs, several resources were functional in moderating the associations between demands and intention to leave: social support, vertical trust, and humanity moderated work pace and workflow moderated emotional demands. For assistant nurses, organizational clarity and interprofessional collaboration moderated emotional demands. None of the resources had a moderating effect on the associations between quantitative demands or illegitimate tasks and intention to leave.

The Potential Importance of Social Capital and Job Crafting for Work Engagement and Job Satisfaction among Health-Care Employees.

(1) Background: Both employees and organizations benefit from a work environment characterized by work engagement and job satisfaction. This study examines the influence of work-group social capital on individuals' work engagement, job satisfaction, and job crafting. In addition, the mediating effect of job crafting between social capital on the one side and job satisfaction and work engagement on the other side was analyzed. (2) Methods: This study used data from 250 health-care employees in Sweden who had completed a questionnaire at two time points (six to eight months apart). Analyses of separate cross-lagged panel designs were conducted using structural regression modeling with manifest variables. (3) Results: Social capital was predictive of both job satisfaction and work engagement over time. The results also indicated that higher degrees of social capital was predictive of more cognitive and relational, but not task-related job crafting over time. There was no clear evidence for a mediating effect of job crafting for social capital to work engagement or job satisfaction. (4) Conclusion: It would be beneficial for the health-care sector to consider setting up the organizations to promote social capital within work groups. Individual workers would gain in well-being and the organization is likely to gain in efficiency and lower turnover rates.

Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care.

BACKGROUND: Patients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety. AIM: To evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED). METHODS: This randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83). RESULTS: There was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety. CONCLUSION: Patient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.

Development and psychometric testing of an instrument to assess existential aspects of mother's initial breastfeeding difficulties (ExBreastS).

OBJECTIVE: Mothers who have negative breastfeeding experiences due to initial breastfeeding difficulties are in demanding existential situations. Therefore, it is important for healthcare professionals to identify and address such breastfeeding problems. The aim of this study was to develop an instrument designed to assess existential aspects of mothers' initial breastfeeding difficulties and evaluate its psychometric properties. METHODS: This study reports on the development of a new instrument and was carried out in three steps: (1) a questionnaire about various existential aspects of initial breastfeeding difficulties, based on 66 items derived from two phenomenological studies, was developed; (2) information was collected using the questionnaire; (3) and the resulting data were statistically analysed. Spearman's correlation coefficient was used to assess comparative validity; exploratory factor analysis with principal axis factoring and varimax rotation were used to assess construct validity; and Cronbach's alfa was used to assess internal consistency and reliability. Three hundred and nine Swedish-speaking mothers aged 20-46 participated in the study. RESULTS: Correlation and factor analysis of the 66 items revealed that 16 of the items were of psychometric value and valid. Factor analysis generated three factors that accounted for 62.9% of the total variance: Mother-Child Interdependency, Exposure and Vulnerability and Security and Trust. The instrument shows adequate sensitivity to identify existential aspects of mothers' initial breastfeeding difficulties. CONCLUSION: The instrument satisfactorily assesses existential aspects of initial breastfeeding difficulties and can be used as a sensitive tool by healthcare professionals to screen for and identify mothers who have negative breastfeeding experiences.

Sleep duration and sleeping difficulties among adolescents: exploring associations with school stress, self-perception and technology use.

Sleeping problems are increasing among adolescents worldwide. This study aimed to describe the prevalence of self-reported sleep duration and sleeping difficulties, as well as to explore their associations with school stress, self-perception, that is how adolescents perceive their appearance and happiness, and technology use among adolescents. Data were collected in 2015 using a questionnaire. A total of 937 ninth grade adolescents, 15-16 years, from a city in western Sweden participated, resulting in a response rate of 83%. The result showed that 55% of the adolescents slept less than the recommended 8 hours per night and 11% had sleeping difficulties. School stress and technology use were associated with short sleep duration. School stress and self-perception were associated with sleeping difficulties. The girls had worse outcomes for sleeping difficulties, school stress, self-perception and technology use than the boys. Based on the results, there is a need for school nurses to implement preventive measures to improve adolescents' sleep.

The impact of restricted decision-making autonomy on health care managers' health and work performance.

AIM: The aim of this study was to investigate how restricted decision-making autonomy and conflicting demands impact operational managers' work performance and health. BACKGROUND: Managers at operational level (first- and second-line managers') in health care organisations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited. METHODS: A prospective design with questionnaire data collected at two points in time, 1 year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model analysis with cross-lagged paths. RESULTS: Restricted decision-making autonomy was negatively associated with both the managers' health and their managerial work performance over time. CONCLUSIONS: Health care managers' work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision-making. IMPLICATIONS FOR NURSING MANAGEMENT: This study suggests that nursing leaders should create the circumstances for operational managers' to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload.

Perceptions and Experiences of an Attachment-Based Intervention for Parents Troubled by Intimate Partner Violence.

It is known that intimate partner violence (IPV) negatively affects both parental capacity and children's well-being, but few studies have focused on the experiences of those taking part in family interventions focused on IPV. In this study, 26 parents (16 mothers and 10 fathers) with a history of IPV participated in focus groups concerning their attachment-based group intervention experience in the program Parenting and Violence. The transcripts, subjected to thematic analysis, showed that participants experienced the intervention as supportive and confirming of their role as parents. Parents described feeling more in control, more self-confident, more skilled in communicating, and more able to provide security for their children. However, they also expressed a need for continuing support to maintain their improved parenting strategies.

The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study.

Patients in intensive care suffer from severe illnesses or injuries and from symptoms related to care and treatments. Environmental factors, such as lighting at night, can disturb patients' circadian rhythms. The aim was to investigate whether patients displayed circadian rhythms and whether a cycled lighting intervention would impact it. In this pilot study (N=60), a cycled lighting intervention in a two-bed patient room was conducted. An ordinary hospital room functioned as the control. Patient activity, heart rate, mean arterial pressure and body temperature were recorded. All data were collected during the patients' final 24h in the intensive care unit. There was a significant difference between day and night patient activity within but not between conditions. Heart rates differed between day and night significantly for patients in the ordinary room but not in the intervention room or between conditions. Body temperature was lowest at night for all patients with no significant difference between conditions. Patients in both conditions had a natural circadian rhythm; and the cycled lighting intervention showed no significant impact. As the sample size was small, a larger repeated measures study should be conducted to determine if other types of lighting or environmental factors can impact patients' well-being.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people.

BACKGROUND AND AIM: Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling. METHODS: Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit. RESULTS: The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (ß=0.13, p=0.059) but it was a predictor of HS either through affecting PA (ß=0.31, p<0.001) or I (ß=0.57, p<0.001). CONCLUSION: Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. STUDY SAMPLE: A total of 415 children aged nine years. RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

To recommend the local primary health-care centre or not: what importance do patients attach to initial contact quality, staff continuity and responsive staff encounters?

OBJECTIVE: This study aims to examine the circumstances associated with patients' tendencies to recommend a primary care centre, based on four hypotheses, the initial contact's quality, care relationship continuity, treatment encounter responsiveness and whether the significance of encounter responsiveness differs depending on whether the patient has been seeing a nurse or physician. DESIGN: The study is based on the patient' self-reported responses, retrieved from the Swedish National Patient Survey. The design is cross-sectional, and data were analysed using a binary logistic regression. SETTING: Data were collected from three primary healthcare centres in the region of Västra Götaland, Sweden. PARTICIPANTS: A total of 362 patients (62% females) having visited any of three publicly run healthcare centres in September 2010 constitute the analytical sample. Participants were fairly evenly distributed across all age groups. MAIN OUTCOME MEASURES: Recommendation was captured by patients' binary responses to the question: Would you recommend the visited primary healthcare centre? RESULTS: The hypotheses involving initial contact quality, care relationship continuity and treatment encounter responsiveness were supported by the analyses. The latter was strongly associated with patient tendency to recommend the primary healthcare centre. However, the profession (nurse or physician) involved in the treatment encounter made no difference for the predictive significance of encounter responsiveness for a patient's tendency to recommend the healthcare centre. CONCLUSIONS: Striving for stable and responsive patient/staff relationships and an open approach towards patients are potentially successful strategies for primary healthcare centres seeking to attract new patients and maintain current ones.

The protective role of supportive friends against bullying perpetration and victimization.

A crossed-lagged regression model was tested to investigate relationships between friendship support, bullying involvement, and its consequences during adolescence. Students, 12-16 years (N = 880), were administered questionnaires twice, one year apart. Using structural equation modeling, a model was specified and higher levels of support from friends were related to lower levels of bullying and victimization one year later. Additionally, a bidirectional relationship between victimization and depression was found, and greater property crimes commission was related to higher levels of future bullying. These findings support the 'friendship protection hypothesis' and suggest the quality of support in friendships can protect against bullying victimization and perpetration. Prior research has shown that friendships can protect against victimization; however this is one of the few longitudinal studies to focus on the quality of friendship, rather than other characteristics of the friends. It is suggested that interventions should focus on increasing perceptions of support within existing friendships.

Adolescents' deliberate self-harm, interpersonal stress, and the moderating effects of self-regulation: a two-wave longitudinal analysis.

The predictive effects of peer victimization and harsh parenting on deliberate self-harm were examined. As derived from the experiential avoidance model, the study also tested whether these links were moderated by individual self-regulation approaches. Data were collected at two points in time from 880 junior high school students (mean age=13.72) in Sweden. Analyses using structural equation modeling revealed that Peer Victimization was predictive of self-harm. Although Harsh Parenting was not predictive of self-harm, this link was moderated by adolescents' gender. No moderating effect of self-regulation was revealed. The study concludes that the high prevalence of deliberate self-harm recently found in community samples of adolescents cannot be prevented without attending to environmental psychosocial factors.