Association Between Nursing Discussions, Resilience, Workplace Social Support and Burnout: A Quantitative Study in Japan.

Background: Although it is known that resilience is negatively associated with burnout, and that certain interventions can effectively increase resilience, little is known about online resilience-enhancing interventions during the COVID-19 crisis. The aim of this study was to identify the association between an online resilience-enhancing intervention and workplace social support, and burnout among nurses working in the mainland and remote islands of Japan during the COVID-19 crisis. Methods: Pretest-posttest was conducted between April 2020 and February 2021, and the questionnaire survey included the bidimensional resilience scale, the Japanese version of Pine's Burnout Measure, and the workplace social support scale. Changes in burnout, resilience, and social support and the associations with nursing discussions as intervention were analyzed. Participants were 98 Nurses with 1 to 10 years of experience from Japan's mainland and remote island hospitals of Kagoshima Prefecture participated in a baseline survey in April 2020. Of these, 76 participated in a secondary survey in September 2020, and 69 participated in the intervention program and a third survey in February 2021. The online intervention over Zoom consisted of small-group nursing discussions based on the broaden-and-build theory. Results: Changes in burnout showed a significant negative association with change in workplace social support (Coef. = -0.019, 95% CI -0.035- -0.003), as did the interaction between change in acquired resilience and intervention (Coef. = -0.088, 95% CI -0.164- -0.011). Conclusion: Change in workplace social support was significantly negatively associated with changes in burnout, as was the interaction of intervention and acquired resilience. Promotion of this intervention and making workplace social support more accessible may contribute to reduce burnout in nurses.

The Effects of Resilience and Related Factors on Burnout in Clinical Nurses, Kagoshima, Japan.

Background: Burnout, due to extreme mental and physical fatigue, and emotional exhaustion, leads to decreased nursing quality and turnover. However, not all nurses are observed as burnouts in the same work environment, and resilience and related factors may have effects on the development of burnouts. Therefore, we conducted a cross-sectional study to examine the effects of resilience and related factors on the burnout in clinical nurses, Kagoshima, Japan. Methods: Data for this cross-sectional study involving nurses (n = 98) was collected using the following questionnaire surveys: the Bidimensional Resilience Scale, The Workplace Social Support Scale, and the Japanese version of the Pine's Burnout Scale. Using burnout as a dependent variable, analyses were conducted using one-way analysis of variance and multiple regression analysis after adjusted for related factors. Results: The prevalence of burnouts was 19.6% on the mainland and 36.1% on remote island. Innate resilience, acquired resilience, workplace social support, and burnout showed no significant difference between nurses on the mainland and remote island. In the mainland participants, innate resilience (ß = -0.492, P < 0.001) and acquired resilience (ß = -0.325, P = 0.007) showed a negative association with burnout, and similar associations were observed innate resilience (ß = -0.520, P = 0.004) and acquired resilience (ß = -0.336, P = 0.057) in the remote island participants. For all participants, innate resilience (ß = -0.443, P = 0.001) and workplace social support (ß = -0.204, P = 0.031) showed a negative association with burnout, and turnover intention was positively associated (ß = 0.025, P = 0.021). Conclusion: A negative association between burnout and innate resilience factors was observed in the mainland and remote island. Further evaluation of innate resilience is necessary for burnout prevention in clinical nurses.

Association between the Perception of Behavior Change and Habitual Exercise during COVID-19: A Cross-Sectional Online Survey in Japan.

In general, the perception of behavior change may be associated with habitual exercise. However, this association might not be well-understood due to the state of emergency of the COVID-19 pandemic. This study collected data from 1499 internet users aged 20-86 years living in Japan who participated in the online survey from 26 to 27 February 2021. Having a perception of behavior change was defined as preparation, action, and maintenance of the transtheoretical model. The habitual exercise was defined as 600 metabolic equivalent min/week or more based on the International Physical Activity Questionnaire. Multivariate logistic regression analysis was used to calculate the odds ratio of habitual exercise and a 95% confidence interval was estimated after adjusting for related factors. We found that perception of behavior change was positively associated with habitual exercise (adjusted odds ratio = 2.41, 95%CI = 1.89-3.08), and similar associations were found in states of emergency (2.69, 1.97-3.69) and non-emergency (2.01, 1.34-3.01). Moreover, women were negatively associated in all analyses with habitual exercise compared to men (0.63, 0.49-0.80; 0.65, 0.44-0.96; 0.62, and 0.45-0.84, respectively). Thus, the perception of behavior change may be involved in the implementation of habitual exercise, suggesting that women face difficulties in engaging in habitual exercise.

Association between Regular Exercise and Self-Rated Health and Sleep Quality among Adults in Japan during the COVID-19 Pandemic.

Regular exercise may be associated with better self-rated health and sleep status. However, this correlation among various age groups, such as young, middle-aged, and older people, as well as during the COVID-19 pandemic, has not been examined. This study examined the correlation between regular exercise and self-rated health and sleep quality among adults in Japan during the COVID-19 pandemic. Data were collected using an online survey conducted between February 26 and 27, 2021. A total of 1410 adults in Japan (age range, 20-86 years) completed the online survey. Regular exercise was divided into: (1) more than 30 min of moderate exercise a day, (2) more than 2 days per week, and (3) continuous for 1 year or longer. Self-rated health and sleep quality were assessed using the Likert scale. After adjusting for multiple confounders, regular exercise was correlated with decreased poor self-rated health and poor sleep quality in middle-aged adults; however, no significant correlation was observed among young and older adults. The promotion of regular exercise among middle-aged people during the COVID-19 pandemic may contribute to better self-rated health and sleep quality status.

The Acquisition of a New Self-image in Patients with Type 1 Diabetes: A Qualitative Study.

BACKGROUND: In this study, we aim to highlight the transformation of self-image in patients with type 1 diabetes after diagnosis. Our objective in examining the self-image of these patients is to provide practical insights for nursing, as well as a basic reference for understanding patients. METHODS: The participants were 15 patients (2 men and 13 women) over 20 years of age who visited an outpatient setting to treat type 1 diabetes and had no serious complications, and who agreed to participate in the study. Semi-structured interviews were conducted 1-2 times, with a duration of 60-75 minutes per person, from February 2016 to March 2017. We drew on Krippendorff's (1999) content analysis to carry out our analysis. RESULTS: We identified a total of 107 codes. The self-image of patients with type 1 diabetes was categorized into 8 subcategories and 4 categories. The 4 categories were 'the wavering of a self-image that is distinct from the past,' 'loss of former self-image,' 'discovery of a new self-image,' and 'developing a new self-image.' Ultimately, we were able to extract a fifth core category, 'acquisition of a new self-image.' CONCLUSION: The self-image of patients with type 1 diabetes transformed from a negative to a positive one; ultimately, patients acquired a new self-image that was congruent with their ideal self-image. Our results showed that the new self-image that patients acquired through various experiences influenced motivation for treatment and continuation of self-care. When caring for patients with type 1 diabetes, it is crucial for healthcare professionals be aware of the meaning that patients derive from their disease and related difficulties, as well as to provide care while considering patients' self-image.

Self-stigma of Patients with Type 1 Diabetes and Their Coping Strategies.

BACKGROUND: The purpose of this study was to examine the stigma and coping strategies of patients with type 1 diabetes. METHODS: Data were collected from 24 adult patients with type 1 diabetes via in-depth semi-structured interviews that took place in clinic waiting rooms. Qualitative and descriptive data analysis was conducted to identify stigma and coping strategies of patients with type 1 diabetes. RESULTS: Stigma of patients with type 1 diabetes consisted of four categories: (i) "hatred of insulin" due to a treatment-oriented lifestyle after the onset of the disease, (ii) "imperfect body" due to systemic changes caused by the disease, (iii) "social outcast" as a diabetes patient who used to be healthy, and (iv) "poor me," a negative self-image due to the responses and attitudes of others. Regarding the coping strategies for reducing stigma, the following four categories were derived from the analysis: (i) In a stable disease stage, patients coped with stigma by "hiding their disease" or (ii) "pretending to be healthy" by avoiding self-care behaviors in public. When they told others about their disease, they (iii) "gradually spoke out to those around them about their illnesses." (iv) When they could not do either (i) or (ii), they resorted to "limiting their social life" or limiting interactions with others. CONCLUSION: Patients with type 1 diabetes changed their coping strategies for reducing stigma as the disease progressed because stigma was tied to their disease. Physical, psychological, social, and spiritual coping strategies are required to reduce stigma, and the strategies are interrelated. It is important for nurses to assess patients from various viewpoints, including the viewpoint of stigma.

Structure of Resilience among Japanese Adult Patients with Type 1 Diabetes: A Qualitative Study.

BACKGROUND: Resilience is the process of overcoming adversities and difficulties. We clarified the structure of resilience and its motivational power among adult Japanese patients with type 1 diabetes. This is likely to help ensure effective nursing support to empower patients with diabetes and help them recuperate and improve their personal lives. METHODS: Participants were 17 patients with type 1 diabetes, and data were collected using semi-structured interviews. Participants shared their experiences of coping with self-management and diabetes control issues, the meaning of living with diabetes, and their support from family and friends since their diagnosis. Glaser's grounded theory was used to analyze the data and the results were used to create a new model of resilience for type 1 diabetes. RESULTS: Five categories were extracted: "suffering from a guilty conscience," "suffering from an insulin-dependent body," "social disability," "a driving force to advancement," and "possessing a strategy to live with the disease." CONCLUSION: The five categories formed two stages: preparatory resilience and resilience formation. Once patients recognized the presence of empathetic others, they could obtain better disease comprehension and cooperation. Recognizing this support system served as a "driving force to advancement" and was termed the "resilience battery." Through the resilience battery, patients shifted from preparatory resilience to "resilience formation," or acquiring "a strategy to live with the disease." To forge patient resilience, nurses should encourage disease comprehension and cooperation among patients' significant others. We further propose that high-quality nursing care would involve supporting patients' inner resilience.

Qualitative Analysis of the Resilience of Adult Japanese Patients with Type 1 Diabetes.

BACKGROUND: Resilience strategies are what we use to avoid and recover from error. In this study, we used the grounded theory approach to evaluate the resilience of Japanese patients with Type 1 diabetes. METHODS: Semi-structured interviews were conducted with 15 adults with Type 1 diabetes. Then, using grounded theory, we created a new model of resilience in this population. RESULTS: The results suggested a core category, "to make progress along the resilience path," comprising seven concepts classified into three stages. These seven concepts were as follows: "suffering from treatment," "damaged trust as a person," "persistence of afflictions," "awareness of supporters," "joy to be kept alive by insulin," "actively seeking a future," "being able to manage by oneself." Individuals with Type 1 diabetes used difficult experiences to motivate their resilience and to improve their situation. Additionally, resilience was an important contributor to these individuals' beliefs in their ability to face difficulties, to accept their illness and insulin therapy, and to control their illness. Resilience was also important to these individuals' faith in the future and in medical care. Our results are applicable to clinical care and research, such as the development of preventive interventions aimed at building or strengthening protective skills related to diabetes and its management. CONCLUSION: Ultimately, our goal is to equip adults with Type 1 diabetes with the tools to obtain sufficient behavioral and health-related resilience. Furthermore, these results highlight that maintaining resilience-related coping skills is important for adults and indicate that different psychological processes underlie resilience across the lifespan.

A Qualitative Study of Confusing Experiences among Japanese Adult Patients with Type 1 Diabetes.

BACKGROUND: In this study, we investigated the powerlessness of patients with type 1 diabetes (T1D), and described the structure of powerlessness that these individuals experienced. In order for patients to recover from this state, we recommend that they take steps to regain their power. METHODS: Fifteen Japanese adults with T1D participated in this study. Data were collected from all subjects between July 2013 and March 2014 via in-depth semi-structured interviews. Qualitative data analysis was conducted according to a grounded theory approach. Finally, the core category was identified, which allowed us to build a new powerlessness structure for T1D. RESULTS: The results suggested a core category, 'Wandering a tangled path,' comprising four categories, eight subcategories, and twenty-six concepts. These four categories were as follows: 'being burdened by T1D,' 'suffering from insulin-related troubles,' 'being unable to cope with difficulties in self-management,' and 'facing social prejudice.' In the state of powerlessness, negative emotional experiences snowballed, with patients feeling more and more depressed until they ultimately reached 'rock bottom.' CONCLUSION: We found that as negative emotional experiences related to powerlessness increased, negative feelings intensified until the patients reached rock bottom. Powerlessness is like 'wandering a tangled path,' a state in which T1D patients struggle to cope with reality on their own when faced with both internal and external events. 'Wandering a tangled path' is at the core of powerlessness. A primary characteristic of the structure of powerlessness is suffering from confusing experiences. To help patients cope with T1D without being crushed by powerlessness, nurses must pay attention to signs of powerlessness. Powerlessness is not just an emotional state, but a combination of feelings, perceptions, and thoughts; therefore, it is important to comprehensively understand patients' narratives.

Opinions and Satisfaction Regarding Continuous Subcutaneous Insulin Infusion Therapy in Adult Patients with Type 1 Diabetes.

BACKGROUND: This study examined the treatment satisfaction of type 1 diabetic patients undergoing continuous subcutaneous insulin infusion (CSII) therapy, and patients' thoughts regarding CSII. METHODS: We provided a self-administered questionnaire survey over the internet. Participants were 106 individuals with type-one diabetes aged 20 years or older, undergoing CSII. The survey examined patients' treatment satisfaction, and their thoughts regarding CSII. Descriptive statistics were calculated. We compared relationships between treatment satisfaction and other variables using the Kruskal-Wallis rank sum test, and performed content analysis on participants' thoughts regarding CSII. RESULTS: Regarding treatment satisfaction, the response, "neither of them" was the most frequent. Comparing relationships between treatment satisfaction and other variables, significant differences were found for the variables "age," "presence of dissatisfaction regarding doctors' response," and "presence of a significant medical expense burden." Participants' thoughts regarding CSII were classified into 10 categories. CONCLUSION: Participants expressed positive evaluations, such as that their blood sugar control had improved due to CSII, and that they perceived improvement in their health. Participants also expressed negative evaluations, however, such as that medical expenses resulting from CSII were high, and that these expenses may cause distress and future economic insecurity. In future, patients may benefit from nursing support that allows patients to confidently continue with CSII.

Type 1 Diabetes Patients Using Continuous Subcutaneous Insulin Infusion Therapy: Feeling Burdened Correlated with Factors.

BACKGROUND: The purpose of this study was to investigate factors related to feelings of being burdened in type 1 diabetes patients using continuous subcutaneous insulin infusion (CSII) therapy. METHODS: Participants were 106 subscribers to the Diabetes Network's e-mail newsletter. An online survey was used. Eligible participants were aged at least 20 years, had type 1 diabetes, and were using CSII. Survey questions concerned whether participants found CSII burdensome, and seven potential reasons for feelings of burden. Analysis calculated correlations among participants' demographic and treatment-related factors, and among participants' reasons for feeling CSII to be burdensome. RESULTS: Regarding demographic and treatment-related factors, gender was found to be weakly negatively correlated with the following variables: employment status, and whether participants had discussed their concerns with a doctor. Employment status was found to be weakly correlated with diabetes duration; employment status and diabetes duration were found to be weakly correlated with age. Regarding reasons for finding CSII therapy burdensome, "It takes too much time" was found to be strongly positively correlated with "It interferes with work responsibilities"; 16 weak positive correlations were also found. CONCLUSION: To explain our results, we suggest that medical expenses, glycemic control, scheduling outpatient visits around home and work responsibilities, and interacting with medical staff may have caused participants to find CSII therapy burdensome. Most participants had never discussed their treatment concerns with a doctor. This suggests that nurses may be able to mitigate feeling burdened in participants using CSII therapy.