Cardiovascular nurses and organizational well-being: a systematic review.

AIMS: This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it. METHODS AND RESULTS: The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive. CONCLUSION: Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes. REGISTRATION: PROSPERO: CRD42022355669.

Measuring Nurses' Organizational Well-Being: A Systematic Review of Available Instruments.

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

Work-related stress, job satisfaction, and quality of work life among cardiovascular nurses in Italy: Structural equation modeling.

AIM: To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life. BACKGROUND: Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion. METHODS: A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed. RESULTS: Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction. CONCLUSION: Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates. METHODS: An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome. RESULTS: Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. CONCLUSIONS: Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial.

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Measuring academic satisfaction in nursing students: a systematic review of the instruments.

Student academic satisfaction is one of the most important factors affecting the success and quality of a higher education institute and is an indicator about teaching and learning. This study aims to summarize and critically evaluate the instruments assessing academic satisfaction in nursing education. A systematic review was undertaken, PRISMA were used for the screening of studies. MEDLINE, Cochrane, Scopus and CINAHL were searched using MeSH terms; seven eligible articles were identified referring to five assessment tools. COSMIN was used for evaluation of the methodological of the instruments. The systematic review identified five satisfaction measurement tools used in nursing education. The analysis of the instruments rarely considered a confirmative validity structure, measurement error or criterion validity. The best available instrument was the Nursing Students Satisfaction Scale (NSSS) for validation methodology; however, it needs further validation studies that consider CFA, reliability, criteria validity, hypothesis testing and measurement error.

Towards a new conceptual model for nurses' organizational well-being: An integrative review.

AIM: The aim of this study is to summarize conceptual models of nurses' organizational well-being and identify common variables among them. BACKGROUND: To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than health care and not always considering the particularities of the profession of nursing. EVALUATION: This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. KEY ISSUES: Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model; the Job Demands-Resources (JD-R) model; the Utriainen et al. model; the Demands-Resources and Individual-Effects (DRIVE) model; the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model and the Nursing Worklife Model (NWM). CONCLUSION: There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being or on working environment characteristics to be studied or monitored for defining nurses' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality and in improving nursing performance and caring outcomes.

Nursing leadership in clinical practice, its efficacy and repercussion on nursing-sensitive outcomes: A cross-sectional multicentre protocol study.

AIM: The aim of this study to describe a research protocol for evaluating the relationship between nursing leadership, organisational well-being and nurse and patient outcomes. BACKGROUND: The head nurses' leadership style influences the organisational context. When an organisation promotes nurses' well-being, they perform better performances and are more satisfied and engaged with their job. This reduces stress levels, burnout and absenteeism and improves physical and psychological health. METHODS: A multicentre study will be conducted. A self-report questionnaire will be administered to head nurses and nurses they coordinate. Study findings will include nurse-sensitive outcomes (e.g., pressure injuries, infections and mortality). Descriptive and correlational analyses will be conducted, and a structural equation model will be tested. RESULTS: Results might verify that a correctly judged leadership style of the head nurse will enhance the organisational context experienced by nurses and improve nursing sensitive outcomes. CONCLUSION: This study will demonstrate the organisational role of middle managers and the direct repercussions on their staff and patients, understanding the relationship between organisational, process and outcomes variables. IMPLICATIONS FOR NURSING MANAGEMENT: If the results confirmed the hypothesis, health care managers would cultivate and stimulate the head nurses' leadership style, thus increasing nurses' organisational well-being and achieving better patient outcomes. No Patient or Public Contribution.

The Wounded Healer: A Phenomenological Study on Hospital Nurses Who Contracted COVID-19.

Since the pandemic began nurses were at the forefront of the crisis, assisting countless COVID-19 patients, facing unpreparedness, social and family isolation, and lack of protective equipment. Of all health professionals, nurses were those most frequently infected. Research on healthcare professionals' experience of the pandemic and how it may have influenced their life and work is sparse. No study has focused on the experiences of nurses who contracted COVID-19 and afterwards returned to caring for patients with COVID-19. The purpose of this study was therefore to explore the lived personal and professional experiences of such nurses, and to describe the impact it had on their ways of approaching patients, caring for them, and practicing their profession. A phenomenological study was conducted with 54 nurses, through 20 individual interviews and 4 focus groups. The main finding is that the nurses who contracted COVID-19 became "wounded healers": they survived and recovered, but remained "wounded" by the experience, and returned to caring for patients as "healers," with increased compassion and attention to basic needs. Through this life-changing experience they strengthened their ability to build therapeutic relationships with patients and re-discovered fundamental values of nursing. These are some of the ways in which nurses can express most profoundly the ethics of work done well.

Effect of a wound healing protocol on patients with stage III and IV pressure ulcers: a preliminary observational study.

OBJECTIVE: To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection. METHOD: This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter-a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively. RESULTS: Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p<0.001). Nutritional status was predictive of wound healing (R2=0.12). CONCLUSION: Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.

Self-efficacy, burnout and academic success in nursing students: A counterfactual mediation analysis.

AIM: To test the mediating role of burnout in the relationship between self-efficacy and academic success in nursing students. DESIGN: This was a cross-sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students. METHODS: We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018-2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self-Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed. RESULTS: The participants (n = 556) had a median age of 20 years (IQR 19-22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self-efficacy on academic success and also a significant indirect effect of this relationship via burnout. CONCLUSION: The mechanism by which self-efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification. IMPACT: Nurses' professors should be engaged in strategies to promote self-efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse.

Nurses' Quality of Life Scale: Validation and Psychometric Properties.

The Nursing Quality of Life Scale (NQOLS) is a 28-item self-report measure evaluating the four dimensions of nurses' quality of life, namely, the physical, emotional, working, and social dimensions. The purpose of this study is to assess the psychometric properties, including validity and reliability, of the NQOLS. The study enrolled 1105 nurses who provided direct assistance to patients. The NQOLS factorial structure was tested using a cross-validation approach via Exploratory Structural Equational Modeling, which confirmed the instrument's four-dimension structure. Reliability was assessed using omega coefficients, proving excellent for all factors. Cluster analysis identified five distinct groups, each composed of participants sharing a substantial similarity with respect to their profile in the NQOLS. These five identifiable clusters presented significant differences not only in the NQOLS but also in the risk of work-related stress, emotional labor, and burnout. The results show that NQOLS is a simple, reliable, lean tool for measuring nurses' overall QoL, whose various parts can additionally be used to answer specific research questions.

Development and psychometric evaluation of the motivation for nursing student scale (MNSS): a cross sectional validation study.

OBJECTIVES: To develop a self-report scale to measure academic motivation among nursing students and to test its psychometric properties. METHODS: a cross-sectional validation study with a convenience sample of nursing students (n=1,635) was performed. The Motivation Nursing Students Scale was developed; content, face, construct validity, hypothesis testing and reliability were evaluated. RESULTS: The validity structure revealed a four-factor solution and the model reached a satisfactory fit (χ2=622.835 df=160, p<0.01, CFI=0.90, TLT=0.83, RMSEA=0.060 (90% [CI] 0.055-0.064, p=0.001, SRMR=0.067). The hypothesis testing was confirmed with a positive correlation of the academic self-efficacy with Introjected, Intrinsic motivation and a negative correlation with Amotivation. CONCLUSIONS: We verified a link between academic self-efficacy and motivation. Both motivation and self-efficacy may increase academic achievement and the possibility for HEIs to degrees a number of students in line with demands.

Psychometric Evaluation of the Oldenburg Burnout Inventory for Nursing Students.

BACKGROUND: Higher education students, especially nursing students, have drawn more attention as a group that is vulnerable to the risk of developing burnout syndrome. PURPOSE: To test the psychometric properties of the Oldenburg Burnout Inventory in Nursing (OLBI-N). METHODS: The OLBI-N validity and reliability was tested in a sample of 476 nursing students. The validity was assessed with explorative and confirmative factor analyses. For hypothesis testing, we evaluated the correlation between burnout and academic self-efficacy. RESULTS: Two factors (exhaustion and disengagement) were identified, and the confirmative factor analysis of the OLBI-N yielded a good fit. The OLBI-N was significantly correlated with academic self-efficacy (r = .29, -.37, p < .01). CONCLUSIONS: The OLBI-N is a valid, reliable questionnaire for measuring burnout among nursing students.

A mixed methods study of an organization's approach to the COVID-19 health care crisis.

BACKGROUND: Healthcare emergency can increase work-related stress and reduce nurses' job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes. PURPOSE: The purpose of this study was to verify whether a proactive organizational approach can limit nurses' work-related stress and help preserve their job satisfaction and quality of life during a health emergency. METHODS: A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data. FINDINGS: After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased. DISCUSSION: Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.

Academic failure and its predictors in Baccalaureate nursing students: A longitudinal study.

AIMS AND OBJECTIVES: To describe the sociodemographic and academic characteristics of nursing students who report academic failure and to identify the determinants of academic failure (no degree on time) in a population of nursing students. BACKGROUND: Although prior studies have shown that academic failure is influenced by multiple factors, the studies mentioned have mostly focused on specific single variables associated with academic failure, and they have reported inconsistent results. DESIGN: A prospective follow-up study design was used in an Italian Baccalaureate Nursing Degree program. A total sample of 2,040 at baseline and a random subsample of 753 students were considered for academic failure determinants. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology). METHODS: We included in the model academic background, self-efficacy, sociodemographic variables and self-efficacy in psychomotor skills and motivation. We used the Academic Nurse Self-Efficacy Scale (ANSEs), the Nursing Self-Efficacy in Psychomotor Skill Scale (NSE-PS) and the Motivation Nursing Students' Scale (MNSS) which have been validated on nursing students. For the assessment of predictors of academic failure, a two-stage hierarchical logistic regression analysis was performed. RESULTS: Students who had academic failure were 69.4% of the sample. Predictors of academic failure were the secondary school certification grade, the university pre-admission test score; the academic self-efficacy, self-efficacy in psychomotor skills and clinical training examination grades were additional predictors. CONCLUSIONS: The secondary school certification grade, the University pre-admission test score, low academic self-efficacy, low self-efficacy in psychomotor skills and low clinical training examination grades were predictors of academic failure in nursing students. RELEVANCE TO CLINICAL PRACTICE: Our findings suggest that the universities could consider a cut-off in the pre-admission test score as a critical value for identifying students who are likely to fail. In addition, nursing faculty staff should consider strategies for developing self-efficacy and motivation.

Nursing students' academic self-efficacy: A longitudinal analysis of academic self-efficacy changes and predictive variables over time.

AIM: To analyse any changes seen in the academic self-efficacy of nursing students during the three years of their academic education as well as the associated predictive factors. DESIGN: A longitudinal study design was applied. METHODS: The sample included 220 students who attended a large university in central Italy. The students' academic self-efficacy was measured using the Academic Nurses' Self-Efficacy Scale. Data were collected annually from 2014/2015 to 2017/2018 at the beginning of the first year (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3). A repeated measure univariate analysis of variance (ANOVA) was conducted to detect any possible changes in the students' academic self-efficacy scores over the four measurement points. To identify the factors that are predictive of academic self-efficacy, a linear regression model was used. RESULTS: Overall, the students' academic self-efficacy did not change significantly over the three-year period of their education. Both sex (female) and age (24-50 years) during T0-T2 significantly predicted changes in the students' academic self-efficacy over time. Moreover female students started with lower academic self-efficacy scores than male students, although their academic self-efficacy increased over time, while the male students' academic self-efficacy actually decreased over time. In addition, students with a scientific background reported higher academic self-efficacy than other students. CONCLUSIONS: Although the students' academic self-efficacy did not change over time, from a theoretical perspective, academic self-efficacy can be developed using a number of strategies such as a well-organised tutorial during the clinical learning phase and feedback or encouragement. IMPACT: Academic staff should monitor nursing students' academic self-efficacy over time, particularly in the case of male and younger students, students with a partner and students with a humanities background during the first 2 years of the course.

Outcomes of wound care nurses' practice in patients with pressure ulcers: An integrative review.

BACKGROUND: Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers. AIMS AND OBJECTIVES: To identify, summarise and map all available evidence related to the outcomes of wound care nurses' practice in individuals with pressure ulcers. DESIGN: Integrative literature review. REVIEW METHOD: To report the review, we followed the modified version of Cooper's five-step methodology, and the PRISMA guidelines. METHODS: The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses. RESULTS: Of the 439 peer-reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers' stage, number of completely healed wounds, treatment costs and physical discomfort. No patient-reported outcomes were assessed. CONCLUSION: This review indicates that clinical-related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers. RELEVANCE TO CLINICAL PRACTICE: There is promising evidence of a positive impact of wound care nurses' practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners.

An integrated system for Peripherally Inserted Central Catheter tip confirmation in oncology and haematology patients.

INTRODUCTION: Although there are many methods to confirm vascular device tip, chest x-ray represents the recommended procedure to verify the correct positioning of a central device, but it exposes patients to x-rays, delays treatment, and permits device length to be checked post-procedure. AIM: To evaluate the efficacy of Peripherally Inserted Central Catheter positioning through an Integrated System (ultrasound-guided and electrocardiogram confirmation). METHODS: A case-control study was conducted on a randomized sample of 165 patients, requiring Peripherally Inserted Central Catheter placement for chemotherapy treatment. The case group was composed of patients with vascular device placed through the Integrated System and the control group devices' length was anthropometrically estimated. Chest radiography was performed on both groups to verify tip location. RESULTS: No cases of primary malposition related to the Integrated System were registered. The vascular devices positioned with the Integrated System were all correctly placed and in 91.8% (n=101) the intra-procedural tip location was comparable to the one identified in the x-ray. CONCLUSION: The Integrated System represented a simple and efficient method to correctly place vascular device, allowing intra-procedural tip confirmation and avoiding primary malposition. It would eliminate the need for performing chest radiography, reduce costs and time for healthcare professionals and patients.