Adult Severe Asthma Registries: A Global and Growing Inventory.

Aim: The International Severe Asthma Registry (ISAR; http://isaregistries.org/) uses standardised variables to enable multi-country and adequately powered research in severe asthma. This study aims to look at the data countries within ISAR and non-ISAR countries reported collecting that enable global research that support individual country interests. Methods: Registries were identified by online searches and approaching severe asthma experts. Participating registries provided data collection specifications or confirmed variables collected. Core variables (results from ISAR's Delphi study), steroid-related comorbidity variables, biologic safety variables (serious infection, anaphylaxis, and cancer), COVID-19 variables and additional variables (not belonging to the aforementioned categories) that registries reported collecting were summarised. Results: Of the 37 registries identified, 26 were ISAR affiliates and 11 non-ISAR affiliates. Twenty-five ISAR-registries and 4 non-ISAR registries reported collecting >90% of the 65 core variables. Twenty-three registries reported collecting all optional steroid-related comorbidity variables. Twenty-nine registries reported collecting all optional safety variables. Ten registries reported collecting COVID-19 variables. Twenty-four registries reported collecting additional variables including data from asthma questionnaires (10 Asthma Control Questionnaire, 20 Asthma Control Test, 11 Asthma Quality of Life Questionnaire, and 4 EuroQol 5-dimension 5-level Questionnaire). Eight registries are linked to databases such as electronic medical records and national claims or disease databases. Conclusion: Standardised data collection has enabled individual severe asthma registries to collect unified data and increase statistical power for severe asthma research irrespective of ISAR affiliations.

Memories of nursing in Singapore - an oral history approach.

Background: Documentation of the voices of nurses provided valuable insight and a greater understanding of the nursing experience in Singapore. Aim: To record nurses' experiences of journey of nursing profession in the acute care setting in Singapore from the early days of formalisation of nursing education to today's practice as a profession with various specialisation and career tracks. Method: An oral history research approach was adopted, with purposive and snowball sampling to recruit nurses (both current and retired) who had trained in Singapore from 1956 which marked the beginning of the founding of the School of Nursing to current. Interviews were conducted with an interview guide. Thematic analysis was utilised to analyse the audio-recorded data. Results: The 54 participants with a range of 10-54 years of nursing experience were interviewed and they completed their nursing training between 1952 and 2006. Four themes were generated: essence of nursing, inevitable changes across nursing profession, resilience and future outlook in nursing. Conclusions: Understanding the experiences of these nurses generated an in-depth understanding of the personal, social and historical events that were at play in fostering today's nursing practice. With the evolution of the roles in nursing, compassion in current practice needs to be re-evaluated. Continuous learning is essential to meet the needs of the changing healthcare landscape.

Differing pathways to resiliency: A grounded theory study of enactment of resilience among acute care nurses.

It is well-recognized that nurses are exposed to high levels of stress, thus resilience has been postulated as a key trait in enabling nurses to cope successfully and remain in the profession. In this qualitative study, we used Glaser's approach to grounded theory. Nine nurses who scored low and nine nurses who scored high on the Connor-Davidson Resilience Scale were recruited for one-on-one semistructured interviews of the factors contributing to their work-related stress and how they overcome these stressors. Three categories emerged from the data: outlook on work, self-efficacy, and coping responses. These categories led to the emergence of the theory "differing pathways to resiliency". Despite the stresses experienced at work, some nurses were highly resilient, while others were not. Highly-resilient nurses tend to adopt active coping mechanisms, whereas nurses who have low resilience tend to undertake passive measures to let nature runs its course. The emerging theory provided an understanding of the different pathways to resiliency and how nurse leaders can potentially develop and grow the level of resiliency among nurses.

A Photovoice study on nurses' perceptions and experience of resiliency.

AIM: To explore the meaning of resilience to nurses and their perceived resilience enhancing factors. BACKGROUND: With challenges faced at work, nurses' professional quality of life is adversely affected with nurses experiencing compassion fatigue, depression, burnout and even signs of post-traumatic stress disorder. Degree of resilience can determine job satisfaction and nursing attrition. METHODS: The study adopted a descriptive qualitative design using Photovoice. Eight nurses from an academic medical centre in Singapore participated in focus group interviews and data were analysed with inductive content analysis approach. RESULTS: Four themes were generated: (a) resilience is performing nursing duties despite adversities; (b) resilience is a dynamic process that develops over time; (c) religion and faith help build resilience; and (d) support of others is important in overcoming work-related stress. CONCLUSIONS: Knowledge on resilience is vital to understand influencing factors of personal resilience and relationship to stress and burnout. Building nurses' resilience is significant to improve and sustain healthy and effective functioning of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: With sufficient external resources and psychosocial support from hospital administrators, early resilience-based approach may provide the buffer and protective factor in facing workplace stress, to improve overall job satisfaction and improve nurses' retention.

Understanding the influence of resilience on psychological outcomes - Comparing results from acute care nurses in Canada and Singapore.

BACKGROUND: Building resilience among nurses is one of the ways to support and retain nurses in the profession. Prior literature which evaluated influence of resilience on psychological outcomes, were conducted in relatively homogeneous populations. It is of interest to evaluate whether relationships between resilience and psychological outcomes remain consistent across nations and among different nursing populations. AIM: To evaluate a theoretical model of the impact of resilience on burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS) by comparing results between nurses in Canada and Singapore. METHOD: A self-reported questionnaire consisting of questions on demographics, resilience (Connor-Davidson Resilience Scale), and psychological adjustment (Professional Quality of Life) was administered via an online survey. One thousand three hundred and thirty-eight nurses working in two Academic Medical Centres in Singapore responded to the online survey. Similar data was also collected from 329 nurses in Canada. Hypotheses were tested using structural equation modeling. RESULTS: Resilience exerts a significant negative direct impact on STS, and a significant negative direct impact on BO. Additionally, resilience has a positive direct impact on compassion satisfaction. STS exerts a positive direct impact on BO while CS has a negative direct impact on BO. CONCLUSION: Current study affirmed significant associations between resilience and professional quality of life. Knowledge on resilience is key in informing design and implementation of resilience-building strategies that include professional development, and strengthening of interpersonal skills. A resilience-based approach will help reduce nurses' BO and STS while caring for their patients, and in turn reduce turnover.

Demographics and Personality Factors Associated with Burnout among Nurses in a Singapore Tertiary Hospital.

Background. The aim of the study was to evaluate the prevalence and extent of burnout among nurses in Singapore and investigate the influence of demographic factors and personal characteristics on the burnout syndrome. Methods. A cross-sectional survey design was adopted. All registered nurses working in Singapore General Hospital were approached to participate. A questionnaire eliciting data on demographics, burnout (measured using the Maslach Burnout Inventory, MBI), and personality profile (measured using the NEO Five-Factor Inventory, NEO-FFI) was used. Results. 1830 nurses out of 3588 responded (response rate: 51%). Results from 1826 respondents were available for analysis. The MBI identified 39% to have high emotional exhaustion (EE, cut-off score of >27), 40% having high depersonalization (DP, cut-off score of >10), and 59% having low personal accomplishment (PA, cut-off score of <33). In multivariable analysis, age, job grade, and neuroticism were significantly associated with each of the 3 components of the MBI. Staff nurses less than 30 years with high to very high neuroticism were more likely to experience high EE, high DP, and low PA. Conclusion. Younger nurses in Singapore are at increased risk of burnout. Personality traits also played a significant role in the experience of burnout.