"Picturing a Way Forward": Strategies to Manage the Effects of COVID-19-Related Isolation on Long-Term Care Residents and Their Informal Caregivers.

BACKGROUND AND OBJECTIVES: Strategies to manage the coronavirus disease 2019 (COVID-19) pandemic included widespread use of physical distancing measures. These well-intended strategies adversely affected long-term care (LTC) residents' socialization and their caregiving arrangements, leading to exacerbation of social isolation and emotional distress for both residents and their caregivers. This study aimed to understand how these measures affected informal caregivers of people living in LTC homes in Ontario. Strategies to increase socialization and promote social connection during and post-COVID-19 were also explored. RESEARCH DESIGN AND METHODS: This qualitative study used descriptive and photovoice approaches. Of the 9 potential caregivers identified, 6 participated in the study and shared their experiences and photographic reflections in virtual focus group sessions. RESULTS: Findings highlighted the increased social isolation experienced by people living in LTC and their caregivers during COVID-19. Caregivers reported pronounced declines in residents' well-being and were frustrated by challenges connecting with their family members during quarantine. Attempts made by LTC homes to maintain social connections, such as window visits and video calls, did not fulfill the social needs of residents and their caregivers. DISCUSSION AND IMPLICATIONS: Findings underscore a need for better social support and resources for both LTC residents and their caregivers going forward to prevent further isolation and disengagement. Even in times of lockdown, LTC homes must implement policies, services, and programs that promote meaningful engagement for older adults and their families.

Insight into the experiences of caregivers of older adults in long-term care homes: A photovoice study.

AIMS: To explore the lived experiences of caregivers of people living in long-term care (LTC) homes during the initial phases of the COVID-19 pandemic and potential supports and resources needed to improve caregivers' quality of life. BACKGROUND: Carers (or care partners) of adults in LTC contribute substantially to the health and well-being of their loved ones by providing physical care, emotional support and companionship. Despite their critical role, little is known about how caregivers have been impacted by the pandemic. DESIGN: An interpretive descriptive approach that incorporated the photovoice method was used. METHODS: Using a purposive sampling strategy, six family carers in Ontario, Canada were recruited between September and December 2021. Over a 4-week period, caregivers took pictures depicting their experience of the pandemic that were shared in a virtual focus group. Visual and text data were analysed using thematic analysis with an inductive approach. FINDINGS: Caregivers expressed feelings of frustration, confusion and joy. Emerging themes included: (i) feeling like a 'criminal' amidst visitor restrictions and rules; (ii) experiencing uncertainty and disappointment in the quality of care of long-term care homes; (iii) going through burnout; and (iv) focusing on small joys and cherished memories. CONCLUSIONS: The combination of visual and textual methods provided unique insight into the mental distress, isolation and intense emotional burdens experienced by caregivers during the pandemic. IMPACT: Our findings underscore the need for LTC organizations to work in unison with caregivers to optimize the care of residents and support the mental health of caregivers. REPORTING METHOD: This work adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist. PUBLIC CONTRIBUTIONS: The caregivers included in the study were involved in the co-creative process as active contributors informing the design and validation of the codes and themes.

Engaging care partners of persons living with dementia in acceptance and commitment therapy (ACT) programs: a scoping review.

OBJECTIVES: Acceptance and commitment therapy (ACT) is a relatively new type of psychotherapy effective for treating depression and anxiety amongst family care partners of persons living with dementia [PLWD]. However, care partner engagement in mental health services is low and specific guidelines for designing ACT programs for care partners of PLWD do not exist. The purpose of this scoping review was to examine patterns in care partner engagement in ACT programs to identify program factors potentially influencing engagement. METHODS: A comprehensive scoping review according to Arksey and O'Malley's framework was followed. Databases and grey literature were searched for primary studies of ACT programs with care partners of PLWD. Data were charted and synthesized. RESULTS: Ten studies met inclusion criteria and were analyzed. Amongst these, engagement was highest in three ACT programs that were delivered individually, remotely and were therapist-led or supported. Conversely, engagement was the lowest in two ACT programs that were self-directed, web-based and had minimal or no care partner-therapist interaction. Program factors perceived as influencing engagement included tailoring and personalization, mode of delivery and format, therapeutic support and connectedness, program duration and pace. CONCLUSION: Findings from this review suggest that care partners engagement may be promoted by designing ACT programs that focus on the therapeutic client-therapist relationship, are delivered remotely and individually. Future research should focus on evaluation of best implementation practices for engagement and effectiveness.

Working through a pandemic: The mediating effect of nurses' health on the relationship between working conditions and turnover intent.

AIM: While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID-19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession. DESIGN: Secondary data from a cross-sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling. METHODS: Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes. RESULTS: Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job. PATIENT OR PUBLIC CONTRIBUTION: The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study.

Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial.

INTRODUCTION: Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme. METHODS AND ANALYSIS: A cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis. ETHICS AND DISSEMINATION: The study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals. TRIAL REGISTRATION NUMBER: NCT039359.

What mobility factors are critical to include in a comprehensive mobility discharge assessment framework for older adults transitioning from hospital-to-home in the community? An international e-Delphi study.

PURPOSE: To prioritize and achieve consensus on mobility determinant factors [cognitive, financial, environmental, personal, physical, psychological, social] considered critical to include in the COmprehensive Mobility Discharge Assessment Framework (COMDAF) for older adults transitioning from hospital-to-home. MATERIALS AND METHODS: We conducted a three-round modified e-Delphi process with 60 international experts (seven older adults, nine family caregivers, 24 clinicians, and 20 researchers) from nine countries with universal or near-universal health coverage. Expert members rated 91 factors identified from scoping reviews using a 9-point scale: not important (1-3), important (4-6), and critical (7-9). RESULT: A total of 41 of 91 factors (45.1%) met the a-priori consensus criterion after three rounds: five cognitive, five environmental, two personal, 19 physical, six psychological, and six social factors. No financial factors reached a consensus. The older adult steering committee member recommended the addition of two environmental factors, resulting in 43 mobility factors included in the COMDAF. CONCLUSIONS: We advanced a comprehensive mobility framework by developing, through consensus, 43 mobility factors to be assessed as part of a COMDAF. However, its use in hospital-to-home may not be feasible. Therefore, future research will determine the core mobility factors for COMDAF and which measurement instruments best measure these factors. RELEVANCE: An interdisciplinary discharge rehabilitation team can utilize the COMDAF during hospital-to-home transition.Implications for rehabilitationMobility assessment following a hospital discharge is a complex process requiring an interdisciplinary discharge rehabilitation team.This study provided a comprehensive list of 91 factors across all seven mobility determinants (cognitive, environmental, financial, personal, physical, psychological, and social) for clinicians in other care settings to use as a starting point to determine which mobility factor should be assessed during older adults' hospital-to-home transition.This international e-Delphi study identified 43 factors within mobility determinants (cognitive, environmental, personal, physical, psychological, and social) to be included in a Comprehensive Mobility Discharge Assessment Framework to assess older adults' mobility during the hospital to home transition.Using these 43 factors, clinicians can identify which assessment tool is best suited to assess the factors while reflecting on the logistics and feasibility; this is the next phase of this project.

Predictors of Nursing Faculty Job and Career Satisfaction, Turnover Intentions, and Professional Outlook: A National Survey.

BACKGROUND: Retaining talented and experienced nurses in clinical practice and academia is crucial for maintaining continuity, ensuring high-quality care and education, and fostering a positive work environment. Although factors influencing nursing staff retention are well documented, little is known about how workplace factors impact nursing faculty retention outcomes. METHODS: A national survey involving 645 nursing faculty across Canada was undertaken. Multivariate regression analysis with interaction effects was conducted to determine the association between work-related factors (i.e., workplace culture and work-life imbalance) and faculty job and career satisfaction, turnover intentions, and professional outlook. RESULTS: Supportive workplace culture positively influenced faculty job and career satisfaction and professional outlook, while it negatively impacted turnover intentions. Conversely, work-life imbalance decreased faculty job and career satisfaction and professional outlook (i.e., confidence in nursing program, profession), and it increased intentions to leave the job. CONCLUSION: Our results offer insights into the work-life experiences of Canadian faculty members and shed light on key factors that impact their job-related outcomes. In the context of competing resources, every effort must be made to improve modifiable workplace factors such as the academic work environment and create targeted interventions and policies to promote faculty retention.

Compassion fatigue in healthcare providers during the COVID-19 pandemic: a scoping review protocol.

INTRODUCTION: The COVID-19 pandemic has negatively impacted the psychological health and well-being of healthcare providers. An amplification in chronic stressors, workload and fatalities may have increased the risk of compassion fatigue and disrupted the quality of patient care. Although current studies have explored the general psychological status of healthcare providers during the COVID-19 pandemic, few have focused on compassion fatigue. The purpose of this review is to explore the impacts of the COVID-19 pandemic on compassion fatigue in healthcare providers and the repercussions of compassion fatigue on patient care. METHODS AND ANALYSIS: This scoping review will follow Joanna Briggs Institute and Arksey and O'Malley scoping review methodology. Comprehensive searches will be conducted in the following relevant databases: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Ovid), CINAHL, Scopus, Web of Science. To expand the search, reference lists of included studies will be handsearched for additional relevant studies. Included studies must report on the impact of COVID-19 pandemic on compassion fatigue in healthcare providers and have been published in English since January 2020. ETHICS AND DISSEMINATION: This review does not require research ethics board approval. By examining the impacts of the COVID-19 pandemic on compassion fatigue in healthcare providers, this scoping review can offer important insight into the possible risks, protective factors and strategies to support healthcare providers' psychological health and patient care amidst persisting stressful conditions.

Workplace Predictors of Violence against Nurses Using Machine Learning Techniques: A Cross-Sectional Study Utilizing the National Standard of Psychological Workplace Health and Safety.

BACKGROUND: Nurses experience an alarming rate of violence in the workplace. While previous work has indicated that working conditions play an important role in workplace violence outcomes, these studies have not used comprehensive and systematically operationalized variables. METHODS: Through cross-sectional survey responses from 4066 British Columbian nurses, we identified which of the 13 psychosocial factors, as outlined in the National Standard of Psychological Workplace Health and Safety, are most predictive of workplace violence perpetrated against nurses by patients and their visitors (Type II violence) and organizational employees (Type III violence). RESULTS: Eighty-seven percent of respondents indicated that they had experienced Type II violence, whereas 48% indicated they had experienced Type III violence over the last year. Lack of physical safety, workload management, and psychological protection were the top three psychosocial factors in the workplace predictive of Type II violence, whereas lack of civility and respect, organizational culture, and psychological support were the top three factors associated with Type III violence. CONCLUSIONS: The findings in this study shed light on the distinct psychosocial factors in the workplace in need of investment and intervention to address Type II and III violence.

Exploring the factors influencing meaningful engagement of persons living with advanced dementia through the Namaste Care Program: a qualitative descriptive study.

Background: Meaningful engagement has been described as active participation based on a person's interests, preferences, personhood, or perceived value. It has many benefits for persons living with dementia in long-term care (LTC) homes, including improvement in physical and cognitive function, and mental health. People with advanced dementia continue to need and benefit from inclusion and social contact in LTC, yet there is not a well-developed understanding of how to support this. A tailored intervention called Namaste Care has been shown to be an effective approach to meaningfully engage residents in LTC, decrease behavioral symptoms, and improve their comfort and quality of life. There is a need to consider how best to deliver this intervention. Objective: The aim of this study was to describe environmental, social, and sensory factors influencing meaningful engagement of persons with advanced dementia during Namaste Care implementation in LTC. Methods: In this qualitative descriptive study, focus groups and interviews were conducted with families, volunteers, staff, and managers at two LTC homes. Directed content analysis was conducted. The Comprehensive Process Model of Engagement was used as a coding framework. Results: With respect to environmental attributes, participants emphasized that a designated quiet space and a small group format were helpful for engagement. In terms of social attributes, participants emphasized Namaste Care staff capacity to deliver individualized care. Regarding sensorial factors, familiarity with the activities delivered in the program was emphasized. Conclusion: Findings reveal the need to offer small group programs that include adapted recreational and stimulating activities, such as Namaste Care, for residents at the end of life in LTC. Such programs facilitate meaningful engagement for persons with dementia as they focus on individual preferences, comfort, and inclusion while recognizing changing needs and abilities of residents.

Pressures in the Ivory Tower: An Empirical Study of Burnout Scores among Nursing Faculty.

(1) Background: The COVID-19 pandemic has exacerbated incidents of burnout among academics in various fields and disciplines. Although burnout has been the subject of extensive research, few studies have focused on nursing faculty. This study aimed to investigate the differences in burnout scores among nursing faculty members in Canada. (2) Method: Using a descriptive cross-sectional design, data were collected via an online survey in summer 2021 using the Maslach Burnout Inventory general survey and analyzed using the Kruskal-Wallis test. (3) Result: Faculty members (n = 645) with full-time employment status, worked more than 45 h, and taught 3-4 courses reported high burnout (score ≥ 3) compared to those teaching 1-2 courses. Although education levels, tenure status or rank, being on a graduate committee, or the percentage of hours dedicated to research and services were considered important personal and contextual factors, they were not associated with burnout. (4) Conclusions: Findings suggest that burnout manifests differently among faculty and at varying degrees. As such, targeted approaches based on individual and workload characteristics should be employed to address burnout and build resilience among faculty to improve retention and sustain the workforce.

Experiences of Healthcare Workers in Long-Term Care during COVID-19: A Scoping Review.

Background: Although healthcare workers (HCWs) in long-term care (LTC) have experienced significant emotional and psychological distress throughout the pandemic, little is known about their unique experiences. Objective: This scoping review synthesizes existing research on the experiences of HCWs in LTC during the COVID-19 pandemic. Method: Following Arksey and O'Malley's framework, data published between March 2020 to June 2022, were extracted from six databases. Results: Among 3808 articles screened, 40 articles were included in the final analysis. Analyses revealed three interrelated themes: carrying the load (moral distress); building pressure and burning out (emotional exhaustion); and working through it (a sense of duty to care). Conclusion: Given the impacts of the pandemic on both HCW wellbeing and patient care, every effort must be made to address the LTC workforce crisis and evaluate best practices for supporting HCWs experiencing mental health concerns during and post-COVID-19.

The role of community-level characteristics in comparing United States hospital performance by magnet designation: A propensity score matched study.

AIMS: To assess the impact of community-level characteristics on the role of magnet designation in relation to hospital value-based purchasing quality scores, as health disparities associated with geographical location could confound hospitals' ability to meet outcome metrics. DESIGN: This cross-sectional study was carried out between October 2021 and March 2022 using data from 2016 to 2021. METHODS: Propensity score analysis was used to match hospital and community-level characteristics, implementing nearest neighbour matching to adjust for pre-treatment differences between magnet and non-magnet hospitals to account for multi-level differences. Secondary data were obtained from all operational acute-care facilities in the United States that participated in the Centers for Medicare and Medicaid Services' hospital value-based purchasing (HVBP) program. Dependent variables were the four value-based purchasing domains that comprise the Total Performance Score (TPS; Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction). RESULTS: Magnet hospitals had increased odds for better scores in the HVBP domains of Clinical Care and Person and Community Engagement, and decreased odds for having better Safety. However, no statistically significant difference was found for the Efficiency domain or the TPS. CONCLUSION: Measuring performance equitably across organizations of various sizes serving diverse communities remains a key factor in ensuring distributive justice. Analysing the TPS components can identify complex influences of community-level characteristics not evident at the composite level. More research is needed where community and nurse-level factors may indirectly affect patient safety. IMPACT: This study's findings on the role of community contexts can inform policymakers designing value-based care programs and healthcare management administrators deliberating on magnet certification investments across diverse community settings. NO PATIENT OR PUBLIC CONTRIBUTION: For this study of US hospitals' organizational performance, we did not engage members of the patient population nor the general public. However, the multi-disciplinary research team does include diverse perspectives.

Using Photovoice as a Method for Capturing the Lived Experiences of Caregivers During COVID-19: A Methodological Insight.

Although the extant literature identifies photovoice as one of the most innovative and creative research methods that encourage reflection and introspection, few studies have described the use of photovoice with family/informal caregivers. This paper discusses the implementation of photovoice as a novel approach in exploring the experiences of informal caregivers (n = 10) of older adults in long-term care homes during the COVID-19 pandemic. The article describes the four stages of the photovoice process undertaken: (1) preparation; (2) pre-focus group meeting; (3) taking photographs; and (4) reflection and implementation insights, to researchers. The different stages in the research process inspired several key learnings, including the use of co-learning tools, the valuable combination of photographic images and words to provide rich description of participants' perspectives, and creative ways to engage and support caregivers in sharing their stories. This paper also addresses some practical challenges of using this methodology with informal caregivers and explore issues surrounding research ethics and photographs. Knowledge gained from this case example provides strong support for the use of photovoice as a creative approach to better illuminate and understand the experiences of caregivers and can inform the design of future virtual studies.

Parenting practices and family relationships during the COVID-19 lockdown in Ghana.

The effects of the COVID-19 pandemic have been far reaching across almost every sphere of life. Families, which are the basic units of society, have not been spared the ravages of the pandemic. Changes in family daily routines as a result of COVID-19 can affect spousal relationships, parenting and childcare practices. However, the extent to which the pandemic has affected parenting practices and family relationships in Ghana is not known. The goal of this study was to assess how parenting practices and family relationships have been influenced during the COVID-19 pandemic in Ghana. Data for this paper was drawn from an online questionnaire response from 463 participants in Ghana as a subset analysis from a multi-country study on personal and family coping system with COVID-19 pandemic in the global south. The mean score for pre-COVID-19 relationship with partner (36.86) was higher (p<0.0001) than the mean score for during COVID-19 relationship with partner (35.32) indicating that COVID-19 has had negative influence on relationships. The mean score for pre-COVID-19 parenting (32.78) was higher (p<0.0001) compared to the mean score for during COVID-19 parenting (31.40) indicating negative influence on parenting. We have predicted that participants whose coping levels were "Well" on the average, are likely to be doing well in relationship with partners and parenting practices during the COVID-19 period The challenging public health containment measures of the COVID-19 pandemic have negatively influenced the relationship between partners and parenting practices in Ghana.

Hospital-Acquired Conditions Reduction Program, Racial and Ethnic Diversity, and Magnet Designation in the United States.

OBJECTIVE: A key quality indicator in any health system is its ability to reduce morbidity and mortality. In recent years, healthcare organizations in the United States have been held to stricter measures of accountability to provide safe, quality care. This study aimed to explore the contextual factors driving racial disparities in hospital-acquired conditions incident rates among Medicare recipients in Magnet and non-Magnet hospitals. METHODS: A cross-sectional observational study was performed using data from Hospital-Acquired Condition Reduction Program. Performance from 1823 hospitals were used to examine the association between Magnet recognition and community's racial and ethnic differences in hospital performance on the Hospital-Acquired Condition Reduction Program. The unit of analysis was the hospital level. A propensity score matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. The outcome measures were risk-standardized hospital performance on the Hospital-Acquired Condition Reduction Program domains and overall performance. RESULTS: Study findings show that Magnet hospitals had decreased methicillin-resistant Staphylococcus aureus (MRSA) rate (ß = -0.22; 95% confidence interval, -0.36 to -0.08) compared with non-Magnet hospitals. No other statistical difference was identified. CONCLUSIONS: Results from this study show community's racial and ethnic differences in hospital-acquired conditions occurrence differ between Magnet and non-Magnet hospitals for MRSA, indicating its association with nursing practice. However, because this improvement is limited to only MRSA, there are likely opportunities for Magnet hospitals to continue process improvements focused on additional Hospital-Acquired Condition Reduction Program measures.

The impact of transformational leadership on nurse faculty satisfaction and burnout during the COVID-19 pandemic: A moderated mediated analysis.

AIMS: To examine the effects of nursing deans/directors' transformational leadership behaviours on academic workplace culture, faculty burnout and job satisfaction. BACKGROUND: Transformational leadership is an imperative antecedent to organizational change, and employee well-being and performance. However, little has been espoused regarding the theoretical and empirical mechanisms by which transformational leaders improve the academic workplace culture and faculty retention. DESIGN: A cross-sectional survey design was implemented. METHODS: Nursing faculty employed in Canadian academic settings were invited to complete an anonymous online survey in May-July 2021. A total of 645 useable surveys were included in the analyses. Descriptive statistics and reliability estimates were performed. The moderated mediation model was tested using structural equation modelling in the Analysis of Moment software v24.0. Bootstrap method was used to estimate total, direct and indirect effects. RESULT: The proposed study model was supported. Transformational leadership had both a strong direct effect on workplace culture and job satisfaction and an inverse direct effect on faculty burnout. While workplace culture mediated the effect of leadership on job satisfaction and burnout, the moderation effect of COVID-19 was not captured in the baseline model. CONCLUSION: The findings provide an in-depth understanding of the factors that affect nursing faculty wellness, and evidence that supportive workplace culture can serve as an adaptive mechanism through which transformational leaders can improve retention. A transformational dean/director can proactively shape the nature of the academic work environment to mitigate the risks of burnout and improve satisfaction and ultimately faculty retention even during an unforeseen event, such as a pandemic. IMPLICATION: Given the range of uncertainties associated with COVID-19, administrators should consider practicing transformational leadership behaviours as it is most likely to be effective, especially in times of uncertainty and chaos. In doing so, academic leaders can work towards equitable policies, plans and decisions and rebuild resources to address the immediate and long-term psychological and overall health impacts of COVID-19.

The Association between Mental Health Symptoms and Quality and Safety of Patient Care before and during COVID-19 among Canadian Nurses.

(1) Background: While the association between nurse mental health and quality and safety of patient care delivery was well documented pre-pandemic, fewer research studies have examined this relationship in the context of COVID-19. This study examines the impact of various mental health symptoms experienced by nurses on quality and safety before and during the COVID-19 pandemic; (2) Methods: A secondary analysis of cross-sectional survey data from 4729 and 3585 nurses in one Canadian province between December 2019 and June-July 2020 was conducted. Data were analyzed using between group difference tests and logistic regression; (3) Results: Compared to pre-COVID-19, during COVID-19 nurses reported a higher safety grade, a greater likelihood of recommending their units for care and lower quality of nursing care. Most mental health symptoms were higher during COVID-19 and higher levels of mental health symptoms were correlated with lower ratings of quality and safety both pre- and during COVID-19; (4) Conclusion: Mental health symptoms have implications for nurses' quality and safety of patient care delivery, with the association between mental health symptoms and quality and safety following a dose-response relationship before and during COVID-19. These findings suggest that it is worthwhile for nurse mental health symptoms to be included as hospital level performance metrics.

Striking a Balance between Work and Play: The Effects of Work-Life Interference and Burnout on Faculty Turnover Intentions and Career Satisfaction.

BACKGROUND: The interactions between work and personal life are important for ensuring well-being, especially during COVID-19 where the lines between work and home are blurred. Work-life interference/imbalance can result in work-related burnout, which has been shown to have negative effects on faculty members' physical and psychological health. Although our understanding of burnout has advanced considerably in recent years, little is known about the effects of burnout on nursing faculty turnover intentions and career satisfaction. OBJECTIVE: To test a hypothesized model examining the effects of work-life interference on nursing faculty burnout (emotional exhaustion and cynicism), turnover intentions and, ultimately, career satisfaction. DESIGN: A predictive cross-sectional design was used. SETTINGS: An online national survey of nursing faculty members was administered throughout Canada in summer 2021. PARTICIPANTS: Nursing faculty who held full-time or part-time positions in Canadian academic settings were invited via email to participate in the study. METHODS: Data were collected from an anonymous survey housed on Qualtrics. Descriptive statistics and reliability estimates were computed. The hypothesized model was tested using structural equation modeling. RESULTS: Data suggest that work-life interference significantly increases burnout which contributes to both higher turnover intentions and lower career satisfaction. Turnover intentions, in turn, decrease career satisfaction. CONCLUSIONS: The findings add to the growing body of literature linking burnout to turnover and dissatisfaction, highlighting key antecedents and/or drivers of burnout among nurse academics. These results provide suggestions for suitable areas for the development of interventions and policies within the organizational structure to reduce the risk of burnout during and post-COVID-19 and improve faculty retention.

Investigating the work-life experiences of nursing faculty in Canadian academic settings and the factors that influence their retention: protocol for a mixed-method study.

INTRODUCTION: While all research-oriented faculty face the pressures of academia, female faculty in fields including science, engineering, medicine and nursing, are especially susceptible to burnout. Nursing is unique in that it remains a predominantly female-dominated profession, which implies that there is a critical mass of females who are disproportionately affected and/or at higher risk of burnout. To date, little is known about the experiences of nursing faculty especially, new and early career researchers and the factors that influence their retention. This study aims to understand the work-life (the intersection of work with personal life) experiences of nursing faculty in Canadian academic settings and the factors that influence their retention. METHODS AND ANALYSIS: A mixed-method design will be used in this study. For the quantitative study, a sample of approximately 1500 new and early career nursing faculty across Canadian academic institutions will be surveyed. Eligible participants will be invited to complete a web-based structured questionnaire in both French and English language. Data will be evaluated using generalised linear regression model and structural equation modelling. Given the complexities of work-life issues in Canada, qualitative focus group interviews with about 20-25 participants will also be conducted. Emerging themes will be integrated with the survey findings and used to enrich the interpretation of the quantitative data. ETHICS AND DISSEMINATION: This study has received ethical approval from the Hamilton Integrated Research Ethics Board (#1477). Prior to obtaining informed consent, participants will be provided with information about study risks and benefits and strategies undertaken to ensure confidentiality and anonymity. The study findings will be disseminated to academics and non-academic stakeholders through national and international conference presentations and peer-reviewed open-access journals. A user-friendly report will be shared with professional nursing associations such as the Canadian Associations of Schools of Nursing, and through public electronic forums (e.g., Twitter). Evidence from this study will also be shared with stakeholders including senior academic leaders and health practitioners, government, and health service policy-makers, to raise the profile of discourses on the nursing workforce shortages; and women's work-life balance, a public policy issue often overlooked at the national level. Such discussion is especially pertinent in light of the disproportionate impact of COVID-19 on women, and female academics. The findings will be used to inform policy options for improving nursing faculty retention in Canada and globally.