Evaluating the role of heart rate variability in monitoring stress and sleep quality among nurses in the aftermath of the COVID-19 pandemic.

AIM: To assess heart rate variability (HRV) as a measure to assess job stress and sleep quality among nurses in the post-COVID-19 period. BACKGROUND: The COVID-19 pandemic significantly affected nurses, with heightened job stress and impaired sleep quality impacting their well-being and effectiveness in patient care. HRV could offer insights for supporting strategies in the pandemic aftermath. DESIGN: A quantitative cross-sectional study. METHODS: This study involved 403 clinical nurses recruited from a teaching hospital in Taiwan. Data on job stress, work frustration, sleep quality and HRV were collected and analysed. RESULTS: Among the nurses surveyed during the COVID-19 pandemic, 72.7% reported poor sleep quality (PSQI = 9.369). Job stress emerged as a strong predictor of work frustration. High stress levels and poor sleep quality were correlated with significantly decreased HRV, indicating a potential physiological impact of stress on the nurses' health and well-being. CONCLUSIONS: HRV is a valuable and cost-effective measure for monitoring and managing nurses' well-being in the post-COVID-19 era. Targeted interventions can be implemented to support nurses' overall performance and promote their well-being by identifying those at high risk of job stress and poor sleep quality.

Nurses' perceived health and occupational burnout: A focus on sleep quality, workplace violence, and organizational culture.

AIM: This study investigates the mediation of sleep quality between perceived health and occupational burnout in hospital nurses, considering the moderation of workplace violence and organizational culture. BACKGROUND: Occupational factors lead to physical and mental distress, burnout, and sleep issues in nurses. Approximately two-thirds of nurses experience burnout, impacting patient care quality and safety. Cultivating a positive organizational culture is essential for nursing workforce stability. METHODS: This cross-sectional study employed convenience sampling to recruit 346 nurses from a teaching hospital in southern Taiwan in July-August 2020 (response rate: 87.3%). Self-administered questionnaires containing validated instruments were employed, including an adapted occupational burnout scale, the Chinese version of an organizational culture scale, a Perceived Health Questionnaire, a Workplace Violence Experience Scale, and the CPSQI; all instruments were reliable and valid. The analysis involved descriptive statistics, linear regression, and the Johnson-Neyman technique. RESULTS: Nurses with better perceived health exhibited significantly lower occupational burnout (p < 0.001). Perceived health indirectly impacted burnout through sleep quality (p < 0.01) with organizational culture as a partial moderator. Bureaucratic organizational culture exacerbated this relationship. Additionally, decreased workplace violence moderated the connections among perceived health, sleep quality, and occupational burnout among nurses. CONCLUSIONS: Given the inverse correlation between nurses' perceived health and occupational burnout and considering factors such as workplace violence, organizational culture, and sleep quality, healthcare institutions can proactively take steps to enhance nurses' overall well-being and mitigate burnout. IMPLICATIONS FOR NURSING AND HEALTH POLICY: By implementing wellness programs, mental health support, security training, robust reporting, and a zero-tolerance approach to violence, healthcare stakeholders can foster a safe and supportive work environment for nurses, thus improving well-being, patient outcomes, and healthcare quality.

Heart rate variability as an indicator of the beneficial effects of Qigong and mindfulness training on the mind-body well-being of cancer survivors.

BACKGROUND: Cancer-related fatigue (CRF) and fear of recurrence (FOR) are frequently experienced by cancer patients. This study aimed to improve cancer survivors' CRF, FOR, quality of life (QOL), and heart rate variability (HRV) through Qigong and mindfulness interventions. METHODS: A quasi-experimental design was adopted, and 125 cancer survivors were recruited using snowball sampling. The participants were assigned to 1 of 3 groups (Qigong, mindfulness, and control) based on their needs and preferences. All groups received 4 h of nutrition education at the pretest (T0). CRF, FOR, and QOL questionnaires and HRV parameters were used as the measurement tools. Data were collected at the pretest (T0), posttest (T1), and follow-up (T2). RESULTS: Qigong had a better effect on improving CRF (ΔT1-T0 = - 0.108, ΔT2-T1 = - 0.008) and FOR (ΔT1-T0 = - 0.069, ΔT2-T1 = - 0.150) in the long term, while mindfulness improved QOL (ΔT1-T0 = 0.096, ΔT2-T1 = 0.013) better in the long term. Both Qigong and mindfulness had a short-term effect in improving SDNN (Q: ΔT1-T0 = 1.584; M: ΔT1-T0 = 6.979) and TP (Q: ΔT1-T0 = 41.601; M: ΔT1-T0 = 205.407), but the improvement in LF (Q: ΔT2-T1 = - 20.110; M: ΔT2-T1 = - 47.800) was better in the long term. CONCLUSION: HRV evaluation showed that Qigong and the mindfulness interventions had short-term effects in significantly improving overall physical and mental health, self-emotional regulation, and QOL and relieving fatigue and autonomic dysfunction. HRV may serve as an observational indicator of interventions to improve physical and mental health. The consistent practice of mind-body interventions is the primary means of optimizing overall health and well-being.

The Effectiveness of a Critical Appraisal Skills Workshop 6 Months After Nurses' Participation.

Background The aim of this study was to explore whether nursing staff retained knowledge, self-confidence, and attitudes 6 months after participating in a critical appraisal skills workshop. Method A retrospective matched case-control study was conducted to ascertain the effects of this training on the ability to appraise literature. Results Mean scores on the critical appraisal knowledge test, self-confidence, and attitudes were significantly higher in the case group compared to the control group (p < .001, p < .05, and p = .031, respectively). Conclusion Six months after the workshop, critical appraisal knowledge, self-confidence, and attitudes remained improved among the nursing staff who participated. This indicates that the workshop was effective for learning and can be used for clinical training. [J Contin Educ Nurs. 2022;53(8):372-378.].

Mindfulness Stress Management for Female Cancer Survivors Facing the Uncertainty of Disease Progression: A Randomized Controlled Study.

This study aimed to determine the effect of a mindfulness stress management intervention on fear of recurrence and quality of life among female cancer survivors. A longitudinal, randomized design with two groups (60 participants) was used for pretest/posttest comparisons. Twelve weeks of mindfulness stress intervention effectively attenuated fear of recurrence symptoms (T1 p = 0.002, T2 p = 0.047), and quality of life (T1 p = 0.000, T2 p = 0.001) significantly increased. The results were significantly different between the intervention and control groups. Over time, group differences became more significant (T1 p = 0.002), demonstrating the effectiveness of the mindfulness stress management intervention. When female cancer survivors face uncertain disease progression, fear of recurrence affects their quality of life. When these women receive supportive intervention sooner, their improvement is more significant. Healthcare providers should encourage female cancer survivors to engage in mindfulness stress management actions to achieve a better benefit.

Exploring the relationships among training needs, willingness to participate and job satisfaction in disaster nursing: The mediating effect of achievement motivation.

OBJECTIVES: Disaster nursing competencies and their willingness to participate are essential for the success of disaster relief nurses. This study investigates the correlations among emergency room and intensive care unit nurses' training needs, willingness to participate, achievement motivation and job satisfaction as well as their mutual influences on disaster relief efforts. METHODS: A convenience sampling cross-sectional study was conducted, where 488 emergency room and intensive care unit nurses from five hospitals in Taiwan participated (response rate: 84.4%). The relationships among the variables were verified using structural equation modelling. RESULTS: Training needs in disaster nursing were found to be positively correlated with willingness to participate and job satisfaction. Moreover, willingness to participate was found to be positively correlated with achievement motivation and job satisfaction. Achievement motivation was found to be positively correlated with job satisfaction. Furthermore, willingness to participate in disaster relief was found to indirectly mediate job satisfaction through achievement motivation. CONCLUSIONS: The fulfilment of training needs for disaster nursing and willingness to participate may have an impact on nurses' job satisfaction through the mediating effect of achievement motivation. Nurses' learning needs should be the foremost consideration in disaster nursing training to alleviate human resource shortages and improve disaster responses. These findings can serve as a reference for increasing preparedness training for nurses in disaster management. RELEVANCE TO CLINICAL PRACTICE: Nurses substantially contribute to the progression of disaster relief and postdisaster reconstruction. Successful and effective disaster management relies on sufficient nurse responses and training preparedness. Nurses' willingness to participate and achievement motivation in disaster nursing can have an impact on their job satisfaction and alleviate distress for both themselves and patients for the purpose of disaster relief.

The mediating and moderating effects of shared decision making and medical autonomy on improving medical service satisfaction in emergency observation units.

OBJECTIVE: Distinct from other medical settings, the emergency setting is unique and requires flexible and adaptive decision making to provide quality medical services. This study was designed to investigate the mediating and moderating effects of shared decision making (SDM) and patient attitude toward medical autonomy (AMA) on improving medical service satisfaction (MSS) in emergency observation units. METHODS: In this cross-sectional study, we collected data via a verified structured questionnaire. A total of 165 participants met the inclusion criteria, and 100% of the questionnaires recovered were valid. RESULTS: The results show that SDM had a partial mediating effect (p < 0.01) and that it significantly improved MSS. AMA had a moderating effect on some domains (p < 0.01). Meeting patient needs and increasing their participation in decision making can effectively improve MSS. However, excessive patient participation might not be productive, which is an important finding of this study. CONCLUSION: In emergency observation units, SDM-based doctor-patient interactions and cooperation, effective patient-centered communication, and respect for patients' medical autonomy improve the doctor-patient relationship and patients' health literacy. Patients can thus participate in selecting the best treatment plan to achieve expected health outcomes, and ultimately improve MSS.

Effects of multimedia-based fall prevention education on the knowledge, attitudes, or behaviors of patients.

OBJECTIVES: Patient safety is regarded as a critical quality monitoring indicator for medical institutions. The effects of a multimedia-based patient education intervention on knowledge, attitudes, and behaviors regarding fall prevention were observed. METHODS: The study had a quasi-experimental research design and enrolled 140 participants. Seventy participants in the experimental group received multimedia-based patient education and a health education leaflet, while those in the control group received only the health education leaflet. A structured questionnaire was used for data collection at baseline, and a posttest was applied after the intervention. RESULTS: The participants were predominantly treated in the gastroenterology department (45.7%), followed by the pulmonology department (33.6%). A total of 86.4% of patients had not experienced a fall within 3 months. After the intervention, the average scores for all variables in the experimental group were higher than those in the control group. The results indicate that attitudes, knowledge, and behaviors regarding fall prevention among patients in the pulmonology department were higher than those among patients in the gastroenterology department; the differences were statistically significant. CONCLUSION: The individualized health education content was of substantial significance for patients with different disease backgrounds and facilitated changes in their knowledge, attitudes, and behaviors regarding falls. RELEVANCE TO CLINICAL PRACTICE: Multimedia-based patient education influenced inpatients' knowledge, attitudes, and behaviors for preventing falls.

Improved urinary melatonin level as the perspective indicator that leads to better sleeping quality in bladder cancer patients.

BACKGROUND: Individuals with higher-than-average melatonin concentrations are less likely to develop cancer. In cancer patients, psychosomatic coping patterns and treatment side effects are important indicators of cancer prevention and immune system deterioration. This study focused on changes in the urinary melatonin concentration, life resilience, and sleep quality in bladder cancer patients before, and 3 months after, treatment. METHODS: A controlled before-and-after study was performed. The subjects were patients who were previously diagnosed with bladder cancer and had received treatment (transurethral resection of bladder tumor + intravesical chemotherapy). Data from 23 subjects were analyzed. RESULTS: The results showed a significant difference in the melatonin concentration before and after treatment (Wilcoxon signed-rank test, Z = -2.220, p = 0.026). The melatonin concentration in 16 patients (70%) increased after treatment. The mean Pittsburgh Sleep Quality Index (PSQI) score before treatment was 7.348 (SD = 4.030), which was associated with poor sleep quality. The mean PSQI score after treatment was 6.435 (SD = 3.300; Z = -2.071; p = 0.038). These results represent the improved sleep quality in patients post-treatment. CONCLUSIONS: After treatment, the urinary melatonin concentration and sleep quality (PSQI) improved, both of which were statistically significant in bladder cancer patients. Consequently, bladder cancer treatment should be initiated as soon as possible. There was no significant difference in overall life resilience before and after treatment, possibly because elderly individuals have strong personality traits and emotional stability and are not easily affected by life events or stress.

The Health Promoting Mindfulness or Qigong Educational Programs for Beneficial Lifestyle Changes of Cancer Survivors.

This study used heart rate variability (HRV) to monitor levels of cancer-related fatigue (CRF) and quality of life (QOL) of cancer survivors subjected to program measures at different psychosomatic or functional levels. A longitudinal study was conducted at a cancer center in Taiwan. Fifty-two cancer survivals were randomly assigned to either the mindfulness group (n = 25) or the Qigong group (n = 27). Both groups received a 12-week mindfulness and Qigong programs, respectively. Improvements in CRF, QOL, and HRV after a 12-week program and at the 3-month follow-up point. For the long-term effects in both mindfulness and Qigong groups, CRF showed a significant downward trend (p < 0.05), but a significant upward trend was observed in HRV (p < 0.001). Mindfulness and Qigong exhibited different effectiveness in individuals, indicating that the mental and physical aspects of health are equally essential and should be addressed in a complementary combination. These findings are worthy of being shared with cancer survivors to benefit their physical and mental well-being. We suggest that healthcare professionals incorporate mindfulness and Qigong in cancer survivors' daily life as means to encourage lifestyle changes for improving their health.

Influence of work excitement and workplace violence on professional commitment and turnover intention among hospital nurses.

AIM AND OBJECTIVES: This study aimed to determine the influence of work excitement, workplace violence and the violence prevention climate on professional commitment and turnover intention. BACKGROUND: Workplace violence can easily cause the quality of nursing care to decline. Improvements in the working environment and working conditions can improve nurses' professional commitment and satisfaction. DESIGN: A cross-sectional multicentre study with convenience sampling was conducted. We have complied with the guidelines of STROBE Checklist in presenting this research. METHODS: Out of 900 questionnaires, 696 were deemed valid for analysis (77.33%). This study collected data on sociodemographic information, experiences of workplace violence, professional commitment, work excitement, violence prevention climate and turnover intention. RESULTS: The results show that professional commitment has a significant effect on turnover intention. Professional commitment positively influences work excitement, especially when the work is challenging and varied. It also indirectly influences turnover intention by generating work excitement. Workplace violence introduces an interactive moderating effect on the relationship between professional commitment and work excitement. A violence prevention climate changes the interactive moderating effect of workplace violence on professional commitment, which in turn influences turnover intention. CONCLUSIONS: Positive work experience, institutional organisational policies and support systems are the mediating and moderating factors in the relationship between professional commitment and turnover intention. Nurses expect organisations to maintain good staff relations, provide a positive working environment and learning opportunities and strengthen communication channels, all of which affect nurse retention. RELEVANCE TO CLINICAL PRACTICE: Workplace violence is a serious crisis that can lead to turnover intention among hospital nurses. To enhance interpersonal relationships in the workplace and improve nurse retention, hospitals should schedule an adequate amount of staff and provide sufficient equipment and supplies to create a safe and positive work environment.

Promoting Physical and Psychological Rehabilitation Activities and Evaluating Potential Links Among Cancer-Related Fatigue, Fear of Recurrence, Quality of Life, and Physiological Indicators in Cancer Survivors.

OBJECTIVES: Cancer-related fatigue and fear of recurrence (FOR) are the most common symptoms in cancer survivors and severely affect quality of life (QOL). This study aims to promote and evaluate the effectiveness of physical and psychological rehabilitation activities for cancer survivors. METHODS: A longitudinal study with an interventional research design was conducted. A total of 80 participants were randomly assigned to experimental groups E1 (Qigong exercise [QE]) or E2 (stress management [SM]) or the control group. The E1 and E2 groups received QE and SM, respectively, as interventions once a week for 12 weeks, and effects were assessed. Cancer-related fatigue, FOR, QOL, and heart rate variability (HRV) were evaluated at baseline (T0), after 12 weeks (T1), and at the 3-month follow-up (T2). RESULTS: QE and SM effectively strengthened the physical and psychological functions of cancer survivors at the T1 phase. Although differences in FOR and QOL were not statistically significant, the scores were decreased and increased, respectively. Although the effects during the T2 phase were not as significant as those during T1, the score progress was maintained. The effects on HRV were significantly different among the E1, E2, and control groups at T1, which shows that the performance of both experimental groups was better than that of the control group. CONCLUSIONS: Physical and psychological rehabilitation activities should be practiced periodically and should be led by professional staff. Long-term educational resources and care should also be provided. HRV can be used to efficiently monitor the status of the mind-body balance and is a more suitable index than questionnaires for physical and psychological function evaluation in cancer survivors.

Violence-prevention climate in the turnover intention of nurses experiencing workplace violence and work frustration.

AIMS: To determine the moderating effect of a violence-prevention climate and the mediating effect of work frustration on the relationship between workplace violence (WPV) and the turnover intention of nurses. BACKGROUND: To maintain the stability and work quality of nurses, WPV should be studied to provide effective prevention measures. METHODS: A cross-sectional study with a convenience sample was adopted. Participants were nurses from three hospitals in Taiwan. Of 1,531 questionnaires, 973 were valid for analysis (63.6%). RESULTS: A total mediating effect of work frustration on nurses' own experiences of WPV increased turnover intention. Witnessing WPV toward coworkers caused a significant partial mediating effect on work frustration that further increased turnover intention. A violence-prevention climate had a significant moderating effect on the work frustration and turnover intention of nurses after they had witnessed violence against others. CONCLUSION: Effective policies and an incentivized reporting system can foster a safe and friendly work environment not only for nurses who experience violence but also for those who witness violence. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and leaders must create a positive consultative pipeline to ensure a safe climate and environment for both the victims of WPV and the nurses who witness violence against others.

Interaction effect of work excitement and work frustration on the professional commitment of nurses in Taiwan.

BACKGROUND: The current shortage of professional nurses in Taiwan both undermines hospital quality of care and raises hospitals' human resource management costs. Few studies have concurrently investigated the interaction effect between professional commitment and, respectively, the positive and negative work attitudes of nurses. Results of this investigation may help improve strategies designed to raise nurse retention rates. PURPOSE: This study used the interaction effects of work excitement and work frustration to assess their influence on the professional commitment of nurses. METHODS: This study was conducted at one hospital in southern Taiwan and used a cross-sectional design with self-administrated questionnaires. Seven hundred thirty-five nurses completed and submitted valid questionnaires (valid response rate: 68.5%). Exploratory and confirmatory factor analysis confirmed the reliability and validity of the three measurement models of work excitement, work frustration, and professional commitment. Correlation and hierarchical regression analysis verified the direct and interaction effects with the correlations among the three measured variables. RESULTS: Work frustration was higher than work excitement among participants (M = 2.72, SD = 0.71 vs. M = 2.26, SD = 0.62). The mean participant score for professional commitment was 2.72 (SD = 0.45) on a 4-point Likert scale. There was a significant and positive correlation between work excitement and professional commitment and a significant and negative correlation between work frustration and professional commitment. High work frustration had a negative effect on professional commitment, whereas high work excitement had a higher positive effect on professional commitment. The two-way interaction between work excitement and frustration was statistically significant in explaining the effects of professional commitment (p < .01). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Nurses often work in conditions that are highly frustrating. Although work excitement has been shown as having a greater influence on professional commitment when nurses experienced the dual work affects simultaneously, work frustration significantly reduces the professional commitment effect of nurses. This study suggests that managers should not only construct a positive and exciting work environment but also work to mitigate the causes of work frustration to promote professional commitment and retention among nurses.

pH-Dependent spectroscopic and luminescent properties, and metal-ion recognition studies of Re(I) complexes containing 2-(2'-pyridyl)benzimidazole and 2-(2'-pyridyl)benzimidazolate.

A series of Re(I) complexes, [Re(CO)(3)Cl(HPB)] (1), [Re(CO)(3)(PB)H(2)O] (2), [Re(CO)(3)(NO(3))(PB-AuPPh(3))] (3), and [Re(CO)(3)(NO(3))(PB)Au(dppm-H)Au](2) (4) [HPB = 2-(2'-pyridyl)benzimidazole; dppm = 2,2'-bis(diphenylphosphinomethane)], have been synthesized and characterized by X-ray diffraction. Complex 1, which exhibits interesting pH-dependent spectroscopic and luminescent properties, was prepared by reacting Re(CO)(5)Cl with an equimolar amount of 2-(2'-pyridyl)benzimidazole. The imidazole unit in complex 1 can be deprotonated to form the imidazolate unit to give complex 2. Addition of 1 equiv of AuPPh(3)(NO(3)) to complex 2 led to the formation of a heteronuclear complex 3. Addition of a half an equivalent of dppm(Au(NO(3)))(2) to complex 2 yielded 4. In both 3 and 4, the imidazolate unit acts as a multinuclear bridging ligand. Complex 4 is a rare and remarkable example of a Re(2)Au(4) aggregate in combination with µ(3)-bridging 2-(2'-pyridyl)benzimidazolate. Finally, complex 2 has been used to examine the Hg(2+)-recognition event among group 12 metal ions. Its reversibility and selectivity toward Hg(2+) are also examined.

Br2 molecular elimination in 248 nm photolysis of CHBr2Cl by using cavity ring-down absorption spectroscopy.

Elimination of molecular bromine is probed in the B (3)Pi(ou) (+)<--X (1)Sigma(g) (+) transition following photodissociation of CHBr(2)Cl at 248 nm by using cavity ring-down absorption spectroscopy. The quantum yield for the Br(2) elimination reaction is determined to be 0.05+/-0.03. The nascent vibrational population ratio of Br(2)(v=1)Br(2)(v=0) is obtained to be 0.5+/-0.2. A supersonic beam of CHBr(2)Cl is similarly photofragmented and the resulting Br atoms are monitored with a velocity map ion-imaging detection, yielding spatial anisotropy parameters of 1.5 and 1.1 with photolyzing wavelengths of 234 and 267 nm, respectively. The results justify that the excited state promoted by 248 nm should have an A(") symmetry. Nevertheless, when CHBr(2)Cl is prepared in a supersonic molecular beam under a cold temperature, photofragmentation gives no Br(2) detectable in a time-of-flight mass spectrometer. A plausible pathway via internal conversion is proposed with the aid of ab initio potential energy calculations. Temperature dependence measurements lend support to the proposed pathway. The production rates of Br(2) between CHBr(2)Cl and CH(2)Br(2) are also compared to examine the chlorine-substituted effect.

248 nm photolysis of CH2Br2 by using cavity ring-down absorption spectroscopy: Br2 molecular elimination at room temperature.

Following photodissociation of CH2Br2 at 248 nm, Br2 molecular elimination is detected by using a tunable laser beam, as crossed perpendicular to the photolyzing laser beam in a ring-down cell, probing the Br2 fragment in the B 3Piou+ -X 1Sigmag+ transition. The nascent vibrational population is obtained, yielding a population ratio of Br2(v = 1)Br2(v = 0) to be 0.7 +/- 0.2. The quantum yield for the Br2 elimination reaction is determined to be 0.2 +/- 0.1. Nevertheless, when CH2Br2 is prepared in a supersonic molecular beam under cold temperature, photofragmentation gives no Br2 detectable in a time-of-flight mass spectrometer. With the aid of ab initio potential energy calculations, a plausible pathway is proposed. Upon excitation to the 1B1 or 3B1 state, C-Br bond elongation may change the molecular symmetry of Cs and enhance the resultant 1 1,3A'-X 1A' (or 1 1,3B1-X 1A1 as C2v is used) coupling to facilitate the process of internal conversion, followed by asynchronous concerted photodissociation. Temperature dependence measurements lend support to the proposed pathway.