Reliability and Validity of Measures Commonly Utilized to Assess Nurse Well-Being.

BACKGROUND: A healthy nursing workforce is vital to ensuring that patients are provided quality care. Assessing nurses' well-being and related factors requires routine evaluations from health system leaders that leverage brief psychometrically sound measures. To date, measures used to assess nurses' well-being have primarily been psychometrically tested among other clinicians or nurses working in specific clinical practice settings rather than in large, representative, heterogeneous samples of nurses. OBJECTIVES: This study aimed to psychometrically test measures frequently used to evaluate factors linked to nurse well-being in a heterogeneous sample of nurses within a large academic health system. METHODS: This cross-sectional, survey-based study used a convenience sample of nurses working across acute care practice settings. A total of 177 nurses completed the measures that included the Professional Quality of Life (proQOL), the short form of the Professional Quality of Life measure, the Connor Davidson Resiliency 2-Item (CD-RISC-2), the World Health Organization Well-being Index (WHO-5), the Secondary Traumatic Stress Scale (STSS), and the single item Mini-Z. Internal reliability and convergent validity were assessed for each measure. RESULTS: All the measures were found to be reliable. Brief measures used to assess domains of well-being demonstrated validity with longer measures, as evident by significant correlation coefficients. DISCUSSION: This study provides support for the reliability and validity of measures commonly used to assess well-being in a diverse sample of nurses working across acute care settings. Data from routine assessments of the nursing workforce hold the potential to guide the implementation and evaluation of interventions capable of promoting workplace well-being. Assessments should include psychometrically sound, low-burden measures, such as those evaluated in this study.

Design health care systems to protect resilience in nursing.

This panel paper is the fourth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion, and this panel paper is focused on resilience in nursing. It addresses the importance of organizational culture in nursing retention, the role of leadership in reducing nurse turnover, and strategies for how to build resilience systems that counteract or eliminate sources of moral distress. Cost rationales are discussed as part of 'the busienss case' for investing in resilience systems.

An Integrative Review of "The Pause" After Patient Death.

Background: Healthcare providers are engrossed in high-stakes, high-stress situations during their daily work with patient death being a potential negative outcome of work-related stress. Many interventions exist to combat work-related stress among nurses. The Pause, an intervention to offer a moment of silence for the healthcare team after a patient death, is one example. Objective: An integrative review of The Pause was conducted to investigate its use and how it impacts healthcare providers and their work environments. Methods: The integrative review methodology by Whittemore and Knafl was used to guide this study. Steps included were problem identification, literature search, data evaluation, data analysis, and presentation. Content analysis was used to identify themes. Results: Seven databases were searched in 2022 and seven studies were identified for inclusion in this review. Two themes were identified: personal benefits and professional benefits. Findings reveal benefits from self-care and grief processing to a better work environment. Conclusions: The Pause is a low-cost, low-risk intervention that can be implemented at an organizational level to help reduce burnout, unresolved grief, increase resilience, increase retention, and improve patient outcomes. Future research should include an examination of how The Pause may affect patient outcomes and workplace culture.

Burned Out on Burnout-The Urgency of Equity-Minded Structural Approaches to Support Nurses.

This JAMA Forum discusses a health equity framework to address burnout and professional fulfillment among nurses.

An Abundance Mindset Approach to Support Nurse Well-Being: The Feasibility of Peer Support.

This article describes the process of building a system-wide, interprofessional peer support program at the onset of the COVID-19 pandemic. With limited resources, but with a dedicated team driven by the desire to provide psychological first aid, nurse leaders from a large academic medical center developed a peer support program, inclusive of 16 hours of peer supporter training and quarterly continuing education. To date, this program has 130 trained peer supporters who offer peer support, active listening, and close partnerships with the health care system and university employee assistance programs. This case study shares lessons learned and considerations on how leaders can initiate their own local peer support programs.

Changes in Posttraumatic Growth After a Virtual Contemplative Intervention During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to describe the effects of an intervention called "Compassion & Growth Workshops" on reported posttraumatic growth (PTG) using the Posttraumatic Growth Inventory-Expanded (PTGI-X). BACKGROUND: Few studies measure the impact of interventions, such as contemplative practices, on nurse PTG. METHODS: We delivered a series of three 2-hour microretreats to nurses and advanced practice nurses and measured their impact on PTG scores. Using multivariate logistic regression, we identified cofactors predictive of 25% overall improvement on the PTGI-X. RESULTS: Overall PTG increased among participants, with the greatest improvement in relating to others, new possibilities, and personal strength. Posttraumatic growth improved as workshop attendance increased; nurses providing direct patient care also benefitted the most. CONCLUSIONS: Contemplative interventions can substantively improve PTG. This may be particularly relevant for coping with COVID pandemic stress among nurses on the frontlines and for healthcare leaders seeking to strengthen psychological support within their teams and reform the workplace environment.

Burnout Research at a Crossroads.

We have enough evidence that burnout exists-let's investigate solutions.

A white dwarf accreting planetary material determined from X-ray observations.

The atmospheres of a large proportion of white dwarf stars are polluted by heavy elements1 that are expected to sink out of visible layers on short timescales2,3. This has been interpreted as a signature of ongoing accretion of debris from asteroids4, comets5 and giant planets6. This scenario is supported by the detection of debris discs7 and transits of planetary fragments8 around some white dwarfs. However, photospheric metals are only indirect evidence for ongoing accretion, and the inferred accretion rates and parent body compositions heavily depend on models of diffusion and mixing processes within the white dwarf atmosphere9-11. Here we report a 4.4σ detection of X-rays from a polluted white dwarf, G29-38. From the measured X-ray luminosity, we derive an instantaneous accretion rate of [Formula: see text], which is independent of stellar atmosphere models. This rate is higher than estimates from past studies of the photospheric abundances of G29-38, suggesting that convective overshoot may be needed to model the spectra of debris-accreting white dwarfs. We measure a low plasma temperature of kBT = 0.5 ± 0.2 keV, corroborating the predicted bombardment solution for white dwarfs accreting at low accretion rates12,13.

Posttraumatic Growth as a Model to Measure and Guide Implementation of COVID-19 Recovery and Resiliency.

The COVID-19 pandemic has forced leaders to reconsider the various factors that attribute to work-life balance, a healthy work environment, and resilience among nurses. Posttraumatic growth (PTG) provides a lens through which clinicians and leaders can measure, articulate, and espouse resilient recovery through unprecedented times. This article suggests the use of PTG as a framework, measured by the Posttraumatic Growth Inventory to guide leaders as they implement job-specific resiliency interventions for professional nurses. This article also suggests 3 science-based interventions intended to increase PTG. Published data support the efficacy of these interventions: resilience retreats, resilience rounds, and "The Pause," while longitudinal impacts of PTG following these interventions remain currently unknown.

Innovation Amid Pandemic: Construction of a COVID-19 Intensive Care Unit Surge Care Delivery Model.

This article details a shared leadership structure and decision-making processes used to construct an innovative and evidence-based care delivery model for safety and optimal outcomes in the intensive care unit during the novel coronavirus (COVID-19) pandemic. Insights into ways professional development practitioners can facilitate changes in care delivery models, support nurses in their professional roles, and contribute to improved patient care outcomes during the COVID-19 pandemic are provided.

The Effects of the Medical Pause on Physiological Stress Markers among Health Care Providers: A Pilot Randomized Controlled Trial.

Contemplative practices promote well-being, work engagement and resilience among health care providers. We examined the impact of The Pause, a brief contemplative intervention, on health care providers' physiological stress response. Participants were randomly assigned to either The Pause or the control group. They participated in a high-fidelity, stressful medical simulation. Following the simulation, intervention group practiced The Pause. Outcome measures were heart rate variability, heart rate, and blood pressure. We adjusted for baseline physiological variables, sociodemographic variables, self-care practices, and perceived stress. Participants in the intervention group had a standard deviation of the normal-to-normal RR intervals (heart rate variability indicator) that was 13.8 (95% CI 4.0, 23.5; p < .01) points higher than those in the control group. There were no significant effects of The Pause on heart rate or blood pressure. The Pause may reduce stress reactivity, increase heart rate variability, and enhance resilience in health care providers.

Incidence of COVID-19 in patients treated with infliximab compared with patients treated with rituximab.

OBJECTIVE: To determine whether patients with inflammatory autoimmune diseases treated with rituximab (RTX) have more severe forms of COVID-19 compared with patients treated with anticytokine therapies, such as Tumour Necrosis Factor (TNF) inhibitors. METHODS: We included all patients who were on either RTX or infliximab (IFX) in two Swiss cantons during the first wave of the COVID-19 pandemic. We collected self-reported symptoms compatible with COVID-19, PCR-confirmed diagnoses of COVID-19 and the evolution of COVID-19 infections. We computed the raw and propensity score-adjusted incidence of COVID-19 by treatment group. RESULTS: 190 patients were enrolled, of whom 121 (64%) were in the RTX group and 69 (36%) were in the IFX group. Twenty-one patients (11%) reported symptoms compatible with COVID-19 (RTX: 10, IFX: 11, p=0.14). Among patients with COVID-19 symptoms, four developed severe forms of the disease, with life-threatening pulmonary manifestations requiring intensive mechanical ventilation (RTX: 4 of 10, IFX: 0 of 11, Fisher's exact test p=0.04). The incidence rate of COVID-19 symptoms was 0.73 (95% CI 0.39 to 1.37) cases per 1000 patient-days on RTX vs 1.52 (95% CI 0.82 to 2.85) cases per 1000 patient-days on IFX (crude p=0.10, adjusted p=0.07). The incidence rate of severe COVID-19 was 0.28 (95% CI 0.08 to 0.7.2) cases per 1000 patient-days on RTX compared with null on IFX (95% CI 0.0 to 0.44) (p=0.13). A replication in an independent validation cohort confirmed these findings, with consistent results in the Swiss Clinical Quality Management registry. CONCLUSION: While the incidence of symptoms compatible with COVID-19 was overall similar in patients receiving RTX or IFX, the incidence of severe COVID-19 tended to be higher in the RTX group.

Feedback Methods in an Interprofessional Mock Paging Program.

BACKGROUND: Many medical schools offer a culminating internship readiness experience. Curricula focus on particular knowledge and skills critical to internship, such as answering urgent nursing pages. Studies have shown student performance improvement with mock paging education programs, but the role of feedback versus self-regulated practice has not been studied. DESIGN AND METHODS: The interprofessional mock paging program included 156 medical students enrolled in a 4th-year internship readiness course and 44 master's level direct entry nursing students. Medical students were randomized to receive verbal feedback immediately after each of the three phone calls (intervention group) or delayed written feedback (control group) after the third phone call only. Specialty-specific case scenarios were developed and a single checklist for all scenarios was developed using the communication tool ISBAR. Medical students and nursing students had separate training sessions before the pages commenced. The nursing students administered the phone calls and evaluated the medical students by ISBAR checklist. An interrater reliability measure was obtained with physician observation of a selection of phone calls. RESULTS: After adjusting for the case effects (different case scenarios for different specialties), students showed no statistically significant differences on checklist scores for case 1 (first case, F = 1.491, df = 1, p = .224), but did show statistically significant differences on checklist scores for case 3 (final case, F = 12.238, df = 1, p = .001). Strong interrater reliability was found between the faculty physician and observed nursing students (ICC = .89). CONCLUSIONS: Immediate feedback significantly improves student checklist scores with a mock paging program. This finding suggests that coaching with feedback may have advantages above self-regulated learning.

Nurse Leaders Employ Contemplative Practices to Promote Healthcare Professional Well-being and Decrease Anxiety.

OBJECTIVE: The purpose of this study was to test the effectiveness of a daylong resilience retreat on healthcare professionals' anxiety levels, intention to engage in mindfulness practices, and self-efficacy around mindfulness. BACKGROUND: Caregiver burnout is a concern that needs to be addressed at the organizational level so that professionals can reduce their risk of psychological injury while providing high-quality care. The COVID-19 (novel coronavirus) pandemic has exacerbated symptoms of burnout among nurses nationally. METHODS: Ten sessions of daylong resilience retreats were delivered to independent groups of nurses, nurse practitioners, and other healthcare professionals. Preretreat and postretreat assessments were completed using a 19-item survey developed by the research team to assess state anxiety, intention to engage in mindfulness practices, and self-efficacy around mindfulness. RESULTS: One hundred six healthcare professionals completed the resilience retreats. There was a statistically significant decrease in state anxiety scores following the retreat. The majority of the participants reported high intentions to engage in mindfulness practices and felt confident about incorporating mindfulness in their lives. CONCLUSIONS: Brief resilience retreats endorsed by nurse leadership can reduce perceived anxiety and facilitate engagement in contemplative practices, which are associated with a decrease in the risk of burnout.

"The Only Way We'll Be Successful": Organizational Factors That Influence Psychosocial Well-Being and Self-Care Among Advocates Working to Address Gender-Based Violence.

Advocates who work for nonprofit organizations (NPOs) that address gender-based violence (GBV) experience a wide range of psychosocial health and well-being risks due to the emotionally demanding nature of the work they engage in. Most recommendations for advocates' self-care focus on individual-level activities, failing to hold the NPOs accountable for creating workplace cultures and practices that foster psychosocial well-being, self-care, and resilience among the advocates. The aim of this qualitative research was to further our understanding of organizational-level factors that influence psychosocial well-being and self-care practices among advocates who work for GBV-specific NPOs in a metropolitan area in the southeastern United States. We conducted in-depth interviews with 25 GBV-specific advocates. Constructivist grounded theory methods were used in coding and analyzing the data. Sixteen advocates identified as White, followed by five Black, two Hispanic, and two mixed-race/ethnicity. Mean age was 36 years. Most participants had a master's degree (n = 16). Analysis of the data resulted in three major themes: (a) Management and Leadership Style, (b) Interpersonal Relationship Dynamics, and (c) Culture of Self-Care. The ways in which leaders established relationships with other advocates to accomplish organizational goals, how advocates developed a sense of camaraderie with their coworkers, and shared norms around self-care shaped advocates' willingness and ability to engage in individual and collective self-care. Findings of this study highlight the role of GBV-specific NPOs in creating workplace cultures and practices that are conducive to engaging in self-care and developing resilience among the advocates. By fulfilling this responsibility, organizations would enable the advocates to not only survive, but thrive in their work and make even greater strides in the overall mission of GBV prevention.

The Burden of Resilience Should Not Fall Solely on Nurses.

Health care organizations should manage burnout from the top down.

Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study.

OBJECTIVE: The Pause is a short-term, microbreak created by an emergency nurse in 2009. It provides care team members a few seconds of silence to honor a patient who has died while also honoring the efforts of the team. It is used now on four continents as a standard of care. We investigated how it is being used and why. METHODS: We used a modified Delphi methodology with purposive sampling and a descriptive approach. During the three-round Delphi, we created a data display using open, then axial coding to develop a thematic analysis. Member checking and reflexivity exercises were used to build reliability and trustworthiness of findings. RESULTS: We analyzed 21 transcripts. The Pause is reported to be an ongoing practice in at least 23 health systems globally. Key themes such as Benefits, Self-Care, and Support of other Patients were most pertinent in our analysis. CONCLUSION: The Pause is a low-risk, grassroots intervention that can be led by any member of a care team in emergency settings. It offers self-care for the individual and team. It helps emergency providers feel grounded after a death before going to treat another patient. According to our sample, The Pause helps reduce caregiver stress, which may decrease the risk for burnout. Although further research is recommended, we assert that The Pause be used as a standard of care in emergency departments across the United States.

"The Pause": A Delphi Methodology Examining an End-of-Life Practice.

"The Pause" was first practiced by a nurse at a Level 1 trauma center to honor the death of a deceased patient. This practice has spread internationally and is used in emergency departments, intensive care, transplant, and oncology units, in addition to pre-hospital settings. There is a paucity of research published on the effects of The Pause for health care workers. We used a three-staged Delphi methodology to understand the barriers, benefits, and language used in The Pause. Analyses of email communication and interview transcripts suggest that The Pause poses minimal risk and has considerable benefits. Benefits include increased perceived team cohesion, a moment for reflection, and a method by which to honor a deceased patient. The Pause allows nurses to feel more present to meet the needs of the next patient they care for during a shift. Further research is merited.

Core crystallization and pile-up in the cooling sequence of evolving white dwarfs.

White dwarfs are stellar embers depleted of nuclear energy sources that cool over billions of years1. These stars, which are supported by electron degeneracy pressure, reach densities of 107 grams per cubic centimetre in their cores2. It has been predicted that a first-order phase transition occurs during white-dwarf cooling, leading to the crystallization of the non-degenerate carbon and oxygen ions in the core, which releases a considerable amount of latent heat and delays the cooling process by about one billion years3. However, no direct observational evidence of this effect has been reported so far. Here we report the presence of a pile-up in the cooling sequence of evolving white dwarfs within 100 parsecs of the Sun, determined using photometry and parallax data from the Gaia satellite4. Using modelling, we infer that this pile-up arises from the release of latent heat as the cores of the white dwarfs crystallize. In addition to the release of latent heat, we find strong evidence that cooling is further slowed by the liberation of gravitational energy from element sedimentation in the crystallizing cores5-7. Our results describe the energy released by crystallization in strongly coupled Coulomb plasmas8,9, and the measured cooling delays could help to improve the accuracy of methods used to determine the age of stellar populations from white dwarfs10.

Honoring Life After Death: Mapping the Spread of the Pause.

BACKGROUND:: Health care is a high-risk environment for clinicians and patients. The risk of burnout increases with increased patient acuity and workload demands. The Pause is a contemplative intervention that has been deployed to foster honor and self-care. OBJECTIVE:: We aimed to reveal how clinicians and educators use The Pause and how it changes systems of thinking or practice. METHODS:: Using a modified Delphi method, we interviewed 11 participants who had used The Pause or intend on using it. RESULTS:: The Pause is being used in 4 continents and many countries. It is most widely learned about by the bedside in practice settings. Participants believe it is malleable and has a powerful systemic effect in fostering a culture of support and honor. CONCLUSION:: The Pause should continue to be taught in clinical scenarios to foster a broader humanistic ethos in health care.