Personalized pulmonary rehabilitation program for patients with post-acute sequelae of COVID-19: A proof-of-concept retrospective study.

Long-COVID patients present with a decline in physical fitness. The aim of this study is to reveal the impact of pulmonary rehabilitation (PR) on physical fitness, quality of life (QoL), and parameters of quantified thorax CT. Long-COVID patients enrolled in a 3-month PR program were retrospectively studied. PR included endurance and resistance training three times a week. Assessments pre- and post-rehabilitation included quantified chest CT, pulmonary function tests (PFT), six-minute walk test (6MWT), cardiopulmonary exercise test, and questionnaires: Hospital Anxiety and Depression Scale, post-COVID-19 Functional Status scale, Borg score, and EuroQol. Seventeen subjects (5M/12F), mean age 42 ± 13 years, were included. PR improved all questionnaires' results significantly. Only significant difference in PFT parameters was correlation between baseline total lung capacity (TLC) and difference in TLC pre- and post-rehabilitation (p = 0.002). 6MWT increased from 329 to 365 m (p < 0.001), VO2max changed from 21 to 24 mL/kg/min (p = 0.007), peak load increased from 116 to 141 Watt (p < 0.001). Blood volume in small pulmonary vessels of 1.25 to 5 mm2 in cross-sectional area (BV5%) was higher than observed in patients with acute COVID-19 infection. After rehabilitation, BV5% decreased from 65% to 62% (p = 0.020). These changes correlated directly with changes in TLC (p = 0.039). Quantified CT airway volume increased after rehabilitation (p = 0.013). After rehabilitation, TLC tended to normalize due to (re)opening of small airways, with decline in air trapping and recruitment of alveoli. Furthermore, this study revealed that pulmonary rehabilitation can improve QoL and physical fitness in long-COVID patients.

Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards.

OBJECTIVES: This prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards. RESEARCH METHODOLOGY/DESIGN: Data was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded. SETTING: The study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included. MAIN OUTCOME MEASURES: The primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes. RESULTS: In a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion. CONCLUSION: The NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety. IMPLICATIONS FOR CLINICAL PRACTICE: The Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.

Unraveling pathophysiologic mechanisms contributing to symptoms in patients with post-acute sequelae of COVID-19 (PASC): A retrospective study.

Patients with post-acute sequelae of COVID-19 (PASC) present with a decrease in physical fitness. The aim of this paper is to reveal the relations between the remaining symptoms, blood volume distribution, exercise tolerance, static and dynamic lung volumes, and overall functioning. Patients with PASC were retrospectively studied. Pulmonary function tests (PFT), 6-minute walk test (6MWT), and cardiopulmonary exercise test were performed. Chest CT was taken and quantified. Patients were divided into two groups: minor functional limitations (MFL) and severe functional limitations (SFL) based on the completed Post-COVID-19 Functional Status scale (PCFS). Twenty one patients (3 M; 18 FM), mean age 44 (IQR 21) were studied. Eighteen completed the PCFS (8 MFL; 10 SFL). VO2 max was suboptimal in both groups (not significant). 6MWT was significantly higher in MFL-group (p = 0.043). Subjects with SFL, had significant lower TLC (p = 0.029). The MFL-group had more air trapping (p = 0.036). Throughout the sample, air trapping correlated significantly with residual volume (RV) in L (p < 0.001). An increase in air trapping was related to an increase in BV5 (p < 0.001). Mean BV5 was 65% (IQR 5%). BV5% in patients with PASC was higher than in patients with acute COVID-19 infection. This increase in BV5% in patients with PASC is thought to be driven by the air trapping in the lobes. This study reveals that symptoms are more driven by occlusion of the small airways. Patients with more physical complaints have significantly lower TLC. All subjects encounter physical limitations as indicated by suboptimal VO2 max. Treatment should focus on opening or re-opening of small airways by recruiting alveoli.

Predicting patient deterioration by nurse intuition: The development and validation of the nurse intuition patient deterioration scale.

INTRODUCTION: Early warning scores based on vital signs are used in hospitals to estimate patient deterioration and to initiate an adequate and timely response when necessary. These scores show acceptable performance in predicting patient outcomes. However, they tend to generate many false positives leading to an increased workload in clinical practice. Additionally, nurses feel a tension between the application of an early warning score and their own clinical judgement. Nurse intuition is often included as an extra call criterion next to an early warning score. It is therefore important to investigate its predictive value. The aim of this study was to develop and validate a Nurse Intuition Patient Deterioration Scale (NIPDS). METHODS: The NIPDS was developed using the latest evidence after which relevant items were selected by an expert panel. The scale was tested in a prospective observational study in 2 surgical and 2 medical wards in a Belgian hospital. Data were collected from December 1st, 2019 until March 31st, 2020. A NIPDS registration was done at each patient admission and whenever the attending nurse felt worried. The studied outcomes were urgent physician assistance call, resuscitation team call, patient death, and unplanned transfer to intensive/medium care. Psychometric analyses and scale optimisation were carried out using Rasch modelling techniques. Finally, the scale's accuracy and an optimal threshold were determined. RESULTS: The scale item content validity index is 0.88 indicating that the selected items should be included in the instrument according to the expert panel. Item-total score correlation coefficients range between 0.573 (item 9 - pain) and 0.874 (item 6 - behaviour). The Person Separation Index is 0.814 indicating satisfactory discriminatory power. An overall fit of the NIPDS data to the Rasch model was confirmed. Rasch modelling showed that the item 'pain' signalled misfit. Furthermore, the person-item map showed disordered items which were corrected in the final model. The AUROC to predict an event within 24 h after registration was 0.957 (95% CI 0.932-0.982; p < 0.001) indicating excellent model performance. DISCUSSION: The results showed that the NIPDS is a valid and accurate instrument to predict events in surgical and medical patients. It showed better performance compared to an existing score estimating nurse intuition. In practice, the NIPDS could be used by nurses to estimate clinical deterioration in addition to an early warning score. It remains unclear if the combination of NIPDS with an early warning score could reduce workload without losing accuracy and this should be explored in future research. TWEETABLE ABSTRACT: Newly developed nurse intuition scale, which uses clinical cues to estimate deterioration in hospitalised patients, is brief and performs well in predicting physician assistance, resuscitation team calls, patient death and unplanned transfer to intensive or medium care.

CT-derived measurements of pulmonary blood volume in small vessels and the need for supplemental oxygen in COVID-19 patients.

Throughout the COVID-19 pandemic, a portion of those affected have evolved toward acute hypoxic respiratory failure. Initially, this was hypothesized to result from acute lung injury leading to acute respiratory distress syndrome (ARDS). In previous research, a novel quantitative CT post-processing technique was described to quantify the volume of blood contained within pulmonary blood vessels of a given size. We hypothesized that patients with lower BV5 blood flow would have higher supplemental oxygen needs and less favorable arterial blood gas profiles. From the initial data analysis, 111 hospitalized COVID-19 patients were retrospectively selected based on the availability of CT scans of the lungs with a slice thickness of 1.5 mm or less, as well as PCR-confirmed SARS-CoV2 infection. Three-dimensional (3-D) reconstructions of the lungs and pulmonary vasculature were created. Further analysis was performed on 50 patients. Patients were divided into groups based on their need for oxygen at the time of CT scan acquisition. Eighteen out of 50 patients needed >2 L/min supplemental oxygen and this group demonstrated a significantly lower median percentage of total blood flow in the BV5 vessels compared with the 32 patients who needed <2 L/min supplemental oxygen (41.61% vs. 46.89%, P = 0.023). Both groups had significantly less blood as a proportion in BV5 vessels compared with healthy volunteers. These data are consistent with the hypothesis that reduced blood volume within small (BV5) pulmonary vessels is associated with higher needs for supplemental oxygen and more severe gas exchange anomalies in COVID-19 infections.NEW & NOTEWORTHY This research provides, by using new imaging analysis on CT imaging, an insight into the pathophysiology of patients with COVID-19 infection. By visualizing and quantifying the blood in small vessels in the lung, we can link these results to the clinical need for oxygen in patients with COVID-19 infection.

Burnout, stress and Type D personality amongst hospital/emergency physicians.

INTRODUCTION: In previous studies, physicians have been identified as a high-risk group for burnout. Although the work environment has received more attention than specific determinants of personality traits, the latter might contribute to burnout. STUDY OBJECTIVE: We aimed to investigate the association of Type D personality, job and organizational determinants with burnout, stress and work engagement as outcome factors among emergency physicians and hospital physicians working in intensive care and surgery departments. We specifically focused on our group of emergency physicians. METHODS: In this cross-sectional study, self-report questionnaires were distributed via social media using a specific survey link to 531 Belgian hospital physicians working at the Emergency Department, Intensive Care, and Surgery Department between October 21, 2018, and April 11, 2019. The survey instrument included questions about sociodemographic characteristics, job characteristics, organizational factors, job satisfaction, social support by supervisors and colleagues (Leiden Quality of Work Questionnaire for Medical Doctors) and Type D personality (Distress Scale-14) and as outcomes burnout (Oldenburg Burnout Inventory) and work engagement (Utrecht Work Engagement Scale). A multiple regression analysis was used to examine the associations between the determinants and each of the outcomes with emergency physicians as the study population. RESULTS: Eligible data were available for 436 questionnaires and involved 212 emergency physicians, 162 other hospital physicians (Intensive Care and Surgery Department) and 62 residents concerning both groups of physicians. Type D personality ranged from 28.5 to 29.1% in emergency physicians and other hospital physicians. Additionally, even after correcting for job-related and organizational factors, emergency physicians with Type D personality were seven times more likely to have a high risk for burnout. CONCLUSION: As a result, this study offers a new perspective on the associations between burnout, stress and Type D personality. Type D personality might be a personality-related risk factor for burnout among emergency physicians. Therefore, we recommend enhanced prevention measures that take into account this individual factor in the further development of coaching programs. Improving the professional well-being of emergency physicians is necessary, especially in the scope of the recent COVID-19 pandemic, which has put a high demand on acute and emergency care departments.

Sufficient personal protective equipment training can reduce COVID-19 related symptoms in healthcare workers: A prospective cohort study.

BACKGROUND: The association between inadequate personal protective equipment during the COVID-19 pandemic and an increased risk of SARS-CoV-2 infection in frontline healthcare workers has been proven. However, frontline healthcare workers with an adequate supply of personal protective equipment still showed an increased risk of contracting COVID-19. Research on the use of personal protective equipment could provide insight into handling present and future pandemics. OBJECTIVES: This study aims to investigate the impact of the availability, training and correct selection of personal protective equipment on the incidence of SARS-CoV-2 infection or positive suspect cases in healthcare workers during the COVID-19 pandemic in Belgium. DESIGN: This was a prospective cohort study involving Belgian healthcare workers: nurses, nursing aides, and midwives working in hospitals, home care services, and residential care services. METHODS: Respondents were invited from May to July 2020 (period 1) followed by a second time in October 2020 (period 2) to complete a digital survey on personal protective equipment availability, training, personal protective equipment selection, screening ability, COVID-19 testing and status, and symptoms corresponding with the COVID-19 suspect case definition. The main outcome was a composite of COVID-19 status change (from negative to positive) during the study or a positive suspect case definition in period 2. RESULTS: Full data were available for 617 participants. The majority of respondents were nurses (93%) employed in a hospital (83%). In total, 379 respondents provided frontline care for COVID-19 patients (61%) and were questioned on personal protective equipment availability and personal protective equipment selection. Nurses were more likely to select the correct personal protective equipment compared with nursing aides and midwives. Respondents working in residential care settings were least likely to choose personal protective equipment correctly. Of all healthcare workers, 10% tested positive for COVID-19 during the course of the study and a composite outcome was reached in 54% of all respondents. Working experience and sufficient personal protective equipment training showed an inverse relation with the composite outcome. The relationship between personal protective equipment availability and the composite outcome was fully mediated by personal protective equipment training (-0.105 [95% confidence interval -0.211 - -0.020]). CONCLUSIONS: Proper training in personal protective equipment usage is critical to reduce the risk of COVID infection in healthcare workers. During a pandemic, rapid dissemination of video guidelines could improve personal protective equipment knowledge in practitioners. Tweetable abstract: Proper training in personal protective equipment usage is critical to reduce the risk of COVID infection in healthcare workers.

Role of resilience in healthcare workers' distress and somatization during the COVID-19 pandemic: A cross-sectional study across Flanders, Belgium.

AIM: To evaluate the impact and the possible role of psychological resilience in the COVID-19 pandemic outbreak on healthcare workers' mental and physical well-being in Belgium. DESIGN: This cross-sectional, survey-based study enrolled 1376 healthcare workers across Belgium from 17 April 2020 to 24 April 2020. METHODS: The study sample consisted of direct care workers (nurses and doctors), supporting staff and management staff members. The main outcomes are resilience, distress and somatization. RESULTS: Higher educational level was associated with lower symptoms of distress and somatization. Physicians exhibited the lowest risk of experiencing heightened levels of distress and somatization. Controlling for confounding factors, higher levels of resilience were associated with a 12% reduced chance of increased distress levels and 5% lower chance of increased somatization levels. Our results suggest the potentially buffering role of mental resilience on those working on the frontline during the COVID-19 pandemic outbreak.

Validation of the AUDIT and AUDIT-C for Hazardous Drinking in Community-Dwelling Older Adults.

BACKGROUND: One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. METHOD: A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. RESULTS: Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. CONCLUSION: The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender.

The Role of Coping Behavior in Healthcare Workers' Distress and Somatization During the COVID-19 Pandemic.

Background: Constantly searching for a balance between work demands and their own physical and psychological health has challenged medical and nursing staff during the immediate wake of this COVID-19 viral epidemic leading to acute stress reactions and psychosomatic symptoms. Coping behavior might be a buffer for work-related stress in relation to mental well-being. The present study aims to evaluate the role of positive and negative stress-reducing activities on healthcare workers' mental and physical well-being. Methods: This was a cross-sectional study using an online survey that was sent out using our network of healthcare workers at the University of Antwerp and through social media. Socio-demographic data, coping behavior with the Palliative Pallet Scale (P3), and distress and somatization using the Four-dimensional symptom checklist were collected. Surveys were completed by 1,376 participants. Results: The results clearly showed that positive stress-reducing activities are related to fewer symptoms of distress and somatization. Providing direct care to COVID-19 patients was associated with a higher decrease of applying positive stress-reducing activities during the peak of the pandemic compared to the ideal situation. Finally, fewer symptoms of distress and somatization were associated with the following activities: reading, mind sports games, keeping a hobby collection, studying; engaging in sexual activities with your partner; cleaning the house, tidying up, working in the garden, doing household chores; exercising alone; walking, or taking a trip together with someone; exercise together with someone; watching TV, listening/playing (to) music/, playing computer games; playing a card game or other board game; and preparing something extra tasteful outside regular meals. Conclusion: Our study demonstrated an association between concrete coping behaviors and distress and somatization in healthcare workers during the first peak of the COVID-19 pandemic. The results provide relevant and additional insights to develop and investigate interventions among others in personal leadership and resilience.

Work stress-related problems in physicians in the time of COVID-19.

OBJECTIVES: Healthcare workers in the emergency department are exposed to a wide range of physical and psycho-social risks or hazards in the workplace. The aim of this study was to investigate the impact of exposure to, the occurrence and perceived risks of, and the worry about, occupational hazards among emergency and hospital physicians in the time of COVID. MATERIAL AND METHODS: Based on the review of occupational hazards in emergency physicians, a questionnaire already used and validated in another study, conducted in 2016, was constructed. The questionnaire consisted of both socio-demographic questions and questions regarding the exposure to, the occurrence and perceived risks of, and the worry about, the following occupational hazards: infectious diseases, COVID-19, physical hazards, violence at work, and stressful situations at work that can cause burnout. A total of 497 questionnaires were distributed to Belgian emergency and hospital physicians in April 20-May 26, 2020. RESULTS: Overall, 319 responses (out of 497 questionnaires) were collected, of which 196 were eligible for statistical analysis. Of the respondents, 32% stated to be confronted with violence and 54% to suffer from health problems related to their work. The exposure to, and the occurrence and perceived risks of, occupational hazards and, more specifically, the exposure to COVID-19 (88%) and its occurrence (10%), and also the worry about these hazards, appear to be high in physicians working in the emergency department. The worry about each of these outcomes is predicted by the supposed exposure, occurrence, and perceived risks. CONCLUSIONS: The exposure to, and the occurrence and perceived risks of, physical hazards, violence and burnout are generally high in physicians in the time of COVID-19. Emergency and hospital physicians in Belgium worry the most about the impact of violence, burnout and COVID-19. Int J Occup Med Environ Health. 2021;34(3):373-83.

Vulnerability and Stressors for Burnout Within a Population of Hospital Nurses: A Qualitative Descriptive Study.

BACKGROUND: The multitude of negative consequences of nurse burnout calls for interventions to protect the well-being of the individual nurses, patients, and hospital organizations. However, much is still to be discovered about the development of this complex psychological syndrome. PURPOSE: This study aimed to describe the development of nurse burnout for a population of Flemish hospital nurses while considering vulnerability and situational stressors as indicated by the vulnerability-stress model. METHODS: Ten registered nurses were enlisted for semistructured interviews through purposive sampling. All selected nurses were currently suffering from burnout, showed a burnout risk, or had gone through a burnout in the past. A descriptive thematic analysis was performed with themes inductively emerging from the data. RESULTS: Four main themes emerged: "being passionate about doing well or being good," "teamwork," "manager," and "work and personal circumstances." More specifically, it was the discrepancy between the first individual vulnerability factor and the three situational stressors that led to feelings of stress and burnout. CONCLUSIONS: The essence of the development of nurse burnout was found in the discrepancy between individual vulnerability and situational stressors. Therefore, we recommend burnout prevention to target both factors.

The Role of Psychological Distress in the Relationship between Drinking Motives and Hazardous Drinking in Older Adults.

INTRODUCTION: Drinking motives seem to be the most proximal predictors of alcohol outcomes. Consequently, these are an essential factor to consider as they may influence the extent to which alcohol is used in a risky way, even in older adults. OBJECTIVE: We studied the moderating effect of distress on the relationship between drinking motives and drinking behaviour in a community-dwelling older adult sample. METHOD: In a retrospective cross-sectional research study, participants were community-dwelling older adults aged 65 years and older. All respondents completed a questionnaire covering the Drinking Motives Questionnaire (DMQ), the Alcohol Use Disorders Identification Test (AUDIT), and the General Severity Index (GSI) of the Brief Symptom Inventory (BSI). RESULTS: In this sample of 1,148 older adults, drinking motives and hazardous alcohol use were associated (enhancement motives r = 0.478, p < 0.001; coping motives r = 0.367, p < 0.001; and social motives r = 0.235, p < 0.001). Furthermore, moderation analysis showed that older adults drinking predominantly for enhancement or coping motives (respectively, ß = 0.433, CI [95%] = 2.557-3.222 and ß = 0.327, CI [95%] = 1.077-1.491, p < 0.001), and older adults who had higher levels of psychological distress (ß = 2.518, CI [95%] = 2.017-3.019, p < 0.001) were more likely to report higher degree of hazardous alcohol use. CONCLUSION: The relations between coping drinking motives and enhancement drinking motives on hazardous drinking depended on the level of distress. The associations between drinking for coping and drinking for enhancement were stronger in high levels of distress. Although causality cannot be interpreted from cross-sectional data, tackling psychological distress and drinking to cope with negative affect or to enhance positive affect might have strong effects on reducing hazardous drinking behaviour among older adults.

Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey.

BACKGROUND: The ability to cope with challenges and stress in life is generally understood as resilience. Pregnancy and parenthood are challenging times. The concept of resilience is receiving increasing interest from researchers, clinicians, and policy staff because of its potential impact on health, well-being, and quality of life. Nevertheless, the concept is less studied during the perinatal period. OBJECTIVES: The aim of this study is to understand the concept of perinatal resilience, including the underlying processes and more specifically for the first 1,000 days of life. METHODS: A concept analysis according to the Walker and Avant (2011) framework was used, to investigate the basic elements of the concept. Concurrently, a two-round Delphi survey involving researchers, clinicians, epidemiologists, mothers, and fathers (N = 21), was conducted to prioritize the terms associated with perinatal resilience. Data collection took place between January and April 2019. RESULTS: Through concept analysis and Delphi survey, five defining attributes for perinatal resilience were identified: social support, self-efficacy, self-esteem, sense of mastery and personality. The additional terms, rated important by the Delphi survey, were linked to the consequences of being resilient during the perinatal period for the individual and his/her family. Specifically, highlighted were the experiences of families in personal growth and achieving family balance, adaptation, or acceptance. CONCLUSION: Based on the results of the concept analysis and Delphi survey, we describe perinatal resilience for the first 1,000 days as a circular process towards a greater well-being in the form of personal growth, family balance, adaptation or acceptance, when faced with stressors, challenges or adversity during the perinatal period. The presence of resiliency attributes such as social support, sense of mastery, self-efficacy, and self-esteem enhance the capacity to be resilient and probably prevent mental health problems.

Determinants of emergency physician wellness in Belgium.

OBJECTIVES: This cross-sectional study examines first whether emergency physicians differ from a comparison group of surgeons, more specifically general surgeons and orthopedic surgeons, in terms of job and organizational characteristics and second to what extent these characteristics are determinants of professional well-being outcomes in emergency physicians. METHODS: Belgian emergency physicians (n = 346) were invited to participate in this study. Forty-three percent of the eligible participants completed a questionnaire. The survey instrument contained 48 questions on determinants (personal characteristics, job conditions [Job Demand Control Support], organizational and environmental work conditions) as well as 39 questions on outcomes (job satisfaction, turnover intention, subjective fatigue, psychological distress, work-home interference, work engagement) by means of the Leiden Quality of Work Questionnaire for Medical Doctors, the Checklist Individual Strength, the Brief Symptom Inventory, and the Utrecht Work Engagement Scale. Hierarchical multiple regression analyses were used to examine the association between the determinants and each of the outcomes. RESULTS: Emergency physicians reported higher job demands, lower job control, and less adequate work conditions compared with the group of surgeons. High job demands increased turnover intention, subjective fatigue, psychological distress, work-home interference in emergency physicians, but lack of job control, lack of social support from the supervisor, and inadequate communication also contributed in an unfavorable way to some of these outcomes. CONCLUSION: Emergency medicine departments must reduce the constant exposure to high job demands by allowing emergency physicians to have enough time for both physical and mental recovery. Work motivation and work conditions might be improved by increasing job control over job demands by giving emergency physicians more decision latitude and autonomy, improving good communication and teamwork and adequate social support from the supervisor and providing good material resources. These interventions can improve professional well-being outcomes in emergency physicians.

Leadership in Nursing Excellence: The Magnet Recognition® Journey Experiences in Europe.

Improving work conditions and the provision of high-quality care and patient safety is an issue in European hospitals. Inspired by a US program for nursing excellence, Magnet Recognition, a Belgian hospital shared their experiences by organizing a summer school in 2019 with nurses of 21 hospitals from 9 countries. This article explains the hospital's research program, the link between the journey and the content of the summer school, lessons learned, and the extent to which participants of European hospitals were interested in nursing excellence and Magnet designation.

Exploring the influence of core-self evaluations, situational factors, and coping on nurse burnout: A cross-sectional survey study.

Stress has become an inherent aspect of the nursing profession. Chronically experienced work stress can lead to burnout. Although situational stressors show a significant influence on burnout, their power to predict the complete syndrome is rather limited. After all, stressors only exist "in the eye of the beholder". This study aimed to explore how individual vulnerability factors such as core-self evaluations and coping, contribute to burnout in relation to situational stressors within a population of hospital nurses. Cross-sectional data was collected in 2014, using five validated self-report instruments: Dutch Core Self Evaluations Scale, Nursing Work Index Revised, Utrecht Coping List, Ruminative Response Scale, and Utrecht Burnout Scale. 219 of the 250 questionnaires were returned. Core-self evaluations, situational factors and coping each contributed significantly to the predictive capacity of the models of the separate burnout dimensions. Core-self evaluations was significantly related to emotional exhaustion. It was suggested that Core-self evaluations might be placed at the initiation of the loss cycle. However, further research is warranted.

The influence of socio-demographic factors, resilience and stress reducing activities on academic outcomes of undergraduate nursing students: A cross-sectional research study.

BACKGROUND: Nursing students who stop their education before obtaining their degree (dropout) is a common problem. Scientific studies on factors influencing academic outcomes amongst nursing students are sparse and difficult to transfer to undergraduate nursing students. OBJECTIVES: The objective of the present study was to explore in undergraduate nursing students the influence of socio-demographic factors, resilience and stress reducing activities on the academic outcomes: intention to leave, academic success and dropout. DESIGN: A cross-sectional design was used. PARTICIPANTS/SETTING: 554 participants form 6 nursing colleges in the Antwerp region in Belgium were included. METHODS: Data were collected using SurveyMonkey®. In a second phase, these data were linked to the academic outcomes from the school administration. RESULTS: Lower resilience, more destructive and less positive stress reducing activities, having committed a suicide attempt in the past, studying in a densely populated area and starting as a regular student was significantly influenced with higher intentions to leave. Higher resilience significantly predicted academic success. Finally, students that dropped out showed a significantly lower resilience. CONCLUSION: Resilience was the only factor that significantly predicted the three academic outcomes: intention to leave, academic success and dropout. Known predictors of academic outcomes such as young age, gender, previous education, nationality and caring for family members were not confirmed in this study. To study in depth dropout within the undergraduate nursing course, conducting a cohort study might be recommended.

Staff empowerment and engagement in a magnet® recognized and joint commission international accredited academic centre in Belgium: a cross-sectional survey.

BACKGROUND: A substantial number of studies linked aspects of a balanced, healthy and supportive nurse practice environment with quality and patient safety. To what extent balanced work characteristics such as social capital, decision latitude and workload are relevant for all staff engaged in patient care including healthcare and medical staff in a Magnet Recognized and Joint Commission International accredited academic centre is unclear. The study aim is to investigate associations between work characteristics such as social capital, decision latitude and workload, work engagement and feelings of burnout as explanatory variables and job satisfaction, turnover intentions and perceived quality of care as dependent variables in a study population of nursing, healthcare and medical staff taken in account generation differences. METHODS: Hierarchical regression analysis estimated strength of associations with demographic characteristics (block-1), professional category (block-2), work characteristics (block-3) and work engagement or burnout dimensions (block-4) as explanatory variables of job satisfaction and turnover intention and quality of care as outcome variables. RESULTS: The study confirmed and extended previous study findings demonstrating positive impact on staff' job outcomes and assessed quality of care by balanced work characteristics such as social capital, decision latitude and workload in nursing staff (N = 864), healthcare staff (N = 131) and medical staff (N = 241). Generational characteristics and professional category were associated with turnover intentions and less favorable assessed quality of care, respectively. Explained variances of studied models ranged from 14.4 to 45.7%. CONCLUSION: Engaging and committing staff to promote excellent patient outcomes in daily interdisciplinary practice works through clear frameworks, methods and resources supported by governance and policy structure that makes outcomes visible and accountable.

Vulnerability to burnout within the nursing workforce-The role of personality and interpersonal behaviour.

AIMS AND OBJECTIVES: To study the combination of personality and interpersonal behaviour of staff nurses in general hospitals in relation to burnout and its separate dimensions. BACKGROUND: More research on the individual factors contributing to the development of burnout is needed to improve the risk profile of nursing staff. Therefore, a combination of Leary's interpersonal circumplex model, which depicts the interpersonal behaviour trait domain, and the five-factor model was considered in the study at hand. DESIGN: A cross-sectional research method was applied using self-report questionnaires. METHODS: A total of 880 Belgian general hospital nurses were invited to participate in the study. Data were collected from November 2012-July 2013. The questionnaire consisted of three validated self-report instruments: the NEO five-factor inventory, the Dutch Interpersonal Behaviour Scale and the Maslach Burnout Inventory. RESULTS: Of the 880 nurses invited to participate, 587 (67%) returned the questionnaire. Sex, neuroticism, submissive-friendly behaviour, dominant-friendly behaviour and vector length were found to be predictive factors for emotional exhaustion. For depersonalisation, sex, neuroticism, conscientiousness, friendly behaviour, submissive-friendly behaviour, dominant-hostile behaviour and vector length were predictive factors. Finally, personal accomplishment was determined by neuroticism, openness, conscientiousness, and hostile behaviour. CONCLUSIONS: This study confirmed the influence of the Big Five personality factors on the separate dimensions of burnout. Interpersonal behaviour made a significant contribution to the predictive capacity of the regression models of all three dimensions of burnout. Additional longitudinal research is required to confirm the causal relationship between these individual factors and burnout. RELEVANCE TO CLINICAL PRACTICE: The results of this study can help to achieve a better understanding of which vulnerabilities an individual prevention programme for burnout should target. In addition, hospitals could use assessment instruments to identify nurses who are prone to burnout and thus would benefit from additional support or stress reduction programmes.