Relationships between leadership, structural empowerment, and engagement in nurses.

AIM: The aim of this study was to analyse the relationships among structural empowerment, the leadership style of managers, and the engagement of nurses in a health organization of Spain. BACKGROUND: Transformational leadership has an impact on patient security and satisfaction as well as the well-being and engagement of healthcare workers. Empowerment is a management practice that is fundamental for professional growth and positively affects the quality of patient care. DESIGN: A cross-sectional study. METHODS: Randomized sample of 131 nurses recruited from 11 health centres with different levels of care was surveyed to assess managers' leadership style, nurse empowerment, and work engagement. The data were analysed by descriptive and correlational statistics and hierarchical mediated regression. RESULTS: The transformational leadership of the nurse manager directly and positively influences the structural empowerment of nurses. The structural empowerment of nurses directly and positively influences engagement. The transformational leadership of managers positively influences nurse engagement through the mediating effect of structural empowerment. CONCLUSION: The structural empowerment of nurses acts as a mediator between the transformational leadership of nurse managers and nurse engagement. PRACTICAL IMPLICATION: The transformational leadership of nurse managers at the unit level has a double impact on staff nurses: first, increasing empowerment and second, increasing the engagement of the nurse staff.

Flow in Nurses: A Study of Its Relationship With Health and Burnout in a Hospital Work Context.

How does the experience of flow among nurses influences their health? This question is addressed on the basis of a model of flow, stress, burnout, and coping. The results indicate that promoting flow can be a way to enhance the health of ward nurses in a hospital work context.

Relationship between job demand and burnout in nurses: does it depend on work engagement?

AIM: The present study aimed to deepen the understanding of the relationships among job demands, control, social support, burnout and engagement in nurses. BACKGROUND: Burnout is a prevalent phenomenon among nurses because of the interaction between high demands and low resources, according to the job demands-resources model. METHODS: A descriptive, correlational design was used in a stratified random sample of 100 nurses recruited from two Spanish hospitals. Job demand, social support, control, engagement, and burnout were measured. Data were analysed by hierarchical regression analysis. RESULTS: Social support is a significant predictor of nurses' engagement and demands is a predictor of nurses' burnout. Work engagement moderates the relationship between job demands and burnout. CONCLUSIONS: The process that leads to burnout and the process that leads to engagement are not isolated processes; engagement acts as a moderator of burnout. IMPLICATIONS FOR NURSING MANAGEMENT: The prevailing paradigm in combating burnout in nursing can be changed and could be based on the enhancement of nurses' strengths through increasing engagement.

Work engagement in nursing: an integrative review of the literature.

AIM: To critically review empirical research about work engagement in nursing and to synthesise the findings to better understand this construct. BACKGROUND: Empirical research shows that engagement is positively related to work performance, workers' health and client loyalty in different professions. It is, therefore, necessary to increase our understanding about engagement in nursing. EVALUATION: An integrative literature search was conducted to identify articles and studies on work engagement in nursing that were published between January 1990 and December 2013 in the following databases: PsycINFO, MEDLINE and CINAHL. KEY ISSUES: The factors that influence engagement were divided into four areas of analysis: organisational antecedents; individual antecedents; and factors related to managers' leadership and outcomes of engagement. CONCLUSION: There is clear evidence that the quality of care by nurses improves through engagement. However, this depends on contextual factors such as structural empowerment and social support and on dispositional factors such as efficacy and optimism. It is also evident that nurse managers are key to promoting engagement. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and leaders may promote improvements in leadership behaviours and a context of optimism and self-efficacy as a way of increasing work engagement.

Discovery of novel quaternary ammonium derivatives of (3R)-quinuclidinyl amides as potent and long acting muscarinic antagonists.

Novel quaternary ammonium derivatives of (3R)-quinuclidinyl amides have been identified as potent M3 muscarinic antagonists with a long duration of action in an in vivo model of bronchoconstriction. The synthesis, structure-activity relationships and biological evaluation of this series of compounds are reported.

Structure-activity relationships (SAR) and structure-kinetic relationships (SKR) of pyrrolopiperidinone acetic acids as CRTh2 antagonists.

Pyrrolopiperidinone acetic acids (PPAs) were identified as highly potent CRTh2 receptor antagonists. In addition, many of these compounds displayed slow-dissociation kinetics from the receptor. Structure-kinetic relationship (SKR) studies allowed optimisation of the kinetics to give potent analogues with long receptor residence half-lives of up to 23 h. Low permeability was a general feature of this series, however oral bioavailability could be achieved through the use of ester prodrugs.

Structure-activity relationships (SAR) and structure-kinetic relationships (SKR) of bicyclic heteroaromatic acetic acids as potent CRTh2 antagonists I.

A knowledge-based design strategy led to the discovery of several new series of potent and orally bioavailable CRTh2 antagonists where a bicyclic heteroaromatic ring serves as the central core. Structure-kinetic relationships (SKR) opened up the possibility of long receptor residence times.

Structure-activity relationships (SAR) and structure-kinetic relationships (SKR) of bicyclic heteroaromatic acetic acids as potent CRTh2 antagonists III: the role of a hydrogen-bond acceptor in long receptor residence times.

The correct positioning and orientation of an hydrogen bond acceptor (HBA) in the tail portion of the biaryl series of CRTh2 antagonists is a requirement for long receptor residence time. The HBA in combination with a small steric substituent in the core section (R(core) ≠ H) gives access to compounds with dissociation half-lives of ⩾ 24h.

Mindfulness-based interventions for improving mental health of frontline healthcare professionals during the COVID-19 pandemic: a systematic review.

BACKGROUND: Mindfulness-based interventions (MBIs) appear to be effective for improving the mental health of healthcare professionals (HCPs). However, the effectiveness of MBIs on extreme psychological trauma caused by the coronavirus disease 2019 (COVID-19) pandemic is largely unknown. The aim of this paper was to systematically review empirical studies of MBIs for HCPs carried out during the COVID-19 pandemic, to evaluate them and their effectiveness in different areas of mental health. METHODS: The electronic databases searched were Web of Science, Scopus, PubMed, and PsycINFO. The date when each database was last searched was September 15, 2023. Randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and non-randomized non-controlled trials (NRNCTs) focused on MBIs for health care staff who were working in healthcare centers during the COVID-19 pandemic were included. All of them employed standardized measures of mental health. The review followed the best practices and reported using PRISMA guidelines. A data collection form, adapted from the Cochrane handbook for systematic reviews of interventions, was used to extract and synthesize the results. The methods used to assess the risk of bias in the included studies were the Cochrane Risk of Bias Tool and the ROBINS-I Tool. RESULTS: Twenty-eight studies were included in the systematic review. Overall, the methodological quality of the studies was moderate. The results showed the effectiveness of MBIs in improving levels of stress, mindfulness, and mental well-being. However, no conclusive results were found regarding the effectiveness of MBIs in improving the levels of burnout, anxiety, depression, sleep quality, and resilience of HCPs. CONCLUSIONS: The MBIs for HCPs carried out during the COVID-19 pandemic have mainly contributed to improving stress, mindfulness, and mental well-being at a time of serious health emergency. However, more robust studies at a methodological level would have been desirable. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021267621.

2-(1H-Pyrazol-4-yl)acetic acids as CRTh2 antagonists.

High throughput screening identified the pyrazole-4-acetic acid substructure as CRTh2 receptor antagonists. Optimisation of the compounds uncovered a tight SAR but also identified some low nanomolar inhibitors.

Leadership to improve nurse engagement and empowerment: evidences to improve the training of nurses.

AIM: The objective of this study was to identify the key dimensions of transformational leadership that influence the promotion of engagement and structural empowerment in a population of nurses from different care settings. METHOD: A cross-sectional survey study asking about engagement, leadership style and structural empowerment was used. Descriptive and correlational statistics were applied followed by hierarchical regression. 131 nurses were recruited from a Spanish health organisation using random sampling. RESULTS: Individualised consideration and intellectual stimulation were predictors of structural empowerment in a hierarchical regression of transformational leadership dimensions controlled by demographic variables (R2=0.467). In addition, intellectual stimulation was a predictor of engagement (R2=0.176). CONCLUSION: The results are the starting point for the design of an organisationwide educational intervention to increase the engagement of nurses and staff development.

Psychological stress is associated with high levels of IL-6 in HIV-1 infected individuals on effective combined antiretroviral treatment.

This study explores the role of psychological stress in the circulating levels of interleukin-6 (IL-6) in a group of HIV-1 infected individuals on effective cART. We developed a cross-sectional study with 50 individuals with confirmed diagnosis of HIV-1 infection ≥1 and ≤8 years, on continuous cART for >1 and <8 years and with plasma viral load <50 copies/mL for at least 1 year. Clinical, behavioral and psychological variables were collected to control their possible indirect contribution in the relationship between psychological stress and IL-6. Pearson correlation and univariate/multivariate logistic regressions were performed. Eighty-eight percent of the subjects were male: median (IQR) age: 39.0 (32.7-42.2), years since HIV-1 infection: 3.4 (2.1-7.0), years on cART: 2.5 (1.6-5.7), CD4 cell count: 709.0 (573.5-881.0) cell/mm(3), plasma levels of IL-6: 7.0 (0-12.2) pg/ml. A strong correlation between IL-6 and psychological stress was found (r=.81). Psychological stress (coef: 0.49; SD: 0.05), anxiety/depression (0.37; 0.08) and unhealthy diet (2.94; 1.38) were associated with higher levels of IL-6. In the multivariate model psychological stress remained strongly associated with IL-6 (R(2): 59%). In conclusion, individuals with psychological stress presented high levels of IL-6 and psychological stress was the only variable which remained strongly associated with IL-6. This strong relationship suggests evidence for a mechanism through which psychological stress might contribute to the health's impairment of HIV-infected individuals on effective cART.

Discovery of novel quaternary ammonium derivatives of (3R)-quinuclidinyl carbamates as potent and long acting muscarinic antagonists.

Novel quaternary ammonium derivatives of N,N-disubstituted (3R)-quinuclidinyl carbamates have been identified as potent M(3) muscarinic antagonists with long duration of action in an in vivo model of bronchoconstriction. These compounds have also presented a high level of metabolic transformation (human liver microsomes). The synthesis, structure-activity relationships and biological evaluation of these compounds are reported.

How the Lagged and Accumulated Effects of Stress, Coping, and Tasks Affect Mood and Fatigue during Nurses' Shifts.

Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses' mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.

When and how do hospital nurses cope with daily stressors? A multilevel study.

BACKGROUND: During their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses. OBJECTIVES: To identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses. DESIGN: This study uses descriptive, correlational, two-level design with repeated measures. SETTINGS: Wards of two University hospitals. PARTICIPANTS: A random cohort of 113 nurses was studied. METHODS: An ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships. RESULTS: Different momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task. CONCLUSIONS: The choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

Perceived control and psychological distress in women with breast cancer: a longitudinal study.

The relationship between perceived control and psychological distress in cancer patients has been widely studied, but longitudinal designs are scarce. The aim of this study was to examine whether perceived control could predict changes in the evolution of psychological distress in breast cancer patients at stages I or II. One hundred and one women were assessed on five occasions: one week after surgery, and again 1, 3, 6 and 12 months later, using the Mental Adjustment to Cancer (MAC) Scale, a Self-Efficacy Scale, the Personal Competence Scale, the Hospital Anxiety and Depression Scale (HADS), the Profile of Mood Sates (POMS), and the EORTC questionnaire of quality of life. Latent growth curve (LGC) model analysis was used to test the relationship between perceived control and psychological distress in a longitudinal, 1-year study. The results showed that perceived control increases linearly and that distress also decreases linearly. Moreover, the evolution of distress can be predicted from the initial value and the rate of change of perceived control. This close relationship between perceived control and psychological distress was found to be independent of the evolution of the physical state. These findings suggest that perceived control could be used as an early predictor of psychological adjustment to illness.

[Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)]. / Salud del cuidador: adaptación y validación del cuestionario Experience of Caregiving Inventory (ECI) en población española.

OBJECTIVE: To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity. METHOD: Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied. RESULTS: The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale. CONCLUSIONS: The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context.

How primary and secondary appraisals of daily stressful eventsinfluence negative and positive affect / ¿Cómo la evaluación primaria y secundaria de los eventos estresantes cotidianos influyen en el afecto negativo y positivo?

The aim of this study was to evaluate the influence of primary and secondary appraisal, and of coping strategies, on daily stress, taking in-to account any possible effect of the big five personality traits. Over 10 days, a cohort of 122 people filled out an on-line diary in which they rec-orded the most important stressful event each day, their primary and sec-ondary appraisal of this, and how they coped with it. The results indicate that negative affect is influenced by a high degree of primary appraisal, lim-ited secondary appraisal and a high rate of refusal, with no significant in-fluence of personality traits. Positive affect ismainly influenced by a lower extent of primary appraisal, more secondary appraisal, and by a low rate of refusal and of social support seeking. Moreover, a low level of neuroticism was a predictor of greater positive affect. These data are discussed, high-lighting the importance of a situational assessment of stressful episodes at each moment to not only understand the effects of stress on health but al-so, to develop effective interventions.(AU)

El objetivo de este estudio fue evaluar la influencia de la evaluación primaria, secundaria y de las estrategias de afrontamiento sobre el estrés diario, teniendo en cuenta cualquier posible efecto de los cinco grandes rasgos de personalidad. Durante 10 días, una cohorte de 122 personas llenó un diario en línea en el que registraron el evento estresante más importante de cada día, su evaluación primaria y secundaria y cómo lo afrontaron. Los resultados indican que el afecto negativo está influido por una evaluación primaria alta, una evaluación secundaria limitada y una alta tasa de rechazo, sin influencia significativa de los rasgos de personalidad. El afecto positivo está influido principalmente por un menor grado de valoración primaria, una evaluación secundaria alta, por una baja tasa de rechazo y de búsqueda de apoyo social. Además, un nivel bajo de neuroticismo fue el mejor predictor del afecto positivo. Se discuten estos datos, destacando la importancia de una evaluación situacional de episodios estresantes en cada momento para no sólo comprender los efectos del estrés en la salud sino también, para desarrollar intervenciones efectivas.(AU)

Engagement of nurses in their profession. Qualitative study on engagement. / Implicación de las enfermeras en su profesión. Un estudio cualitativo sobre el engagement.

OBJECTIVE: To identify common issues of nurses with high engagement to enable us to develop the construct as it applies to nursing in more depth. METHOD: Based on the constructivist paradigm and with a phenomenological approach, a qualitative content analysis was conducted using an inductive approach. Participants were nurses working in direct care in different healthcare areas. The sample size was determined by data saturation and 15 participants were interviewed. RESULTS: The units of meaning were grouped into 11 subcategories, and then into 7 categories termed vigour, dedication, reward, autonomy, social support, conciliation and attributes of nurses. Then these categories were grouped into 3 major themes: job characteristics, characteristics of organizations, and individual characteristics. CONCLUSIONS: Having high engagement does not mean ignoring the negative aspects of work and organizations. Nurses who maintain high engagement are also affected by the negative aspects, however the assessment of positive aspects such as enjoying the work, the meaning of being a nurse, reward and autonomy enable the process of depletion of engagement to be overcome. In view of the findings, we propose reconceptualising the construct, taking the features of nursing into account.