Effects of Sedation Vacations and Sedation Level Quality Improvement Project

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Exploring the Relationship Between COVID-19 Unit Designation and Nurse Burnout Syndrome

Background: The COVID-19 pandemic impacted healthcare due to surges in infected patient and respiratory failure. Nursing burnout syndrome (NBS) results from occupational factors leading to mental health problems. Nurses working in intensive care units (ICUs) dedicated to caring for COVID-19infected individuals may be even more susceptible to NBS due to increased burdens of futile care delivery and high mortality rates within overstretched healthcare systems. Identifying socio-demographic, work-related, and psychological predictors of NBS may help organizations mitigate, or at least minimize, the negative psychological impact on ICU nurses working during future pandemics. Purpose/Aims: The aim of this study was to compare burnout levels in ICU nurses providing direct care to COVID infected patients with nurses caring for non-COVID infected patients. Methods: An observational descriptive study was conducted using 1) a case-controlled prospective quantitative comparative design to compare neonatal and pediatric ICU to cardiac and medical ICU survey scores measuring nurse burnout, work-related, and psychological predictors of NBS and 2) across-sectional longitudinal quantitative causal and comparative study design comparing NBS scores for nurses working in a cardiac and medical ICU captured in 2019 prior to the COVID-19 pandemic to scores captured in the same units after conversion to dedicated COVID-19 ICUs in 2020. This study will explore the relationship between three subscales(Emotional Exhaustion, Depersonalization, and Personal Accomplishment) of the Maslach Burnout Inventory (MBI) as outcome variables and exposure to COVID-19 infected patients during 12-hour shifts worked as explanatory variables in a subset regression model. The study will also measure four subscales (Vocation, Finances, Health, and Social Relationships) associated with post-traumatic stress disorder using the Well Being Instrument(WBI) as control variables. A convenience sample of direct care registered nurses working in four ICUs in a large tertiary care hospital will be recruited to participate in the study. Female nurses working day shifts were surveyed in February and March 2019in two ICUs. In November 2020, four ICUs were used for sampling of both male and female nurses working either day or night 12-hour shifts based on designation as COVID-19 ICUs. Results: Researchers hypothesize burnout scores among nurses working in neonatal and pediatric ICUs will be less than burnout scores for nurses working in designated COVID ICUs. Additionally, investigators hypothesize nurse burnout measured in cardiac and medical ICUs in 2019 will be less than measurements obtained in 2020 after the same ICUs converted into COVID ICUs. This study will also analyze participant socio-demographic and work-related data for psychological predictors of NBS. Conclusion: NBS has been identified as a global problem facing ICU clinicians. Pinpointing associations betweenCOVID-19 infection and nurse burnout may lead to innovative strategies to mitigate burnout in those caring for the most critically ill individuals during future pandemics. Implications for practice: Further research is required to establish relationships between socio-demographic and work-related psychological predictors of NBS. Understanding relationships between these variables may guide development of strategies to build nurse resilience and decrease NBS in ICU settings impacted during pandemics.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1009/thumbnail.jp

Catheter-Associated Urinary Tract Infection (CAUTI) Prevention Strategy Using Education in an Intensive Care Unit (ICU)

Purpose: To measure clinical impact of an evidence-based educational strategy on urinary tract infection (UTI) rates in a 900+ bed acute care facility located in a southwestern state in the United States (US). Clinical Question: Will a focu son staff education in the ICU on proper placement techniques, care, and early removal of urinary retention catheters reduce incidences of CAUTIs in an ICU setting

Effects of Mindfulness Stress Reduction Program on Nurses: An Integrated Research Review

Background/Purpose: Prevalence of nurse burnout can be as high as 40% (Duarte & Pinto-Gouveia, 2016). Variations of mindfulness-based interventions (MBI) have been utilized to combat burnout among nurses. Many studies utilize an adapted version(s) of the eight week mindfulness-based stress reduction (MBSR) course develop by Dr. Kabat-Zinn, which aims to aid in the improvement of mindfulness through practice of linking one’s physical and mental state in a nonjudgmental way (Ghawadra et al., 2019). Multiple instruments to measure levels of burnout and other psychological effects job stressors may have on nurses have also been applied. Higher levels of burnout have been shown to have a negative impact on job satisfaction, patient outcomes due to quality of care; and in increase in nursing absenteeism and turn over (Green & Kinchen, 2018). Purpose/Aims A systematic integrative search of the literature was performed to evaluate the effectiveness of mindfulness-based interventions among nurses in hospital care settings. Methods: Methodology implemented for the integrative research review was derived from search design recommendations from Brown (2018), Whittemore & Knafle (2005) and “The Preferred Reporting Items for Systematic Review and Meta-Analysis” (PRISMA) guidelines (Page, et al., 2021). A comprehensive literature search was conducted with the following search terms: mindfulness based interventions, nurses, effects or impacts or consequences or influence outcomes; utilizing the Cochrane Library, Medline Complete, Cinahl and Pubmed databases. All databases were set with the same search terms, limitations, and publication year setting (2016-2022) with the exception of the Pubmed database, in which an additional filter was added to limit the search to systematic reviews and meta-analysis. Results: A total of 125 articles were found with thirty-three duplicates leaving ninety-two for review. Of the ninety-two remaining articles eighty were excluded for not meeting inclusion parameters. The remaining twelve articles were reviewed for critical appraisal, and was comprised of four level one, three level two, two level three, one level 4, one level five and one level seven study, which meet the inclusion criteria for the literature review. Appraisal of the studies was performed with the utilization of the evidence based research (EBR) tool, appraising checklist by Brown (2018) and the PRISMA checklist (Long & Gannaway, 2015; Page, et al., 2021). Conclusion: There was inconsistency found among the mindfulness based programs and interventions utilized in each study, as well as the instruments implemented to measure burnout and mental health of nurses. Although each study varied in interventions and data collection strategies each showed some form of positive impact on the overall wellbeing of nurses, however, the statistical significance of the impact varied among studies. As noted by Jung et al., (2021) there is no “gold standard” for primary outcomes for nursing mental health unlike the clear expectations for patient outcomes and may contribute to the heterogeneity of MBI/MBSR studies for nurses. Implication: In the future, researchers studying the effectiveness of an MBI or MBSR on nurses, should consider developing a standardized practice for data collection, which include but not limited to the use of selected validated and reliable measure instruments for example, the Maslach Burnout Inventory (MBI), mass attention awareness scale (MASS), etc. (Jung et a., 2021). In doing so this may potentially create a homogeneous environment in which the effectiveness of the applied MBI, MSBR or abbreviated programs may be measured more effectively and efficiently and may lead to more reliable and creditable findings. References Alkhawaldeh, J. M. A., Soh, K. L., Mukhtar, F. B. M., Peng, O. C., & Anshasi, H. A. (2020). Stress management interventions for intensive and critical care nurses: A systematic review. Nursing in Critical Care, 25(2), 84–92. https://doi.org/10.1111/nicc.12489 Duarte, J., & Pinto-Gouveia, J. (2016). Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study. International Journal of Nursing Studies, 64, 98–107. https://doi-org.lcu.idm.oclc.org/10.1016/j.ijnurstu.2016.10.002 Fadzil, N. A., Heong, W. O., Kueh, Y. C., & Phang, C. K. (2021). The Effect of a Mindfulness-Based Intervention on Nurses in Kelantan, Malaysia. The Malaysian Journal of Medical Sciences : MJMS, 28(6), 121–128. https://doi-org.lcu.idm.oclc.org/10.21315/mjms2021.28.6.12 Ghawadra, S. F., Lim Abdullah, K., Choo, W. Y., Danaee, M., & Phang, C. K. (2020). The effect of mindfulness-based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial. Journal of Nursing Management, 28(5), 1088–1097. https://doi-org.lcu.idm.oclc.org/10.1111/jonm.13049 Ghawadra, S. F., Abdullah, K. L., Choo, W. Y., & Phang, C. K. (2019). Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. Journal of Clinical Nursing, 28(21-22), 3747–3758. https://doi.org/10.1111/jocn.14987 Green, A. A., & Kinchen, E. V. (2021). The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 39(4), 356–368. https://doi-org.lcu.idm.oclc.org/10.1177/08980101211015818 Jung, S.-E., Ha, D.-J., Park, J.-H., Lee, B., Kim, M.-S., Sim, K.-L., Choi, Y.-H., & Kwon, C.-Y. (2021). The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review. International Journal of Environmental Research and Public Health, 18(16). https://doi-org.lcu.idm.oclc.org/10.3390/ijerph18168855 Kang, M.-J., & Myung, S.-K. (2021). Effects of Mindfulness-Based Interventions on Mental Health in Nurses: A Meta-Analysis of Randomized Controlled Trials. Issues in Mental Health Nursing, 1–9. https://doi-org.lcu.idm.oclc.org/10.1080/01612840.2021.1949765 Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2019). The Effects of a Modified Mindfulness-Based Stress Reduction Program for Nurses: A Randomized Controlled Trial. Workplace Health & Safety, 67(3), 111–122. https://doi.org/10.1177/2165079918801633 Sarazine, J., Heitschmidt, M., Vondracek, H., Sarris, S., Marcinkowski, N., & Kleinpell, R. (2021). Mindfulness Workshops Effects on Nurses’ Burnout, Stress, and Mindfulness Skills. Holistic Nursing Practice, 35(1), 10–18. https://doi-org.lcu.idm.oclc.org/10.1097/HNP.0000000000000378 Xie, C., Zeng, Y., Lv, Y., Li, X., Xiao, J., & Hu, X. (2020). Educational intervention versus mindfulness-based intervention for ICU nurses with occupational burnout: A parallel, controlled trial. Complementary Therapies in Medicine, 52, 102485. https://doi-org.lcu.idm.oclc.org/10.1016/j.ctim.2020.102485 Yi-Yan Chen, & Xiang-Shu Cui. (2020). Intervention effect of mindfulness-based stress reduction for psychological health among nurses: A meta-analysis. TMR Integrative Nursing, 4(5), 163–171. https://doi-org.lcu.idm.oclc.org/10.12032/TMRIN2020100

Caring for COVID-19 infected patients admitted to redesignated coronavirus ICUs: Impact on nurse stress and burnout.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic globally impacted healthcare due to surges in infected patients and respiratory failure. The pandemic escalated nursing burnout syndrome (NBS) across the workforce, especially in critical care environments, potentially leading to long-term negative impact on nurse retention and patient care. To compare self-reported burnout scores of frontline nurses caring for COVID-19 infected patients with burnout scores captured before the pandemic and in non-COVID-19 units from two prior studies. METHODS: The descriptive study was conducted using frontline nurses working in eight critical care units based on exposure to COVID-19 infected patients. Nurses were surveyed in 2019 and in 2020 using Maslach Burnout Inventory (MBI), Well Being Instrument, and Stress-Arousal Adjective Checklist (SACL) instruments. Researchers explored relationships between survey scores and working in COVID-19 units. RESULTS: Nurses working in COVID-19 units experienced more emotional exhaustion (EE) and depersonalization (DP) than nurses working in non-COVID units (p= .0001). Pre-COVID nurse burnout scores across six critical care units (EE mean = 15.41; p= .59) were lower than burnout scores in the COVID-19 intensive care units (EE mean = 10.29; p= .74). Clinical significance (p= .08) was noted by an EE subscale increase from low prepandemic to moderate during the pandemic. CONCLUSION: Pinpointing associations between COVID-19 infection and nurse burnout may lead to innovative strategies to mitigate burnout in those caring for the most critically ill individuals during future pandemics. Further research is required to establish causal relationships between sociodemographic and work-related psychological predictors of NBS

Postpartum Genital Melanoma - A Case Report

<div><p>Abstract Melanomas of the female genital tract may occur in the vulva, the vagina, the ovary or the cervix.Pregnancy has been considered an aggravating factor in the evolution and prognosis of melanoma. A 35-year-old female presented with vaginal bleeding 2 months after a term cesarean delivery. An endovaginal ultrasound revealed a lesion in the uterine cervix. The pathological report revealed a small round-cell neoplasm, and the immunohistochemistry confirmed the diagnosis of malignant melanoma. A positron emission tomography revealed an expansive hypermetabolic lesion centered on the cervix, and hypermetabolic lesions in the liver and right kidney. Non-surgical treatment was provided, with biochemotherapy followed by ipilimumab and nivolumab. The patient died one year later. Postpartum vaginal bleeding, even if late-onset, should be investigated, as it may be a pregnancy-associated malignant melanoma, which has a poor prognosis.</p></div