Investigating work-related stress among health professionals at different hierarchical levels: A cross-sectional study

Aim: To determine the extent of stress at work among health professionals working in upper-, middle- and lower-management positions and those not working in management positions. Design: Cross-sectional design and randomly selected hospitals, nursing homes and home care organizations. Methods: The study sample included nursing staff and midwives, physicians, medical– technical and medical–therapeutic professionals at all hierarchical levels (N = 8,112). Data were collected using self-report questionnaires and analysed using multiple regression models. Results: Health professionals in upper- and middle-management positions reported higher quantitative demands, severe work–private life conflicts (p < .05) as well as less role clarity in middle-management positions (B = −1.58, p < .05). In lower-management positions, health professionals reported higher physical (B = 3.80, p < .001) and emotional demands (B = 1.79, p < .01), stress symptoms (B = 1.81, p < .05) and job dissatisfaction (B = −1.17, p < .05). Health professionals without management responsibilities reported the poorest working conditions in relation to various stressors, job satisfaction (B = −5.20, p < .001) and health-related outcomes (e.g. burnout symptoms: B = 1.89, p < .01). KEYWORDS nurses, nursing, stress, work, workforc

Adequate management of phosphorus in patients undergoing hemodialysis using a dietary smartphone app: Prospective pilot study

Background: The renal diet is complex and requires alterations of the diet and careful monitoring of various nutrients. Elevated serum phosphorus is common among patients undergoing hemodialysis, and it is associated with many complications. Smartphone technology could be used to support both dietitians and patients by providing a source of accessible and reliable information. Objective: The aim of this pilot is to assess the potential efficacy of an intervention using the educational and self-monitoring mobile app KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the app and a planned, rigorous large-scale trial intended to assess app efficacy. Methods: This is a prospective pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah, United Arab Emirates). All patients were assessed for eligibility and, based on inclusion criteria, considered for enrollment. Participants met with a dietitian once a week and used the mobile app regularly for 2 weeks. Outcomes (knowledge, self-reported nonadherence, dietary intake, anthropometry, and biochemical data) were measured. This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist for reporting pilot or feasibility trials. Results: Of 26 subjects, 23 successfully completed the pilot. Patient dietary knowledge about phosphorous management improved from 51.4% (SD 13.9) to 68.1% (SD 13.3) after intervention with a large effect size (d=1.22, 95% CI 0.59 to 1.85). Dietary protein intake increased from a mean of 0.9 g/kg (SD 0.3) per day to a mean of 1.3 g/kg (SD 0.5) per day with a large effect size (d=1.07, 95% CI 0.45 to 1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5 mg/g protein with a large effect size (d=0.83, 95% CI 0.22 to 1.43). There was no evidence of change in phosphorous intake, self-reported nonadherence, and serum phosphorus. Conclusions: The findings of this prospective pilot reveal the potential efficacy of a smartphone app as a supportive nutrition education tool for phosphorus management in patients undergoing hemodialysis. This pilot study showed that the KELA.AE app has the potential to improve knowledge and dietary choices. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app use of a long-term intervention

Clinical Utility of the Care Dependency Scale for Stroke Patients in Indonesia:A Descriptive Study

Introduction: Nurses require a care dependency instrument that can be useful for caring stroke survivors. This study aim was to evaluate the clinical utility of the care dependency scale (CDS) in stroke patients. Methods: This is descriptive study with a consecutive sample of 36 nurses included from a pool of 45 eligible nurses. Nurses who had experience using the CDS to assess stroke patients on inpatient wards and in outpatient clinics in four hospitals in Indonesia were asked to use a Staff View Assessment Instrument (SVAI) to evaluate the CDS. The SVAI includes closed-ended and open-ended questions. A descriptive analysis of the answers to the closed-ended questions was performed, while a text analysis were conducted to analyze the answers to the open-ended questions. Results: Thirty-six nurses participated in this study. The results indicate that most nurses agreed that the CDS had clinical utility in the assessment of stroke patients in the hospitals. The majority of nurses stated that the use of the CDS helped them monitor care (in) dependency and support care planning. In addition, the CDS could be used to improve communication among members of the care team between different institutions, as well as help educate family caregivers. The median time required to perform the assessment using the CDS was 15 minutes. Conclusion: Concerning the usefulness of the instrument in practice, we conclude that using the CDS in both inpatient and outpatient care settings presents a solution to the challenge of offering continuous care for stroke patients

Work-related stress among health professionals in Swiss acute care and rehabilitation hospitals-A cross-sectional study

Aims and objectives This study aimed to identify significant work stressors associated with stress symptoms, job satisfaction, intention to leave and health‐related outcomes among health professionals. Background The workforce shortage of health professionals is a current concern, and a reduction of work‐related stress is thus essential for retaining health professionals. Studies on the extent of work‐related stress in different health professions are limited. Methods The research was conducted with a cross‐sectional study encompassing 26 randomly selected acute care and rehabilitation hospitals. The sample consisted of 3,398 health professionals. The study was undertaken in accordance with the STROBE checklist for observational studies. Results Work–private life conflicts were significantly associated with health professionals' stress symptoms, job satisfaction, intention to leave the organisation and profession, their general health status, burnout symptoms and quality of sleep. Also, opportunities for development and the behaviour of the direct line manager (e.g. quality of leadership, unfair behaviour, rewards given) along with various profession‐specific stressors were the important predictors revealed. Conclusions This study shows the high relevance of preventing and reducing work–private life conflicts, enhancing leadership qualities as well as opportunities for development among health professionals working in acute care and rehabilitation hospitals. Also, differences between health professions should be taken into consideration in developing strategies for reducing stress at work. Relevance to clinical practice The results of this study are particularly relevant for health professional leaders and reveal the urgent need in hospital practice for effective strategies to improve health professionals' work–private life balance, opportunities for development and quality of leadership

Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review

INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care and therefore shared decision making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM: To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD: An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS: Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION: SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centered and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE: The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support

Change in Care Dependency of Stroke Patients: A Longitudinal and Multicenter Study

Purpose: The study was conducted to investigate the change of care dependency in stroke patients from inpatient wards and outpatient units in Indonesia. Methods: This study is longitudinal and multicentered. One hundred and nine patients were included from four hospitals on the island of Java. Care dependency was assessed using the Indonesian version of the 15-item Care Dependency Scale (CDS) at five points in time: at inpatient wards for admission and discharge and at outpatient units after discharge in the 1st week, the 5th week, and the 13th week. Results: Most of the patients were male (65.1%), and diagnosed with ischemic stroke (71.5%). The results showed that care dependency in stroke patients decreased significantly from admission to discharge, as well as from the 5th to the 13th week as measured by the CDS. At admission, 23.0% of the patients were completely dependent on care, and at the 13th week about 1.0% were. Patients' care dependency decreased significantly in all care dependency items of the CDS in the inpatient ward, but five care dependency items of the CDS did not significantly decrease in the outpatient unit. Conclusions: Based on the findings of this study, we recommend that hospital-based and community-based services should include continual care dependence monitoring using this comprehensive instrument. Care dependency is subject to change over time, therefore nurses have to plan and tailor adequate nursing care measures to patient needs in the different stages, especially with respect to the aspect of mobility

Aggressive Behavior of Nursing Home Residents Toward Caregivers: A Systematic Literature Review

Aggression challenges and burdens caregivers face when working in nursing homes. The research questions in this review were (1) what types of residents' aggressive behavior do caregivers experience in nursing homes and how often? (2) In what situations does aggressive behavior occur? (3) What strategies do caregivers employ to manage aggressive behavior? Twenty one publications in English and/or German from 1996 to 2006 were identified by search strategies conducted in Medline, CINAHL, PsycINFO, and supplemented by screening citations, references, and unpublished manuscripts. Results show that all types of aggressive behavior occur in nursing homes with verbal and physical aggressive behavior combined. Personal care of the residents was the most frequent context in which aggressive behavior occurs. Strategies for preventing and dealing with aggressive behavior used by caregivers ranged from behavioral strategies aiming to prevent aggression, to medical treatment, or following written institutional guidelines for reducing aggressive behavior. Some care providers demonstrated predominantly positive and others predominantly negative strategies. Furthermore, there was a lack of information about "triggering" factors and interactive events during personal care in the referenced publications