Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

Background: During the COVID-19 pandemic, shortage of nursing staff became even more evident. Nurses experienced great strain, putting them at risk to leave their jobs. Individual and organizational factors were known to be associated with nurses' turnover intention before the pandemic. The knowledge of factors associated with turnover intention during the pandemic could help to foster nurses' retention. Therefore, this review aims to identify factors associated with nurses' turnover intention during the COVID-19 pandemic. Methods: After a systematic search of six databases, the resulting records were screened in a two-step process based on pre-defined inclusion and exclusion criteria. The included quantitative studies were synthesized qualitatively due to their methodological heterogeneity. Results: A total of 19 articles were included in the analysis. Individual factors such as health factors or psychological symptoms and demographic characteristics were associated with nurses' turnover intention. Organizational factors associated with turnover intention were e.g., caring for COVID-19 patients, low job control or high job demands, and moral distress. Resilience and supporting leadership could mitigate adverse associations with turnover intention. Conclusions: The results help to identify high-risk groups according to individual factors and to develop possible interventions, such as trainings for nurses and their superiors, addressing individual and organizational factors. Future research should focus on longitudinal designs applying carefully defined concepts of turnover intention

Schulgesundheitspflege in Brandenburg - SPLASH II, Ergebnisse einer Evaluationsstudie zu ausgewählten Gesundheitsindikatoren

Die Schulgesundheitspflege spielt eine zentrale Rolle für den Erhalt und die Förderung von Gesundheit sowie die Prävention von Erkrankungen. Durch eine am Public Health Action Cycle orientierte Arbeitsweise können Pflegefachpersonen die körperliche Gesundheit und auch das psychosoziale Wohlbefinden von Kindern und Jugendlichen sowie von Eltern, Lehrenden und anderen Personen an den Schulen positiv beeinflussen. Dies war eines der Motive für die Einführung des in Trägerschaft des AWO Bezirksverband Potsdam e. V. seit 2017 in mehreren Phasen durchgeführten Modellprojekts „Schulgesundheitsfachkräfte an öffentlichen Schulen im Land Brandenburg“. Anknüpfend an die wissenschaftliche Begleitung der Einführung der Schulgesundheitspflege in Brandenburg und Hessen (SPLASH I) wurde von Juli 2019 bis Dezember 2020 eine auf ausgewählte Gesundheitsindikatoren ausgerichtete Evaluationsstudie allein zu dem Brandenburger Projekt durchgeführt (SPLASH II). Deren Ziel war es, mögliche Wirkungen der Schulgesundheitspflege auf den Gesundheitszustand, das Gesundheitsverhalten und die Gesundheitskompetenz der Schüler*innen zu ermitteln. Die entsprechenden Daten wurden mittels Fragebögen erhoben, die die Heranwachsenden selbst ausfüllten. Diese Phase der Datenerhebung musste aufgrund der COVID-19-Pandemie nach etwa der Hälfte ausgesetzt werden. Zudem wurde eine schriftliche Befragung der Schulleitungen durchgeführt, um gesundheitsrelevante Strukturmerkmale der Schulen zu erfassen. Die erhobenen Daten wurden statistisch ausgewertet und z. T. mit zuvor erhobenen Daten vergleichend ana-lysiert. Ergänzend wurden qualitative Interviews mit Pflegefachpersonen an den Schulen geführt, um Rollen und Aufgaben der Schulgesundheitspflege angesichts der COVID-19-Pandemie untersuchen zu können. Die qualitativen Daten wurden inhaltsanalytisch ausgewertet und verdichtend aufbereitet. Im Ergebnis zeigte sich, dass das Angebot der Pflegefachpersonen von den Schüler*innen gut angenommen und überwiegend positiv bewertet wurde. Deren Gesundheitszustand schien vor der Pandemie basierend auf den Selbstauskünften insgesamt gut gewesen zu sein. Was Veränderungen im Gesundheitsverhalten betrifft, sind die Ergebnisse ambivalent. Rund ein Fünftel der Schüler*innen zeigte eine hohe Gesundheitskompetenz, allerdings war der Anteil derjenigen mit niedriger Gesundheitskompetenz etwa genauso hoch. Pandemiebedingt deuteten sich aus Sicht der Pflegefachpersonen zusätzliche Gesundheitsrisiken an. Gesteigerter Medienkonsum, mangelnde Bewegung und schlechtere Ernährung wurden berichtet, ebenso wie soziale Isolation, Verunsicherung und Angst vor einer Ansteckung mit SARS-CoV-2. Das Elternhaus war für die Schüler*innen die Hauptinformationsquelle zur COVID-19-Pandemie, was zuweilen mit spezifischen Herausforderungen für die Pflegefachpersonen verbunden war. Deren zusätzliche Aufgabe bestand u. a. darin, auf die Einhaltung der pandemiebedingten Hygiene- und Abstandsregeln zu achten, über SARS-CoV-2 und die Folgen sowie die damit verbundenen Maßnahmen zu informieren und ggf. Fehlinformationen richtigzustellen. Das Modellprojekt „Schulgesundheitsfachkräfte an öffentlichen Schulen im Land Brandenburg“ wurde mit Blick auf ausgewählte Gesundheitsindikatoren erfolgreich fortgesetzt. Zwar lassen sich direkte Effekte der Schulgesundheitspflege auf Gesundheitszustand, Gesundheitsverhalten und Gesundheitskompetenz ohne Bezugnahme auf konkrete, abgegrenzte Einzelinterventionen nach wie vor schlecht ermitteln. Dem wird künftig mit weiteren Bemühungen zur Systematisierung und Standardisierung der Interventionen der Schulgesundheitspflege zu begegnen sein. Gerade hinsichtlich der Förderung von Gesundheitskompetenz und der pandemie-bedingten Herausforderungen ist der Bedarf an Schulgesundheitspflege aber offensichtlich. Die Pflegefachpersonen wissen um ihre Relevanz und haben sich mit ihren diversen Rollen und Aufgaben in den Schulen gut etabliert. Das Spannungsfeld zwischen individuen- und populationsorientierten Perspektiven einerseits und reaktiven und antizipativen Ansätzen andererseits, sollten sie dabei sorgfältig ausbalancieren, um im Kontext der Schulgesundheitspflege auch künftig die gewünschten und angestrebten Gesundheitseffekte erzielen zu können

Critical Health Literacy in a Pandemic: A Cluster Analysis Among German University Students.

Objectives: In the COVID-19 pandemic, critical health literacy (CHL-P) has been proposed as a means of addressing issues of complexity, uncertainty, and urgency. Our study aimed to identify CHL-P clusters among university students in Germany and to analyze associations with potential determinants. Methods: In May 2020, students at four German universities participated in the COVID-19 International Student Well-Being Study, an online survey that yielded a non-probabilistic sample of N = 5,021. CHL-P, COVID-19-related knowledge, worries, risk perception, and adherence to protective measures were measured in an online questionnaire with self-constructed items. We conducted a cluster analysis of the five CHL-P items and performed logistic regression analyses. Results: Two CHL-P clusters were identified: high vs. moderate CHL-P. Belonging to the high-CHL-P cluster (31.2% of students) was significantly associated with older age, female/other gender, advanced education, higher levels of parental education, and moderate importance placed on education. In addition, higher levels of knowledge, risk perception and worries, and adherence to protective measures were associated with high CHL-P cluster membership. Conclusion: Students would benefit from educational measures that promote CHL-P at German universities

Psychosocial working conditions, asthma self-management at work and asthma morbidity: a cross-sectional study

Additional file 1. Details on measures

Associations of loneliness with mental health and with social and physical activity among university students in Germany: results of the COVID-19 German student well-being study (C19 GSWS)

IntroductionUniversity students are at high risk for loneliness with a potential negative impact on health. The COVID-19 measures disrupted students’ academic routine and social life, which might have affected their perception of loneliness. This study investigated the prevalence of perceived loneliness among university students in Germany during the COVID-19 pandemic and its associations with mental health, behavioral outcomes, and sociodemographic characteristics.MethodsCOVID-19 German student well-being study (C19 GSWS) collected data from five German universities from October 27th to November 14th, 2021, resulting in a sample of 7,203 respondents. Associations of loneliness with depressive symptoms, anxiety, social and physical activity, as well as sociodemographic characteristics, were analyzed using multivariable logistic regressions.ResultsA total of 20.6% of students reported loneliness. Students with depressive or anxiety symptoms had more than eight- or sixfold odds, respectively, for reporting loneliness (depressive symptoms: OR = 8.29; 95% CI: 7.21–9.52; anxiety: OR = 6.48; 95% CI: 5.65–7.43) compared with students who did not report any symptoms. Students who were less physically active were more likely to experience loneliness compared with students who were more physically active (no moderate physical activity: OR = 1.39; 95% CI: 1.21–1.59; no vigorous physical activity: OR = 1.19; 95% CI: 1.04–1.36). We found no association between loneliness and social activity. However, loneliness was associated with being single (OR = 2.93; 95% CI: 2.55–3.36), living alone (OR = 1.31; 95% CI: 1.13–1.52), or having a temporary residency status in Germany (OR = 2.24; 95% CI: 1.65–3.04).ConclusionOur findings highlight the importance of loneliness as a relevant factor associated with health. Further research is needed to determine potential protective factors to tackle loneliness and to investigate how study conditions at higher education institutions may affect students’ perceived loneliness

What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries

BackgroundIn Europe, men have lower rates of attempted suicide compared to women and at the same time a higher rate of completed suicides, indicating major gender differences in lethality of suicidal behaviour. The aim of this study was to analyse the extent to which these gender differences in lethality can be explained by factors such as choice of more lethal methods or lethality differences within the same suicide method or age. In addition, we explored gender differences in the intentionality of suicide attempts.Methods and FindingsMethods. Design: Epidemiological study using a combination of self-report and official data. Setting: Mental health care services in four European countries: Germany, Hungary, Ireland, and Portugal. Data basis: Completed suicides derived from official statistics for each country (767 acts, 74.4% male) and assessed suicide attempts excluding habitual intentional self-harm (8,175 acts, 43.2% male).Main Outcome Measures and Data Analysis. We collected data on suicidal acts in eight regions of four European countries participating in the EU-funded "OSPI-Europe"-project (www.ospi-europe.com). We calculated method-specific lethality using the number of completed suicides per method * 100 /(number of completed suicides per method + number of attempted suicides per method). We tested gender differences in the distribution of suicidal acts for significance by using the chi(2)-test for two-by-two tables. We assessed the effect sizes with phi coefficients (phi). We identified predictors of lethality with a binary logistic regression analysis. Poisson regression analysis examined the contribution of choice of methods and method-specific lethality to gender differences in the lethality of suicidal acts.Findings Main ResultsSuicidal acts (fatal and non-fatal) were 3.4 times more lethal in men than in women (lethality 13.91% (regarding 4106 suicidal acts) versus 4.05% (regarding 4836 suicidal acts)), the difference being significant for the methods hanging, jumping, moving objects, sharp objects and poisoning by substances other than drugs. Median age at time of suicidal behaviour (35-44 years) did not differ between males and females. The overall gender difference in lethality of suicidal behaviour was explained by males choosing more lethal suicide methods (odds ratio (OR) = 2.03; 95% CI = 1.65 to 2.50; p &lt;0.000001) and additionally, but to a lesser degree, by a higher lethality of suicidal acts for males even within the same method (OR = 1.64; 95% CI = 1.32 to 2.02; p = 0.000005). Results of a regression analysis revealed neither age nor country differences were significant predictors for gender differences in the lethality of suicidal acts. The proportion of serious suicide attempts among all non-fatal suicidal acts with known intentionality (NFSAi) was significantly higher in men (57.1%; 1,207 of 2,115 NFSAi) than in women (48.6%; 1,508 of 3,100 NFSAi) (chi(2) = 35.74; p &lt;0.000001).Main limitations of the studyDue to restrictive data security regulations to ensure anonymity in Ireland, specific ages could not be provided because of the relatively low absolute numbers of suicide in the Irish intervention and control region. Therefore, analyses of the interaction between gender and age could only be conducted for three of the four countries. Attempted suicides were assessed for patients presenting to emergency departments or treated in hospitals. An unknown rate of attempted suicides remained undetected. This may have caused an overestimation of the lethality of certain methods. Moreover, the detection of attempted suicides and the registration of completed suicides might have differed across the four countries. Some suicides might be hidden and misclassified as undetermined deaths.ConclusionsMen more often used highly lethal methods in suicidal behaviour, but there was also a higher method-specific lethality which together explained the large gender differences in the lethality of suicidal acts. Gender differences in the lethality of suicidal acts were fairly consistent across all four European countries examined. Males and females did not differ in age at time of suicidal behaviour. Suicide attempts by males were rated as being more serious independent of the method used, with the exceptions of attempted hanging, suggesting gender differences in intentionality associated with suicidal behaviour. These findings contribute to understanding of the spectrum of reasons for gender differences in the lethality of suicidal behaviour and should inform the development of gender specific strategies for suicide prevention.</p

Psychosocial working conditions as determinants of asthma self-management at work: A systematic review

<p><i>Objective</i>: Asthma exerts a considerable impact on patients and their employers. While adequate self-management is able to improve patients' prognosis, its actual implementation in everyday life may depend on contextual factors. We aimed to review the literature on the potential determinants of asthma self-management at the workplace.</p> <p><i>Data Sources</i>: We systematically searched Medline and PsycINFO using terms related to the key concepts of interest (i.e., adult asthma, working conditions, and self-management).</p> <p><i>Study Selection</i>: We included original studies published in peer-reviewed journals in English or German since 1992 addressing any type of asthma self-management behavior as the outcome and any type of working condition as the determinant.</p> <p><i>Results</i>: Upon implementation of a multi-stage selection process, seven articles were included. As those studies showed considerable methodological heterogeneity, a qualitative analysis was applied. A first study identified three different adaptation profiles among employees with asthma with implications for self-management behavior. Another study suggested that concerns about taking time off from work may be associated with the utilization of emergency ambulance services for asthma. Five studies among workers with various chronic illnesses addressed determinants of self-disclosure, coping with acute symptoms (e.g., medication use at work), and the potential effect of practical and emotional support from line managers or colleagues on self-management.</p> <p><i>Conclusion</i>: Our review indicates that the evidence for a potential link of occupational factors with asthma self-management at work is relatively sparse. Future research should take a more comprehensive approach by considering multiple types of working conditions and asthma self-management behaviors simultaneously.</p

LGBTQIA+ Adolescents’ Perceptions of Gender Tailoring and Portrayal in a Virtual-Reality-Based Alcohol-Prevention Tool: A Qualitative Interview Study and Thematic Analysis

Gender-sensitive interventions in alcohol-prevention that target adolescents often lead to binary tailoring for girls and boys. However, increased societal and legal recognition of sexual and gender minorities as well as research with this age group demand a broader understanding of gender. Therefore, the present study addresses the question of how interventions should be further developed to include sexual and gender diversity by exploring LGBTQIA+ adolescents’ perceptions of gender portrayal and gender-tailoring using Virtual LimitLab—a virtual-reality simulation for training refusal skills under peer pressure to consume alcohol. Qualitative interviews with 16 LGBTQIA+ adolescents were conducted after individual simulation testing. Using a thematic analysis with reflexive orientation, four themes were identified: Statements on relevance of gender, opinions on tailoring- and flirting options, and opinions on characters. Participants called for greater diversity representation among the characters, regarding gender identity and sexual orientation, as well as for representing, e.g., racialised peers. Moreover, participants suggested expanding the simulation’s flirting options by adding bisexual and aromantic/asexual options. Divergent views on the relevance of gender and wishes for tailoring options reflected the participant group’s heterogeneity. Based on these findings, future gender-sensitive interventions should conceptualise gender in a complex and multidimensional manner that intersects with further diversity categories