Improving mental health of student and novice nurses to prevent dropout:A systematic review

Aims: To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout-related outcomes. Design: Systematic review. Data sources: Research papers published between January 1971–February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar. Review methods: We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer-reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout-related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta-analysis of studies was performed. Results: We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout-related outcomes. The overall risk of bias was high. Conclusion: A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high-quality studies in this field, preferably with a randomized controlled design

Psychosocial work characteristics associated with distress and intention to leave nursing education; a one-year follow-up study

Background: Dropout in later years of the nursing degree programme involves lost investment and is a particular problem for both students and educators. Reasons for late dropout seem to be related to the work and learning environment of the clinical placement. Objectives: The aim of this study was to investigate associations between psychosocial work characteristics and distress and intention to leave nursing education among third-year nursing students. Design: A prospective cohort study. Setting A Bachelor of Nursing programme of a University of Applied Sciences in [name country]. Participants: 363 third-year nursing students. Methods: Baseline and one-year follow-up measurements were used from a prospective cohort study. Third-year nursing students were invited annually in May between 2016 and 2018. Psychosocial work characteristics were psychological demands, supervisor and co-worker support, and acts of offensive behaviour. Logistic regression analyses were used to build multivariate models. Results: Frequent exposure to violence (OR = 2.52, 95% CI: 1.29-4.92) was univariately associated with distress. In the multivariate model for distress, psychological demands (OR = 1.63, 95% CI: 1.05-2.52) and frequent exposure to violence (OR = 3.02, 95% CI: 1.48-6.19) were associated with distress. Supervisor support (OR = 0.54, 95% CI: 0.36-0.80) and co-worker support (OR = 0.41, 95% CI: 0.24-0.72) were negatively associated with intention to leave (i.e. were protective) in the univariate model. In the adjusted multivariate model, only co-worker support (OR = 0.50, 95% CI: 0.25-0.97) was a protective factor for an intention to leave. Conclusion: Psychological demands and frequent exposure to violence are risk factors for distress, and co-worker support is a protective factor reducing the intention to leave nursing education in the last stage of the programme. Improving the psychosocial working climate of nursing students may reduce the intention to leave at a late stage in nursing education, and hence actual late dropout

Dysregulated innate and adaptive immune responses discriminate disease severity in COVID-19

The clinical spectrum of COVID-19 varies and the differences in host response characterizing this variation have not been fully elucidated. COVID-19 disease severity correlates with an excessive pro-inflammatory immune response and profound lymphopenia. Inflammatory responses according to disease severity were explored by plasma cytokine measurements and proteomics analysis in 147 COVID-19 patients. Furthermore, peripheral blood mononuclear cell cytokine production assays and whole blood flow cytometry were performed. Results confirm a hyperinflammatory innate immune state, while highlighting hepatocyte growth factor and stem cell factor as potential biomarkers for disease severity. Clustering analysis reveals no specific inflammatory endotypes in COVID-19 patients. Functional assays reveal abrogated adaptive cytokine production (interferon-gamma, interleukin-17 and interleukin-22) and prominent T cell exhaustion in critically ill patients, whereas innate immune responses were intact or hyperresponsive. Collectively, this extensive analysis provides a comprehensive insight into the pathobiology of severe to critical COVID-19 and highlight potential biomarkers of disease severity

Conflict or connection? A feasibility study on the implementation of a training based on connecting communication in a nursing curriculum

Background: Nursing students frequently experience offensive behaviour and communication problems with patients, clinical supervisors, and nursing and faculty staff. A communication training was developed based on connecting communication to prevent and manage conflict, and build interpersonal trust-based relationships. Objectives: Feasibility study to evaluate the acceptability, demand, implementation, integration, and limited efficacy of a training based on connecting communication within a nursing curriculum. Design: Mixed method design. Participants: Third-year nursing students (n = 24). Setting: A Dutch Bachelor of Nursing degree programme in Rotterdam. Methods: Between November 2019 and March 2020, data were collected from students and trainers, using quantitative and qualitative methods. Feasibility aspects, including limited efficacy testing, were measured with pre- and post-training surveys. Descriptive statistical analyses and (non)parametric tests were used to analyse feasibility aspects and baseline and follow-up scores for empathy, self-compassion, and exposure to violence. In addition, reflection reports of students and two paired interviews with the two trainers were analysed using qualitative content analysis with a deductive approach. Results: The post-training survey and reflection reports showed a positive assessment of the training on acceptability, demand, and integration. Students rated the training as helpful in improving their communication skills and in dealing with conflict situations. Furthermore, they recommended to implement the training in earlier years of the educational programme. According to the trainers, miscommunication, students' lack of preparation for lessons, and the timing of the training prohibited full participation in the training. The pretest-posttest survey results show statistically significant improved self-compassion (3.77 vs. 4.10; p = 0.03) and decreased self-judgement (4.21 vs. 3.50; p = 0.03). Empathy and exposure to violence did not change. Conclusions: From the perspective of nursing students and trainers involved, this 10-week training based on connecting communication is feasible to implement in the Bachelor of Nursing degree programme, preferably before clinical placements

Late dropout from nursing education: An interview study of nursing students’ experiences and reasons

The global shortages of nurses require a closer look at why nursing students stop in the later years of their degree programme. The purpose of this study is to explore nursing students' experiences and reasons that lead to this late dropout. Semi-structured interviews were held in 2017 with eleven former nursing students who dropped out in the third year of their Bachelor's Nursing degree programme in the Netherlands. Data was collected and analysed iteratively, following the principles of Thematic Analysis. Two core themes were identified: ‘ending up in a downward spiral of physical, psychological and social problems’ and ‘experiencing an increasing mismatch between expectations and reality’. Reasons for late dropout from nursing education are diverse and interlinked. In contrast with studies on early dropout, academic difficulties did not play a major role in late dropout. Negative experiences during clinical placements led to dropout in both groups. One group lacked a safe learning environment in clinical placements, study coaching and psychological support. The other group missed realistic information provision about nursing education and the broad range of career opportunities in nursing

“Astonishing successes” and “bitter disappointment”: The specific heat of hydrogen in quantum theory

The specific heat of hydrogen gas at low temperatures was first measured in 1912 by Arnold Eucken in Walther Nernst’s laboratory in Berlin, and provided one of the earliest experimental supports for the new quantum theory. Even earlier, Nernst had developed a quantum theory of rotating diatomic gas molecules that figured in the discussions at the first Solvay conference in late 1911. Between 1913 and 1925, Albert Einstein, Paul Ehrenfest, Max Planck, Fritz Reiche, and Erwin Schrödinger, among many others, attempted theoretical descriptions of the rotational specific heat of hydrogen, with only limited success. Quantum theory also was central to the study of molecular spectra, where initially it was more successful. Moreover, the two problems interacted in sometimes surprising ways. Not until 1927, following Werner Heisenberg’s discovery of the behavior of indistinguishable particles in modern quantum mechanics, did American theorist David Dennison find a successful theory of the specific heat of hydrogen