Sense of Coherence, a Worthy Factor toward Nursing Student and New Graduate Satisfaction with Nursing, Goal Setting Affinities, and Coping Tendencies (Le sens de la cohérence, un facteur déterminant de la satisfaction des étudiantes et des diplômées de leur carrière en sciences infirmières, de leur propension à établir des objectifs et à trouver des mécanismes de coping)

Abstract Background Nursing student readiness for practice is a relevant topic for educators aimed to ready students for a difficult practice environment, and healthcare employers challenged with the high attrition rates of new graduates. The literature suggests that stressors toward burnout may begin in the undergraduate setting with student nurses experiencing feelings of burnout being at significantly higher risk of leaving their position after only 10 to 15 months (Rudman & Gustavsson, 2012; Rudman, Gustavsson, & Hultell, 2014). Readiness for practice as a student informs how new graduate nurses will come into the practice environment. Their sense of coherence, ability to set and achieve goals, and coping skills are important factors toward surviving and thriving in their place of work. This study includes fourth-year nursing students on their final day of school, standing at the threshold of their nursing careers. Objectives The purpose of this study was to investigate the relationship between sense of coherence scores of nursing students upon completion of their undergraduate program with their level of satisfaction in nursing as a career choice, coping skills, and goal setting tendencies. Methods The study uses a cross-sectional survey using quantitative and qualitative methods. Sense of coherence scores were obtained through the Orientation to Life Questionnaire (Antonovsky, 1987). In addition, data is gathered relating to age, coping habits, and goal setting tendencies. Open-ended questions are used to ascertain suggestions to enhance undergraduate curriculum efforts in the aforementioned topic areas. Data was obtained from 51 Western Canadian Baccalaureate nursing students in their last day as an undergraduate. Results Quantitative results demonstrate a positive association between sense of coherence and satisfaction in nursing as a career choice; those with higher sense of coherence scores also demonstrating high levels of satisfaction with nursing. Those who regularly abuse substances to cope with stress were more likely to have lower sense of coherence scores. Additionally, those who were older were more likely to value formal goal setting. Qualitative data, elicited through open-ended questions within the questionnaire, suggested that students want more focused and student-centered curriculum on self-awareness, coping skill development, and goal ownership. Conclusions Sense of coherence is a significant factor for nursing students prior to practice entry. Specifically, it relates to their satisfaction with nursing as a career choice and their risks of engaging in substance abuse to cope with workplace stressors. In addition, age and goal-setting tendencies were also positively correlated. These findings are relevant to undergraduate student and educator practice readiness efforts and to new graduate nurse retention efforts. Résumé Contexte Le degré de préparation des étudiantes à la pratique en sciences infirmières est un sujet pertinent pour les professeures dédiées à les préparer à un milieu de pratique exigeant, mais aussi pour les employeurs des milieux de la santé confrontés à des taux élevés d’attrition chez les nouvelles diplômées. La littérature scientifique suggère que les facteurs de stress menant à l’épuisement professionnel apparaissent dès le premier cycle, et que les étudiantes infirmières qui ressentent cet épuisement présentent un risque considérablement plus élevé d’abandonner leur poste après seulement 10 à 15 mois (Rudman & Gustavsson, 2012; Rudman, Gustavsson & Hultell, 2014). Le degré de préparation d’une étudiante à la pratique renseigne sur la façon dont les nouvelles diplômées s’intègrent dans le milieu de la santé. Leur sens de la cohérence et leur capacité à s’adapter, à établir et à atteindre des objectifs constituent des facteurs essentiels à leur survie et à leur épanouissement dans leur milieu de travail. Cette étude inclut des étudiantes en sciences infirmières au dernier jour de leur quatrième année de formation et à l’orée de leur carrière. Objectifs Cette étude avait pour but d’examiner la relation entre les résultats au sens de la cohérence chez des étudiantes en sciences infirmières à la fin de leur programme de premier cycle et leur niveau de satisfaction quant aux sciences infirmières comme choix de carrière, leur capacité d’adaptation et leur propension à établir des objectifs. Méthodologie La méthode d’enquête transversale par questionnaire comportant une composante quantitative et une qualitative a été utilisée. Les scores liés au sens de la cohérence ont été obtenus à l’aide du questionnaire Orientation to Life Questionnaire (Antonovsky, 1987). De plus, des données relatives à l’âge, aux habitudes de coping et à la propension à établir des objectifs ont été recueillies. Les questions ouvertes visaient à obtenir des suggestions afin d’améliorer l’apport des programmes de premier cycle aux sujets susmentionnés. Les données ont été recueillies auprès de 51 étudiantes au dernier jour de leur programme de baccalauréat en sciences infirmières dans l’Ouest canadien. Résultats Les résultats quantitatifs indiquent une relation positive entre le sens de la cohérence et la satisfaction quant aux sciences infirmières comme choix de carrière; ainsi, les participantes ayant obtenu les plus hauts scores au sens de la cohérence démontrent un degré élevé de satisfaction par rapport aux sciences infirmières. Les participantes qui abusent régulièrement de substances pour gérer le stress ont plutôt obtenu des scores faibles au sens de la cohérence. En outre, les participantes plus âgées avaient davantage tendance à valoriser l’établissement formel d’objectifs. Les données qualitatives, obtenues par les questions ouvertes, indiquent que les étudiantes souhaitent un programme d’études plus axé sur les étudiantes, favorisant la conscience de soi, le développement d’habiletés de coping et l’appropriation de ses objectifs. Conclusions Le sens de la cohérence est un facteur essentiel à développer chez les étudiantes en sciences infirmières avant l’entrée dans la pratique. Il est plus précisément lié à leur satisfaction quant aux sciences infirmières comme choix de carrière et au risque d’opter pour l’abus de substances afin de gérer les facteurs de stress au travail. De plus, une corrélation positive entre l’âge et la propension à établir des objectifs a été établie. Ces résultats sont pertinents au regard des efforts de préparation à la pratique des étudiantes par les professeures de premier cycle, ainsi que de rétention des nouvelles diplômées en sciences infirmières

A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression

Amid an international pandemic and a worsening mental health crisis, ketamine-assisted therapy is emerging as a promising solution for those deemed “treatment resistant.” Post-traumatic stress disorder (PTSD) and depression are on the rise, with accelerating direct (e.g., burden of suffering) and indirect (e.g., disability/role impairment and impact on family) costs. Psychedelic-assisted therapies show significant promise in the treatment of a number of clinically challenging conditions, including depression, anxiety, PTSD, addiction, and end-of-life distress. Ketamine is currently the only safe, effective and legal widely available psychedelic-like medicine. To address the echo pandemic of health care provider distress, a multi-disciplinary team was charged with developing a ketamine-assisted psychotherapy program, delivered in a community of practice (CoP) group model and evaluated in a quality improvement framework. Program evaluation occurred through mixed methods. Quantitative mental health assessments included the PHQ-9 for depression, the PCL-5 for PTSD, GAD-7 for generalized anxiety disorder (GAD), and B-IPF for work/life functionality. Participant narrative feedback was collected to evaluate outcomes and for quality improvement purposes. Mean mental health scores were collected across three cohorts, totaling 94 patients. The mean aggregate scores of participants meeting the mental health assessment cut-off criteria (screening positive) were analyzed to assess clinical significance. Mean aggregate results comparing baseline vs. outcome measures (measured within 1–2 weeks after completion of the 12-week program) were clinically significant, demonstrating significant improvements in depression, post-traumatic stress disorder, generalized anxiety disorder and work/life functionality. In summary, 91% saw improvements in generalized anxiety, 79% saw improvements in depression, 86% of those who screened positive for PTSD now screen negative, and 92% had significant life/work functionality improvements. Qualitative feedback was overwhelmingly positive, with several unsolicited self-reports of transformation. Participant and team feedback enables the program to continue improving with each iteration. Results speak to the effectiveness of ketamine for psychedelic-assisted therapy, supported by a CoP framework. Outcomes are relevant for mental health programming, education and healthcare policy

Changes in Cognitive Control Following a Novel Resilience-Focused Nursing Educational Program: An Exploratory Study

Patient care is currently challenged by various factors including stress and nurse fatigue that can negatively impact nurses’ health and patient safety. Emotional exhaustion and burnout among nurses are at an all-time high. Canadian nurses are reporting clinical rates of depression, anxiety, and panic at disproportionately higher rates than other public safety personnel. Innovative educational programs are desperately needed to mitigate stress and relieve distress, which will ultimately promote a healthier and more productive workforce. Little is known about the effectiveness of research informed cognitive control education within a community of practice (COP) to help nurses and nursing students process difficult experiences in order to thrive in stressful work environments. The purpose of this exploratory mixed methods study is to determine if a novel nursing educational program that was embedded in a COP framework leads to changes in cognitive control in a combined group of 16 nurses and nursing students. It included the delivery of 20 hours of community interaction over a 5-week period. Changes in cognitive control were evaluated through electroencephalographic (EEG) measurements before and after completing the course. Participants’ perceived values and priorities for improvement were captured through a focus group. Data demonstrated an increase in cognitive control before and after the COP intervention. The focus group identified nine themes that centered on promoting connection, self-efficacy, non-attachment, accountability, and trauma-informed support, and culture change. Addressing emotional pain through structured relational practice and resilience development provides a larger context for understanding workplace stress, overload, and degraded function. Connecting these disparate stressors clarifies the supporting relationships between cognitive control, personal value, social identity, and spiritual purpose. Resilience development education within a COP improved cognitive control, promoted an alignment with personal values, buffered participants from workplace stress, and empowered them to carry their learnings as change agents in healthcare. The study was limited by a small sample size and a relatively homogenous population. Further research is needed to examine the impact of evidence-informed and resilience-focused COP on patient care, safety, and costs. Résumé Les soins aux patients sont touchés par divers facteurs, dont le stress et la fatigue des infirmières, qui pourraient avoir un impact négatif sur la santé des infirmières et la sécurité des patients. La prévalence de l’épuisement émotionnel et professionnel chez les infirmières n’a jamais été aussi élevée. Les infirmières canadiennes présentent des taux cliniques de dépression, de troubles d’anxiété et de panique disproportionnellement plus élevés que les autres employés de la sécurité publique. Des programmes éducatifs novateurs sont indispensables pour atténuer le stress et soulager la détresse; ils favoriseront, à terme, une main‑d’œuvre en meilleure santé et plus productive. Nous savons peu de choses sur l’efficacité de l’enseignement du contrôle cognitif fondé sur la recherche au sein d’une communauté de pratique (CDP) afin d’aider les infirmières et les étudiantes en sciences infirmières à surmonter les expériences difficiles et à s’épanouir dans un environnement de travail stressant. L’objectif de cette étude exploratoire à méthodologie mixte était de déterminer si un nouveau programme éducatif en sciences infirmières intégré dans un cadre de communauté de pratique pouvait améliorer le contrôle cognitif d’un groupe combiné de 16 infirmières et étudiantes en sciences infirmières. Le programme comprenait 20 heures d’interactions en communauté de pratique sur une période de 5 semaines. Les changements du contrôle cognitif ont été évalués par des mesures électroencéphalographiques (EEG) avant et après la formation. Les valeurs perçues par les participantes ainsi que les principales améliorations ont été recensées lors d’un groupe de discussion. Les résultats ont montré une augmentation du contrôle cognitif avant et après l’intervention en communauté de pratique. Le groupe de discussion a fait ressortir neuf thèmes axés sur la promotion des relations, de l’auto-efficacité, du non-attachement, de la responsabilité, du soutien adapté aux traumatismes vécus et du changement de culture. Le traitement de la souffrance émotionnelle par une pratique relationnelle structurée et le renforcement de la résilience offrent une perspective élargie qui permet de comprendre le stress au travail, la surcharge et la détérioration des rôles. La mise en relation de ces facteurs de stress variés permet de mieux comprendre les liens de soutien entre le contrôle cognitif, les valeurs personnelles, l’identité sociale et le but spirituel. L’enseignement du renforcement de la résilience dans le cadre d’une communauté de pratique a permis d’améliorer le contrôle cognitif, de favoriser l’adéquation avec les valeurs personnelles, de protéger les participantes du stress professionnel et de leur donner les moyens de transmettre leurs connaissances en tant qu’agentes de changement dans le domaine des soins de santé. Les limites de l’étude sont tracées par un échantillon de petite taille et une population relativement homogène. D’autres recherches seront nécessaires pour examiner les retombées de la communauté de pratique fondée sur des données probantes et axée sur la résilience sur le plan des soins aux patients, de la sécurité et des coûts

The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression

BackgroundSubanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties.MethodsThis article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives’ strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model’s various components, which are presented in detail.ResultsThe Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support.DiscussionOur integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model’s effectiveness and hypothesized psychological mechanisms

Why Are You Thriving When I’m Barely Surviving? An Exploration of Developmental Factors that Enable Novice Nurses to Thrive

Despite exposure to similar workplace stressors, some novice nurses manage to thrive while others experience high levels of emotional exhaustion and burnout. This qualitative research study of eight novice nurses from British Columbia, Canada explored the interplay of personal resiliency factors that enable nurses to thrive in their nursing roles. The study outcomes demonstrate that personal resiliency factors play a significant role in how the novice nurse participants interpreted workplace stimuli, either as challenges they felt confident to navigate, or as threatening stressors. The most prominent personal resiliency factors that impacted the novice nurses’ ability to thrive included congruence, self-compassion, self-efficacy, and the resulting ability to navigate workplace stressors. Personal resiliency impacts the ability to navigate the stressors endemic in many novice nurse work environments. Study results underscore the importance of resilience education for nurses in training and ongoing support as they cross the threshold into professional practice

A Study of the Interplay between New Graduate Life Experience, Context, and the Experience of Stress in the Workplace: Exploring Factors towards Self-Actualizing as a Novice Nurse

Prolonged levels of stress and feelings of insecurity in new graduate registered nurse work environments are an expected part of the transition experience, yet we continue to see high rates of emotional exhaustion leading to burnout. There is a significant amount of literature on the sources of new graduate stress. However, research is lacking regarding what makes one nurse more vulnerable than another within similar work environments. This qualitative study explored the interplay of life experiences that enable and disable eight new graduate nurses from engaging in the process of self-actualization or thriving. Three prominent themes emerged as significant factors that influence the new graduates’ ability to engage in self-actualization. Developmental factors were significant in the capacity to manage workplace stressors and included congruence from their childhood experience or time in their young adult life where they engaged in relationships that provided unconditional positive regard, the habitual practice of self-compassion, and the ability to resolve areas of moral and ethical dissonance. Biological factors also buffered the experience of stress in the field, which included age and having a personality suited to their nursing role. Finally, contextual factors included having a trusted mentor at work, feelings of meaning and purpose within another life role, threats of emotional and physical violence in the workplace, workloads that took novice inefficiencies into account, limiting redeployment, and work schedules that allowed for adequate rest between sets. These insights inform nursing curriculum and transition programs by deepening the understanding of the interplay between previous and current contexts and the experience of stressors that are endemic in the workplace

A photon thermal diode.

A thermal diode is a two-terminal nonlinear device that rectifies energy carriers (for example, photons, phonons and electrons) in the thermal domain, the heat transfer analogue to the familiar electrical diode. Effective thermal rectifiers could have an impact on diverse applications ranging from heat engines to refrigeration, thermal regulation of buildings and thermal logic. However, experimental demonstrations have lagged far behind theoretical proposals. Here we present the first experimental results for a photon thermal diode. The device is based on asymmetric scattering of ballistic energy carriers by pyramidal reflectors. Recent theoretical work has predicted that this ballistic mechanism also requires a nonlinearity in order to yield asymmetric thermal transport, a requirement of all thermal diodes arising from the second Law of Thermodynamics, and realized here using an 'inelastic thermal collimator' element. Experiments confirm both effects: with pyramids and collimator the thermal rectification is 10.9 ± 0.8%, while without the collimator no rectification is detectable (<0.3%)

Retraction: A photon thermal diode.

This corrects the article DOI: 10.1038/ncomms6446