What have we learnt from real-life research in asthma and COPD? : Standards and novel designs for the future

Acknowledgements We thank Dr Ruth B Murray (Medscript NZ Ltd) and Celine Goh, MBBS for their assistance in drafting and editing this commentary.Peer reviewedPublisher PD

Biomarker-defined clusters by level of Type 2 inflammatory involvement in severe asthma

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Real-life biomarker response to anti-IL5 and anti-IgE therapies in severe asthma patients

Funding: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by OPRI for its contribution.Peer reviewedPostprin

Older nurses: A literature review on challenges, factors in early retirement and workforce retention

Introduction: The widespread shortage of nurses has been exacerbated by an ageing workforce. Though skilled and productive, older nurses are more vulnerable to the physical and mental demands of nursing. Hence, this review was performed to determine the existing evidence on challenges faced by older nurses, factors which promote or deter retirement and strategies that could help in their retention. The results of this review would help with the implementation of age-friendly initiatives to enable older nurses to work longer, while simultaneously allowing institutions to maintain high-quality nursing care. Methods: A search was done using three databases, namely MEDLINE, the Nursing and Allied Health Literature (CINAHL) and PsycINFO. Primary studies and reviews published between 2004 and 2015 were retrieved. Keywords used were ‘older nurses’, ‘retirement’, ‘re-employment’ and ‘retention’. Results: Articles retrieved were mainly qualitative studies. A few quantitative surveys and reviews were reported. The definition of older nurses was inconsistent across the literature. Personal health concerns and limitations, computerisation and shift work were common challenges faced by older nurses, while monetary factors, health and workload were consistent themes on early retirement. Financial reasons were also identified as factors associated with retention, along with flexible schedules. Almost all strategies suggested in the literature for retaining older nurses lacked empirical testing. Conclusion: The ageing process may render certain tasks less desirable and more challenging for the older nurses. Employers could pay attention to the needs of an older workforce through improved workplace practices and being familiar with factors associated with early retirement and retention

Differing pathways to resiliency: A grounded theory study of enactment of resilience among acute care nurses

It is well-recognized that nurses are exposed to high levels of stress, thus resilience has been postulated as a key trait in enabling nurses to cope successfully and remain in the profession. In this qualitative study, we used Glaser's approach to grounded theory. Nine nurses who scored low and nine nurses who scored high on the Connor–Davidson Resilience Scale were recruited for one-on-one semistructured interviews of the factors contributing to their work-related stress and how they overcome these stressors. Three categories emerged from the data: outlook on work, self-efficacy, and coping responses. These categories led to the emergence of the theory “differing pathways to resiliency”. Despite the stresses experienced at work, some nurses were highly resilient, while others were not. Highly-resilient nurses tend to adopt active coping mechanisms, whereas nurses who have low resilience tend to undertake passive measures to let nature runs its course. The emerging theory provided an understanding of the different pathways to resiliency and how nurse leaders can potentially develop and grow the level of resiliency among nurses

A Photovoice study on nurses’ perceptions and experience of resiliency

Aim: To explore the meaning of resilience to nurses and their perceived resilience enhancing factors. Background: With challenges faced at work, nurses’ professional quality of life is adversely affected with nurses experiencing compassion fatigue, depression, burn‐out and even signs of post‐traumatic stress disorder. Degree of resilience can determine job satisfaction and nursing attrition. Methods: The study adopted a descriptive qualitative design using Photovoice. Eight nurses from an academic medical centre in Singapore participated in focus group interviews and data were analysed with inductive content analysis approach. Results: Four themes were generated: (a) resilience is performing nursing duties despite adversities; (b) resilience is a dynamic process that develops over time; (c) religion and faith help build resilience; and (d) support of others is important in overcoming work‐related stress. Conclusions: Knowledge on resilience is vital to understand influencing factors of personal resilience and relationship to stress and burnout. Building nurses’ resilience is significant to improve and sustain healthy and effective functioning of nurses. Implications for nursing management: With sufficient external resources and psychosocial support from hospital administrators, early resilience‐based approach may provide the buffer and protective factor in facing workplace stress, to improve overall job satisfaction and improve nurses’ retention

Understanding the influence of resilience on psychological outcomes — Comparing results from acute care nurses in Canada and Singapore

Background: Building resilience among nurses is one of the ways to support and retain nurses in the profession. Prior literature which evaluated influence of resilience on psychological outcomes, were conducted in relatively homogeneous populations. It is of interest to evaluate whether relationships between resilience and psychological outcomes remain consistent across nations and among different nursing populations. Aim: To evaluate a theoretical model of the impact of resilience on burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS) by comparing results between nurses in Canada and Singapore. Method: A self-reported questionnaire consisting of questions on demographics, resilience (Connor-Davidson Resilience Scale), and psychological adjustment (Professional Quality of Life) was administered via an online survey. One thousand three hundred and thirty-eight nurses working in two Academic Medical Centres in Singapore responded to the online survey. Similar data was also collected from 329 nurses in Canada. Hypotheses were tested using structural equation modeling. Results: Resilience exerts a significant negative direct impact on STS, and a significant negative direct impact on BO. Additionally, resilience has a positive direct impact on compassion satisfaction. STS exerts a positive direct impact on BO while CS has a negative direct impact on BO. Conclusion: Current study affirmed significant associations between resilience and professional quality of life. Knowledge on resilience is key in informing design and implementation of resilience-building strategies that include professional development, and strengthening of interpersonal skills. A resilience-based approach will help reduce nurses' BO and STS while caring for their patients, and in turn reduce turnover

Adult severe asthma registries : a global and growing inventory

Acknowledgement The authors would like to thank Mr Joash Tan (BSc, Hons) and Ms Andrea Lim (BSc, Hons) of the Observational Pragmatic Research Institute (OPRI) for their editorial and formatting assistance that supported the development of this publication. The author would also like to acknowledge the collaborators from the following countries, for their valuable contribution to the publication. Funding statement This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was funded by Optimum Patient Care Global. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contributionPeer reviewedPublisher PD