The Impact of Burnout on Emergency Nurses’ Intent to Leave: A Cross-Sectional Survey

IntroductionEmergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave.MethodsA cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses’ intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale.ResultsThe findings revealed that a formal orientation enhanced emergency nurses’ sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment.DiscussionEmotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses’ intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work–life balance and staff retention.     

Dosage Optimization of Efavirenz Based on a Population Pharmacokinetic–Pharmacogenetic Model of HIV-infected Patients in Thailand

PurposeEfavirenz exhibits high interindividual variability in plasma concentrations, leading to unpredictable efficacy and toxicity. Polymorphism of CYP2B6 516G > T has been found to predominantly contribute to efavirenz variability. However, dosage recommendations incorporating CYP2B6 516G > T polymorphism have not been investigated in the Thai population. This study aimed to develop a population model of the pharmacokinetic properties of efavirenz, and to investigate the impact of patients' characteristics and CYP2B6 516G > T polymorphism on the pharmacokinetic properties of efavirenz. Model-based simulations were performed to provide genotype-based dosage optimization in a Thai population.MethodsPlasma efavirenz concentrations measured at 12 h post-dose in 360 Thai HIV-infected patients with and without tuberculosis were analyzed by the nonlinear mixed-effects modeling approach. A 1-compartment model with first-order absorption and elimination was used for describing the pharmacokinetic properties of efavirenz.FindingsThe allele frequency of CYP2B6 516G > T was 34.17%. The efavirenz oral clearance were 11.9, 8.0, and 2.8 L/h in patients weighing 57 kg and having the CYP2B6 516 GG, 516 GT, and 516 TT genotypes, respectively. The use of rifampicin increased efavirenz oral clearance by 28%. The results from the simulations suggest that efavirenz dosages of 400, 300, and 100 mg once daily in Thai HIV mono-infected patients, and 800, 600, and 200 mg once daily in HIV/tuberculosis co-infected patients carrying CYP2B6 516 GG, 516 GT, and 516 TT, respectively.ImplicationThe results from this study provide a rationale for efavirenz dose adjustment based on CYP2B6 516G > T polymorphism in Thai HIV-infected patients, which could help to improve treatment outcomes in this population. ClinicalTrials.gov identifier: NCT01138267.     

Do Psychological Characteristics of Mothers Predict Parenting Stress? A Cross-Sectional Study among Mothers of Children with Different Disabilities

BACKGROUND/OBJECTIVE

We aimed at assessing the parenting stress levels among mothers of children with different disabilities and its association with various mothers' psychological characteristics.

Impact of an Implementation Science Study on Nursing Leader’s Competencies: A Qualitative Study

Nursing leaders must engage with evidence-based practice (EBP) to advance quality patient care. The purpose of this study was to understand the impact of an implementation science study on nurse manager competencies. Qualitative focus group interviews were conducted with leaders following an implementation science study. The AONL Nurse Manager Competency Framework was used as a guide. Leaders felt they were able to promote EBPs, influence others, and grow in their professional role after participating in the implementation science study. Involvement in nurse-led implementation science research can enhance frontline leaders’ ability to engage with and promote EBP.     

Potential Misfortunes in ‘Making Sense’: A Cross-Sectional Study in People with Chronic Pain

Making sense of one's circumstances is normally regarded as helpful, including in the context of chronic pain. However, sense-making may be associated with adverse impacts in daily functioning. To better understand the functions of sense-making, the objective of the current study was to develop, validate, and preliminarily examine a measure of potentially helpful and unhelpful forms of sense-making behavior in people seeking treatment for chronic pain. This measure is called the Sense Making Questionnaire (SMQ). Research participants included 451 adults consecutively attending a specialty interdisciplinary treatment for chronic pain. Data for this study derived from a standard set of measures participants completed prior to treatment. Exploratory Factor Analysis (EFA) produced a 3-factor solution based on 15 items, including Avoidance of Incoherence, Overthinking, and Functional Coherence. The first 2 of these factors and the total achieved adequate internal consistency. Construct validity of the SMQ scores was supported by significant correlations with measures of pain acceptance, committed action, cognitive fusion, and intolerance of uncertainty. The SMQ total score correlated significantly with pain interference, r = .23, depression, r = .41, and work and social adjustment, r = .30, all P < .001. In multiple regression analyses the total score also significantly predicted depression after age, gender, education, pain duration, pain intensity, and pain acceptance were statistically controlled, and it accounted for an additional 8.0% in explained variance. It appears that there is a distinction between literal coherence and functional coherence. In some situations, it may benefit people with chronic pain to shift focus from efforts to make literal sense of pain and instead to keep the focus on taking effective action even if this does not appear at first to make sense.PerspectiveThis study in people seeking treatment for chronic pain includes development of a measure of behavior patterns related to making sense in chronic pain. It shows that sometimes these behavior patterns can be ineffective, as they appear negatively associated with emotional, physical, and social functioning.     

Clinicians’ attitudes towards escalation and management of deteriorating patients: A cross-sectional study

BackgroundInternationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient.ObjectiveThe objective of this study was to explore clinicians’ attitudes towards the escalation, and management of the deteriorating patient.MethodsA cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians’ Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient.ResultsSurvey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001).ConclusionNurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.     

Parental Perceptions of Siblings’ Grieving After a Childhood Cancer Death: A Longitudinal Study

We investigated longitudinally parental perceptions of siblings' bereavement after childhood cancer death. Parents were interviewed 6 months (n = 25) and 18 months (n = 15) post-death. Data are analyzed combined and over time. The following themes emerged: (a) expression of grief: missing deceased child (verbally, crying), behavioral problems, difficulty understanding the meaning of death (pre-schoolers), and avoiding talking with parents about feelings (adolescents); (b) what helps siblings grief: moving on, talking about deceased child and social support; (c) relationship with parents improved for most siblings; and (d) bond with deceased sibling: pretend-play (preschoolers), dreaming, and career choices (adolescents). Over time, themes reflected stability and change.     

Development of a Sexual Needs Rehabilitation Framework in Women Post–Spinal Cord Injury: A Study From Iran

Objective

To develop a sexual needs rehabilitation framework in women after spinal cord injury (SCI).

Spinal Cord Injury With a Narrow Spinal Canal: Utilizing Torg’s Ratio Method of Analyzing Cervical Spine Radiographs

A 65-year-old inebriated mancrashed his car and presented with spinal shock and neurogenic shock from a cervical spinal cord injury without cervical spine fracture or dislocation. The lateral cervical spine radiography was initially read as normal, except for degenerative disk disease; however, Torg’s ratio method of analyzing cervical spinal canal sagittal width indicated the spinal canal was congenitally narrow. Magnetic resonance imaging confirmed this and showed bulging and herniation of multiple invertebral disks between C2 and C7. This case illustrates the value of using Torg’s ratio method of analyzing lateral cervical spine radiographs. Although Torg’s method has not been prospectively validated, it may be useful to identify patients at risk for cervical spinal cord injuries without fractures or dislocations. An abnormal Torg’s ratio may be the only clue to the fact that the patient is at higher risk of spinal cord injury when the patient’s history or examination is questionable because of head injury, drug intoxication, or therapeutic sedation and paralysis.     

Correlations Between Individuals’ Characteristics and Spinal Stiffness in Individuals With and Without Back Pain: A Combined Analysis of Multiple Data Sets

Objective

The purpose of this study was to describe the correlations between individual characteristics and spinal stiffness as measured with different spinal stiffness measurement devices in individuals with and without back pain.

Emergency Room Psychiatric Services: A Qualitative Study of Nurses’ Experiences

Emergency nurses working in general emergency divisions (EDs) are primarily trained to assess and treat acute physical problems. However, ED nurses often care for psychiatric patients and the perceptions of nurses in EDs regarding their experiences with psychiatric patients have not been well-studied. Using focus groups, the purpose of this study was to explore and describe ED nurses’ experiences, and feelings caring for patients with mental illness. Krueger and Casey's qualitative analysis for focus groups was utilized to code and categorize phrases and identify themes from transcribed interviews. Four themes emerged; powerlessness best captured the overarching and substantive experience of the participants. Based on the findings, implications for emergency room care of psychiatric patients are described.     

The Influence of Students’ Perceptions of Learning Environment on Coping with Academic Challenges: A Structural Equation Modeling Study

Abstract

Theory: Self-compassion has been identified as a promising interventional target enabling medical learners to respond effectively to stressors and challenges of medical training. Determining factors in the learning environment that support self-compassion is critical for developing such interventions. What is already known in terms of environmental or contextual factors is that learning environments that are supportive of students’ basic psychological needs for autonomy, competence, and relatedness result in better learning and wellbeing outcomes. As such, satisfaction of basic psychological needs in the learning environment was tested for potential effects on self-compassion among medical students. Hypothesis: It was hypothesized that medical students who perceived their needs for autonomy, competence, and relatedness were supported in the learning environment would be more likely to respond to stressors and challenges by means of positive processes of self-compassion (common humanity, mindfulness, self-kindness) and less likely by means of negative processes of self-compassion (isolation, over-identification, self-judgment). Two models were tested: Model 1 contained the effects of the needs for autonomy, competence, and relatedness on two factors of self-compassion that comprise three positive and three negative processes, respectively. Model 2 contained the direct effects of the psychological needs on six individual processes of self-compassion. Method: Using two online surveys, authors collected data from medical students (n?=?195) at a large Canadian university. The authors used the 12-item basic psychological needs scale to measure the degree of satisfaction of students’ needs for autonomy, competence, and relatedness in the learning environment, as perceived by students. The 12-item self-compassion scale was used to measure the degree of compassion students exhibited toward themselves in challenging times in the medical program. The authors used structural equation modeling (SEM) to test the hypothesized relationships between basic psychological needs satisfaction and self-compassion. Results: The SEM results for Model 2 indicated an improved model fit over Model 1; however, not all the hypothesized effects were determined to be significant in the two models. In the better fitting model (Model 2), significant effects were observed between the needs for competence and relatedness and the three negative processes of self-compassion (isolation, over-identification, self-judgement). Specifically, the need for relatedness had comparable effects on all three negative processes of self-compassion. The need for competence had a significant effect only on isolation. The need for autonomy had no effects on self-compassion processes. None of the effects involving the positive processes of self-compassion (common humanity, mindfulness, self-kindness) were significant. Conclusions: Satisfaction of medical students’ needs for competence and relatedness in the learning environment appears to reduce the negative processes of self-compassion. Future research is needed to determine why basic psychological needs satisfaction appears to have no effects on the positive processes of self-compassion and what factors are likely to foster these beneficial processes among medical students.     

SALIENT FINDINGS: A Potentially Groundbreaking Study on the Neuroscience of Hypnotizability,a Critical Review of Hypnosis’ Efficacy,and the Neurophysiology of Conversion Disorder

Three papers of special interest to researchers and clinicians alike have recently appeared in the general scientific and medical literatures. Two of these papers are original research studies that employ brain-imaging technologies, one using Magnetic Resonance Imaging (MRI), the other position emission tomography (PET). A third paper is a comprehensive review of the empirical findings on the clinical use of hypnosis in pediatric oncology. The research study using MRI technology is extraordinary, because it is the first to document differences in brain morphology between high hypnotizable and low hypnotizable individuals. Arguably, if its findings replicate, the study could be one of the most important developments in scientific hypnosis since the genesis of the Stanford scales 45 years ago. The PET study notes differences in brain activation during intentionally simulated and hypnotically experienced paralysis. The review article examines empirical work addressing the efficacy of hypnosis for procedural pain in pediatric oncology.