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1: COVID-19 ANXIETY AMONG FRONTLINE NURSES: PREDICTIVE ROLE OF ORGANISATIONAL SUPPORT, PERSONAL RESILIENCE AND SOCIAL SUPPORT
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Posted 17 Jul 2020

COVID-19 ANXIETY AMONG FRONTLINE NURSES: PREDICTIVE ROLE OF ORGANISATIONAL SUPPORT, PERSONAL RESILIENCE AND SOCIAL SUPPORT
14,647 downloads medRxiv nursing

Leodoro Labrague, Janet Alexis De los Santos

Aim: This study examines the relative influence of personal resilience, social support and organisational support in reducing COVID-19 anxiety in frontline nurses. Background: Anxiety related to the COVID-19 pandemic is prevalent in the nursing workforce, potentially affecting nurses well-being and work performance. Identifying factors that could help maintain mental health and reduce coronavirus-related anxiety among frontline nurses is imperative. Currently, no studies have been conducted examining the influence of personal resilience, social support and organisational support in reducing COVID-19 anxiety among nurses. Methods: This cross-sectional study involved 325 registered nurses from the Philippines using four standardised scales. Results: Of the 325 nurses in the study, 123 (37.8%) were found to have dysfunctional levels of anxiety. Using multiple linear regression analyses, social support, personal resilience and organisational support predicted COVID-19 anxiety. Nurse characteristics were not associated with COVID-19 anxiety. Conclusions: Resilient nurses and those who perceived higher organisational and social support were more likely to report lower anxiety related to COVID-19. Implication for Nursing Management: COVID-19 anxiety may be addressed through organisational interventions, including increasing social support, assuring adequate organisational support, providing psychological and mental support services and providing resilience-promoting and stress management interventions.

2: LOCKDOWN FATIGUE AMONG COLLEGE STUDENTS DURING THE COVID-19 PANDEMIC: PREDICTIVE ROLE OF PERSONAL RESILIENCE, COPING BEHAVIOURS, AND HEALTH
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Posted 20 Oct 2020

LOCKDOWN FATIGUE AMONG COLLEGE STUDENTS DURING THE COVID-19 PANDEMIC: PREDICTIVE ROLE OF PERSONAL RESILIENCE, COPING BEHAVIOURS, AND HEALTH
3,586 downloads medRxiv nursing

Leodoro Labrague, Cherry Ann Ballad

BackgroundThe lockdown measures imposed by many countries since the onset of the COVID-19 pandemic have been useful in slowing the transmission of the disease; however, there is growing concern regarding their adverse consequences on overall health and well-being, particularly among young people. To date, most studies have focused on the mental health consequences of the lockdown measures, while studies assessing how this disease control measure influences the occurrence of fatigue are largely absent. AimThe aims of this study are two-fold: (a) to examine the levels of lockdown fatigue, and (2) to determine the role of coping behaviours, personal resilience, psychological well-being and perceived health in fatigue associated to the lockdown measure. MethodsThis is an online cross-sectional study involving 243 college students in the Central Philippines during the sixth month of the lockdown measure implemented due to the COVID-19 pandemic. Five standardised scales were used to collect the data. ResultsOverall, college students reported moderate levels of lockdown fatigue, with a mean score of 31.54 (out of 50). Physical exhaustion or tiredness, headaches and body pain, decreased motivation and increased worry were the most pronounced manifestations of fatigue reported. Gender and college year were identified as important predictors of fatigue. Increased personal resilience and coping skills were associated with lower levels of lockdown fatigue. ConclusionCollege students experience moderate levels of fatigue during the mandatory lockdown or home confinement period. Resilient students and those who perceive higher social support experience lower levels of fatigue during the lockdown period compared to students with low resilience and social support. Lockdown fatigue may be addressed by formulating and implementing interventions to enhance personal resilience and social support among college students.

3: Evaluation of Knowledge, Practices, Attitude and Anxiety of Pakistans Nurses towards COVID-19 during the Current Outbreak in Pakistan
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Posted 07 Jun 2020

Evaluation of Knowledge, Practices, Attitude and Anxiety of Pakistans Nurses towards COVID-19 during the Current Outbreak in Pakistan
3,212 downloads medRxiv nursing

Shaheena Salman Alwani, Muhammad Mansoor Majeed, Monia Zeeshan Hirwani, Shahzad Rauf, Syed Muhammad Saad, Sheikh Haroon Shah, Faiq Munir Hamirani

Since the emergence of novel corona virus the front line soldiers during this pandemic are the healthcare professionals because of their direct association with the patients. In the management of COVID-19 patient nurses play a significant role through proper care and preventive measures. Due to the contagious nature, fatality and no proper medicine, it is a risk to the health and life of nurses and has impact on their psychological health. In the current study we accessed the knowledge, attitude, practices and anxiety levels of the nurses who are directly involved in the management of COVID-19 patients. It was an online questionnaire based cross sectional survey targeted only those only nurses involved in the management of COVID-19 patients from different hospitals of Karachi, Pakistan. SPSS 21 was used for data analysis. Descriptive analysis, Chi Square and t-tests were applied. Value <0.05 was considered significant. Data of 78 nurses were analyzed .We observed that nurses possess good knowledge about COVID-19, its sources, symptoms, routes of transmission of virus and etc. The knowledge mean score was calculated 14.67 {+/-} 3.36. Health department /Hospital and social media are the main sources of information regarding COVID-19. We investigated that 92.3% of the nurses had mild to very severe anxiety and anxiety levels are significantly higher among the females (P<0.05). We conclude that the nurses performing their duties with COVID-19 positive patients have good knowledge and attitude. But their anxiety levels are high. Psychological interventions along with training should be given.

4: OPTIMIZING COVID-19 VACCINE USAGE
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Posted 05 Jan 2021

OPTIMIZING COVID-19 VACCINE USAGE
2,405 downloads medRxiv nursing

Carlos P Jara, Licio Velloso, Eliana Pereira de Araujo

As the worldwide vaccination, it is imperative to minimize vaccine wastage by effectively using all doses available. Vaccine wastage can occur at multiple points during the vaccination process, but it is mainly because the device dead space and the filling process technique. However, there are no studies discussing the waste volume effect of COVID-19 vaccines in clinical practice. There is an increasing COVID-19 vaccine demand that we estimate up to several billion dual doses. The objective of this study was to assess the number of 0.3mL doses obtained from a multiple-dose vial using 1ml and 3ml syringes with different type of needles replicating the first COVID-19 vaccination protocol. Our results suggest that it is possible to obtain six or seven doses from each vial instead five. We provide evidence to optimize between 20% and 40% additional vaccine doses per vial if the current 5-dose vials are used, making scarce supplies go further. It is our duty, as researchers, to ensure the efficacy and efficiency of the worldwide COVID-19 vaccination process. However, if standard syringes-needles and technique are used, there may not be sufficient volume to draw extra doses from a single vial.

5: Approaches used to enhance transition and retention for newly qualified nurses (NQNs): a rapid evidence assessment
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Posted 07 Feb 2020

Approaches used to enhance transition and retention for newly qualified nurses (NQNs): a rapid evidence assessment
1,804 downloads medRxiv nursing

Jane Wray, Helen Gibson, David Barrett, Roger Watson

AimTo undertake a rapid evidence assessment of approaches used to enhance nurse transition and retention for NQNs. DesignA rapid evidence assessment. Data sourcesElectronic databases (CINAHL complete, Academic search premier, Open Grey, ERIC* (Education), Web of Science--Social Science Citation Index and PubMed) Review methodsA rapid evidence assessment (REA) was undertaken to gain an overview of the density and quality of evidence on nurse transition and retention from student to Registered Nurse. Electronic databases were searched, and the full texts of relevant papers were retrieved and classified according to methodology. Studies were appraised using relevant CASP and MMAT tools and a single descriptor of quality: high; medium; or low was assigned to each output. Given the disparity in methods, the lack of randomized trials, results could not be combined; therefore, a descriptive approach was used to synthesise and present the data. ResultsOrientation and creating supportive environments were frequently reported as being effective in enhancing transition across a range of studies. A range of methods: quasi-experimental, survey and qualitative were used. Generally speaking the quality of most studies was poor. ConclusionsDespite decades of research into the experiences of NQNs and development of schemes and frameworks to support them during this period, there is little substantive or robust evidence in terms of impact on retention. Further research into the longer-term retention of NQNs is recommended. Longitudinal studies would be beneficial in assessing the efficacy of approaches to enhancing retention. ImpactNurse managers need to work with education providers to facilitate experiences for final year nursing students to ease transition and also implement effective evidence based practices during the first year of registration and monitor the impact of this on retention.

6: The support needs of Australian primary health care nurses during the COVID-19 pandemic
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Posted 20 Jun 2020

The support needs of Australian primary health care nurses during the COVID-19 pandemic
1,782 downloads medRxiv nursing

Elizabeth Halcomb, Anna Williams, Christine Ashley, Susan McInnes, Catherine Stephen, Kaara Ray Calma, Sharon James

Aim: To identify Australian primary healthcare nurses immediate support needs during the COVID-19 pandemic. Background: COVID-19 has had widespread implications for primary healthcare nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. Methods: Primary healthcare nurses were recruited to an online survey via social media and professional organisations in April 2020. Results: Six-hundred and thirty-seven responses were included in analysis. Participants provided 1213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely; personal protective equipment, communication, funding, industrial issues, self-care, workplace factors and valuing nurses. Conclusion: A number of key issues relating to personal health and safety, care quality, and job security need to be addressed to support primary healthcare nurses during the COVID-19 pandemic. Addressing these support issues can assist in retaining nurses and optimising the role of primary healthcare nurses during a pandemic. Implications for nursing management: Responding to the needs of primary healthcare nurses has the potential to facilitate their role in providing community-based healthcare. This knowledge can guide the provision of support for primary healthcare nurses during the current pandemic, as well as informing planning for future health crises.

7: Implementation of nursing process in Ethiopia and its association with working environment and knowledge: a systematic review and meta-analysis
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Posted 08 Oct 2019

Implementation of nursing process in Ethiopia and its association with working environment and knowledge: a systematic review and meta-analysis
1,635 downloads medRxiv nursing

Wondimeneh Shibabaw Shiferaw, Yared Asmare, Tadesse Yirga, Abate Dargie

BackgroundNursing Process is a scientific problem solving approach to direct nurses in caring for clients effectively and to improve quality of health care service. In Ethiopia, the national pooled prevalence of implementation of nursing process remains unknown. Hence, the objective of this systematic review and meta-analysis was to estimate the level of implementation of nursing process and it association with knowledge and working environment. MethodsPubMed, Scopus, Cochrane Library, Google Scholar, PsycINFO and CINAHL were systematically searched online to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Eggers regression test statistic. The random-effect model was fitted to estimate the summary effects, and odds ratios (ORs). All statistical analysis was done using STATA version 14 software for windows. ResultsSeven studies which comprises of 1,268 participants were included in this meta-analysis. The estimated pooled prevalence of implementation of nursing process in Ethiopia was 42.44% (95% CI (36.91, 47.97%)). Based on the subgroup analysis, the highest implementation of nursing process was observed sample size greater than or equals to two hundred, 44.69% (95% CI: 35.34, 54.04). Nurses who have been work in the stressful environment [(OR 0.41, 95%CI (0.08, 2.12)] and having good knowledge about nursing process [(OR 2.44, 95%CI (0.34,17.34)] was not significant associated with the implementation of nursing process. ConclusionThe overall implementation of nursing process in Ethiopia is relatively low. Nurses who have been work in the stressful environment have less likely implement nursing process. On the other hand, Nurses who had good knowledge on nursing process were more likely to implement nursing process. Therefore, policymakers (FMOH) and other concerned body need give special attention to improve the implementation of nursing process.

8: Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis
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Posted 25 Nov 2020

Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis
1,609 downloads medRxiv nursing

Petros A Galanis, Irene Vraka, Despoina Fragkou, Angeliki Bilali, Daphne Kaitelidou

Background: During the COVID-19 pandemic, physical and mental health of the nurses is greatly challenged since they work under unprecedented pressure and they are more vulnerable to the harmful effects of the disease. Aim: To examine the impact of the COVID-19 pandemic on nurses' burnout and to identify associated risk factors. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review and meta-analysis. PubMed, Scopus, ProQuest, and pre-print services (medRxiv and PsyArXiv) were searched from January 1, 2020 to November 15, 2020 and we removed duplicates. We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high. Findings: Fourteen studies, including 17,390 nurses met the inclusion criteria. Five standardized and valid questionnaires were used to measure burnout among nurses; Maslach Burnout Inventory, Copenhagen Burnout Inventory, Professional Quality of Life Scale version 5, Mini-Z, and Spanish Burnout Inventory. The overall prevalence of emotional exhaustion was 34.1% (95% confidence interval [CI]: 22.5-46.6%), of depersonalization was 12.6% (95% CI: 6.9-19.7%), and of lack of personal accomplishment was 15.2% (95% CI: 1.4-39.8%). The following factors were associated with increased nurses' burnout: younger age, higher educational level, higher degree, decreased social support, having a relative/friend diagnosed with COVID-19, low family and colleagues readiness to cope with COVID-19 outbreak, increased perceived threat of Covid-19, longer working time in quarantine areas, working in a high-risk environment (a COVID-19 designated hospital, a COVID-19 unit, etc.), working in hospitals with inadequate and insufficient material and human resources, decreased working safety while caring for COVID-19 patients, increased workload, decreased self-confidence in self-protection, and lower levels of specialized training regarding COVID-19, job experience, and self-confidence in caring for COVID-19. Conclusion: Nurses experience high levels of burnout during the COVID-19 pandemic, while several sociodemographic, social, and occupational factors affect this burnout. Several interventions need to be implemented to mitigate mental health impact of the COVID-19 pandemic on nurses, e.g. screening for mental health illness and early supportive interventions for high-risk nurses, immediate access to mental health care services, social support to reduce feelings of isolation, sufficient personal protective equipment for all nurses to provide security, etc. Governments, health care organizations, and policy makers should act in this direction to prepare health care systems, individuals, and nurses for a better response against the COVID-19 pandemic.

9: The day-to-day experiences of caring for children with Osteogenesis Imperfecta: A qualitative descriptive study
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Posted 05 Oct 2019

The day-to-day experiences of caring for children with Osteogenesis Imperfecta: A qualitative descriptive study
1,524 downloads medRxiv nursing

Aimee R. Castro, Jessica Marinello, Khadidja Chougui, Marilyn Morand, Claudette Bilodeau, Frank Rauch, Argerie Tsimicalis

PurposeOsteogenesis Imperfecta (OI) is a rare genetic condition known to cause bone fragility. Family caregivers, such as parents, of children with OI play an important role in helping these children live well at home. This study aimed to explore the day-to-day experiences of caregivers who are caring for children with OI. Materials and MethodsA qualitative descriptive study was conducted. Eighteen adult caregivers of children with OI were recruited at a childrens hospital in Montreal, Canada to participate in individual interviews. The interviews were transcribed and inductively thematically analysed. ResultsThe following caregiving themes were identified in these interviews: regular day-to-day caregiving activities, including morning routines, evening routines, and the facilitation of their childs mobilization; periods that made the caregiving routine more challenging, such as fractures, surgeries, and pain; and the long-term strategies caregivers employed to support day-to-day care, such as managing the environment, accessing medical and school resources, and coordinating care and respite. ConclusionsThe results showcase what being a caregiver for a child with OI involves on a day-to-day basis. The recommendations include suggestions for future clinical, policy, and research endeavours to better support family caregivers of children with OI.

10: State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Mixed-methods Cross-sectional Survey Study
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Posted 23 Mar 2020

State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Mixed-methods Cross-sectional Survey Study
1,448 downloads medRxiv nursing

Jessica Castner, Lenore Boris

IntroductionState regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments. MethodsA mixed-methods approach was used with a cross-sectional nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, x-rays, over the counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols. Results350 surveys from 48 states and the District of Columbia were received. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with scope of practice prohibitions. Four qualitative categories emerged: advantages, approval, prohibition, and conditions under which protocols can be used. Prohibitive language was associated with less protocol use for emergency care. ConclusionState scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.

11: Psychological preparedness for pandemic (COVID-19) management: Perceptions of nurses and nursing students in India
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Posted 25 Sep 2020

Psychological preparedness for pandemic (COVID-19) management: Perceptions of nurses and nursing students in India
1,223 downloads medRxiv nursing

Sailaxmi Gandhi, Maya Sahu, Radhakrishnan Govindan, Prasanthi Nattala, Paulomi M Sudhir, Rathi Balachandran

Introduction: The growing COVID-19 pandemic has posed a great threat to millions of people worldwide. Nurses and nursing students are an important group of health professionals who are most likely to face many challenges in this unprecedented scenario. The present study aimed at exploring the perception of nurses and nursing students regarding psychological preparedness for the pandemic (COVID-19) management. Materials & Methods: The study employed a quantitative cross-sectional online survey research design. Purposive sampling was used with an attempt to represent the entire nurses (i.e. nursing officers, nurse administrators and nursing teachers) and nursing students group of India. The survey link was shared to their email ID and they were invited to participate in the study. Data were collected using Psychological Preparedness for Disaster Threat Scale (PPDTS)-Modified, General Self Efficacy (GSE) Scale, Optimism Scale and Brief Resilient Coping Scale (BRS). Totally 685 responses were received and 676 forms were completed which were analyzed using SPSS software (version 24). Results: The mean age of the subjects was 31.72 (SD=9.58) years. Around 20% of the subjects previously had some kind of psychological training and 4% of the subjects had taken care of persons with COVID-19. Findings revealed that mean score for PPDTS, GSE, BRCS and Optimism was 73.44 (SD=10.82, 33.19 (SD=5.23), 16.79 (SD=2.73) and 9.61 (SD=2.26) respectively indicating that the subjects had moderate level of psychological preparedness, self-efficacy and resilience but higher level of optimism. Psychological preparedness, self-efficacy, optimism and resilience were positively correlated to each other. Self- efficacy, optimism, and resilience emerged as predictors of psychological preparedness. Conclusion: The findings suggested that self-efficacy, optimism and resilience can be considered as predictors for psychological preparedness in pandemic management. Appropriate training could influence self-efficacy while programs addressing resilience and coping may strengthen psychological preparedness which can help in further management of ongoing pandemic.

12: The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis.
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Posted 29 Sep 2019

The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis.
1,113 downloads medRxiv nursing

Wondimeneh Shibabaw Shiferaw, Tadesse Yirga, Henok Mulugeta, Yared Asmare Aynalem

BackgroundPressure ulcer, one of the common challenging public health problems affecting patient with spinal cord injury, is the formation of lesion and ulceration on the skin specially in the bony prominence areas. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, the objective of this systematic review and meta-analysis was to estimate the global magnitude of pressure ulcers among patient with spinal cord injury. MethodsPubMed, Scopus, Google Scholar, Africa journal online, PsycINFO and web-science were systematically searched online to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. The random-effects model was fitted to estimate the summary effect. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Eggers regression test statistic. All statistical analysis was done using STATA version 14 software for windows. ResultsTwenty-four studies which comprises of 600,078 participants were included in this meta-analysis. The global pooled magnitude of pressure ulcer among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18). ConclusionThis systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policymakers (FMoH) and other concerned bodies need give special attention to reduce the magnitude of pressure ulcers in patient with spinal cord injury.

13: Influence of nursing staff working hours on the stress level during the COVID-19 pandemic: a cross-sectional online survey
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Posted 14 Aug 2020

Influence of nursing staff working hours on the stress level during the COVID-19 pandemic: a cross-sectional online survey
1,055 downloads medRxiv nursing

Manuela Hoedl, Silvia Bauer, Doris Eglseer

Background: Working as a nurse means being responsive and highly accountable 24/7 and to be able to offer high-quality care, specifically during pandemics. Studies have shown that the average number of working hours per week is a significant predictor of stress and that the severity of the COVID-19 pandemic has increased the nurses stress levels. Objective: Therefore, we investigated (1) if a change had occurred in the nurses working hours during the COVID-19 pandemic as compared to the hours employed and (2) the influence of the nursing staffs working hours during COVID-19 pandemic on the perceived level of stress. Design: We used an online survey in this Austrian cross-sectional study, distributed using a snowball sampling method. Participants and methods: In the online survey, we asked the nurses many relevant questions, including how many hours they are employed per week and how many hours they had worked on average per week since the outbreak of COVID-19. We used the Perceived Stress scale to measure stress level among these nurses. Data were collected between mid-May and mid-July 2020. Results: Three-quarters of the 2600 participating nurses reported changes in their working hours during the COVID-19 pandemic. The nursing staffs hours of employment were statistically significantly associated with their average number of working hours during the COVID-19 pandemic. About two-thirds of the nurses who were employed either less than 10 hours or for 31-40 hours worked for more than 40 hours. Most of the nurses experienced a moderate level of stress. We identified a statistically significant association between increasing the number of working hours per week and the nurses perceived stress level. In addition, 15% of the nurses who had worked more than 40 hours reported experiencing a high level of stress. In addition, we found that nurses who worked more hours during the pandemic experienced higher stress than nurses who reduced their working hours or kept the same working hours. Conclusions: We found a statistically significant association between an increase in the nursing staffs working hours and their level of stress. We believe that these results reflect the negative consequences of prolonged working hours. For this reason, a (inter-)national discussion is needed on the topic of restricting the working hours of healthcare workers during such pandemics. This discussion can improve the health and safety of the health care workers, the patients, as well as members of the general population.

14: Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic
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Posted 07 Aug 2020

Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic
1,049 downloads medRxiv nursing

Manuela Hoedl, Doris Eglseer, Silvia Bauer

Background: The results of several projects on the effects of personal protective equipment (PPE) have been published since the outbreak of COVID-19. It is known that wearing PPE, and specifically face masks, has physcial consequences like headache and pain, which can increase stress among nursing staff. However, none of these studies placed a focus on PPE and nursing staff, although nurses are the only members of the health care profession who are at the patients bedsides 24/7, and PPE is the only way to protect them from a COVID-19 infection. Therefore, this study was carried out to investigate the association between the use of PPE and stress among nursing staff during the COVID-19 pandemic. Methods An online, cross-sectional survey was conducted, which we distributed using snowball sampling techniques. The questionnaire was developed on the basis of (inter-)national recommendations as well as the international literature. We used the perceived level of stress scale to measure the nursing staff members stress levels. Results We included data collected from 2600 nurses in this analysis. Nearly all nursing staff wore face masks. We showed that more than two-thirds of the nurses had moderate to high levels of stress. No statistically significant association between the use of PPE and stress was detected. However, we show a statistically significant association between the duration of mask usage and stress. Discussion and conclusions Nearly all participating nurses wore face masks or FFP masks to protect themselves from COVID-19 infection. This observation might indicate that Austrian nurses display a high level of compliance with national and international regulations and play a key role in such pandemics. Our results also show that increased mask-wearing time led to increased stress levels. These results suggest that (inter-)national regulations on how and when to use PPE should include a maximum duration of time for wearing each type of mask. Such regulations could help to prevent work-related stress, particularly in the case of future epidemics, and avoid burnout among nursing staff or even nurses leaving their jobs. The consequences of both of these negative outcomes should be considered in light of the predicted expected future shortage of health care workers.

15: Anxiety among the general population during Coronavirus-19 Disease in Saudi Arabia: Implications for a Mental Support Program
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Posted 11 May 2020

Anxiety among the general population during Coronavirus-19 Disease in Saudi Arabia: Implications for a Mental Support Program
1,046 downloads medRxiv nursing

Mohannad Alkwiese, Salman H. Alsaqri, Mohammed Aldalaykeh, Mada Hamzi, Mada Mahdi, Zainab Shafie

Background: The 2019 outbreak of coronavirus disease (COVID-19) is an worldwide health emergency that threatens mental health of general public. Research data are required to establish evidence-based approaches to alleviate the symptoms of anxiety during the outbreak. This study aimed to survey the general public in Saudi Arabia to help in understanding their levels of anxiety during the COVID-19 outbreak. Methods: The researchers performed an on-line survey using snowball sampling methods from April 1 through April 10, 2020. The online survey collected demographics information data, while the Social Anxiety Questionnaire for Adults (SAQ-A30) was used to measure anxiety level. Results: This study consisted of 709 respondents from different regions of Saudi Arabia. The general population reported mild to moderate rates of anxiety. Married respondents were associated with a significantly higher level of anxiety (p<0.05). Conclusions: The respondents reported mild to moderate anxiety during the outbreak of COVID-19 in Saudi Arabia. Implication for practice: The results of this study identify the implications to lower levels of anxiety that may be used during the COVID-19 outbreak to develop mental health support programs to improve the mental health of vulnerable groups.

16: How has Covid-19 affected mental health nurses and the delivery of mental health nursing care in the UK? Results of a mixed methods study
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Posted 06 Nov 2020

How has Covid-19 affected mental health nurses and the delivery of mental health nursing care in the UK? Results of a mixed methods study
747 downloads medRxiv nursing

Una Foye, Christian Dalton-Locke, Jasmine Harju-Seppanen, Rebecca Lane, Lewys Beams, Norha Vera San Juan, Sonia Johnson, Alan Simpson

IntroductionWhile evidence has emerged concerning the impact of Covid-19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. AimThis paper aims to explore how Covid-19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. MethodWe investigated staff reports regarding the impact of the Covid-19 pandemic on mental healthcare and mental health service users in the UK, using a mixed methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. DiscussionKey themes within the data explore: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for PracticeService developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic. Accessible SummaryO_ST_ABSWhat is known on the subject?C_ST_ABSDuring the Covid-19 pandemic there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. Whilst nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. What the paper adds to existing knowledge?This paper provides a unique insight into the experiences and impact that the Covid-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses, and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. What are the implications for practice?By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced, and the impact the crisis has had on care for mental health service users. By doing so we can plan for the ongoing nature of this pandemic as well as the aftermath that the crisis may leave for our service users and workforce alike. Relevance StatementThis paper provides insight into the impact that the Covid-19 pandemic has had on the service and care that mental health nurses are expected to and can provide. As a workforce that often requires ongoing face to face contact with service users, many in serious distress, in inpatient and community settings, it is important that we understand their experiences and the challenges and risks that face this workforce. This will enable us to ensure that future planning, guidance, support and safeguarding can take place during the ongoing and future crises.

17: Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Preference and Satisfaction in Chinese Patients with Parkinson's Disease
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Posted 02 May 2020

Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Preference and Satisfaction in Chinese Patients with Parkinson's Disease
744 downloads medRxiv nursing

Xian Qiu, Tingting Peng, Zhengyu Lin, Kaiwen Zhu, Yuhan Wang, Bomin Sun, Keyoumars Ashkan, Chencheng Zhang, Dianyou Li

Objective To evaluate the preference and satisfaction in the Chinese Parkinson's disease (PD) patients treated with deep brain stimulation (DBS). Background DBS is a widely used therapy for PD. There is now a choice between fixed-life implantable pulse generators (IPGs) and rechargeable IPGs, each having their advantages and disadvantages. Methods Two hundred and twenty PD patients treated with DBS completed a self-designed questionnaire to assess long-term satisfaction and experience with the type of battery they had chosen, and the key factors affecting their choices. The survey was performed online and double-checked for completeness and accuracy. Results The median value of follow-up length was 18 months. 87.3% of the DBS used rechargeable IPGs (r-IPG). The choice between rechargeable and non-rechargeable IPGs was significantly associated with the patient's affordability ({chi}2(1) = 19.13, p < 0.001). Interestingly, the feature of remote programming significantly affected patients' choices between domestic and imported brands ({chi}2(1) = 16.81, p < 0.001). 87.7% of the patients were satisfied with the stimulating effects as well as the implanted device. 40.6% of the patients with r-IPGs felt confident handling their devices within one week after discharge. More than half of the patients checked their batteries every week. The mean interval for battery recharge was 4.3 days. 57.8% of the patients spent around one-hour recharging and 71.4% of them recharged the battery independently. The most popular way for patients to learn about DBS surgery was through media (79/220, 35.9%), including the Internet and television programs. The rehabilitation (40.6%, 78/192), and programming (36.5%, 70/192) were two main courses that most patients wanted to learn after surgery. Conclusion Most patients were satisfied with their choices of IPGs. The patients' financial status and remote programming function were the two most critical factors in their decision. The skill of using rechargeable IPG was easy to master by most patients.

18: Effects of high-intensity interval training in patients with coronary artery disease after percutaneous coronary intervention: a systematic review and meta-analysis
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Posted 02 Jun 2020

Effects of high-intensity interval training in patients with coronary artery disease after percutaneous coronary intervention: a systematic review and meta-analysis
672 downloads medRxiv nursing

Xinyue Zhang, Dongmei Xu, Guozhen Sun, Zhixin Jiang, Jinping Tian, Qijun Shan

Background: High-intensity interval training, for its characteristic of short-time high oxygen-consumption exercise interphase with periods of low-intensity training or rest for recovery, is easier to persist and execute in cardiac rehabilitation. However, it is little known whether HIIT program has an advantageous effect on patients after percutaneous coronary intervention or not. Methods: Randomized controlled trials (RCTs) focusing on HIIT program in patients after PCI were searched in Cochrane Library, Web of Science Core Collection, EMbase, PubMed, China National Knowledge Infrastructure (CNKI) and SinoMed from the inception to March 24, 2020. Two reviewers conducted the literature retrieval, data extraction, and quality assessment independently. Standard Mean difference (SMD) and 95% confidence intervals (CI) were performed to summarize the effect sizes. Results: 6 RCTs (247 patients) met the criteria. HIIT program had a statistically significant effect on raising left ventricular ejection function (LVEF) (SMD=0.38, 95%CI[0.03, 0.73], p=0.03), VO2peak (SMD=0.94, 95%CI[0.61, 1.28], p<0.01), as well as improving the serum level of high-density lipoprotein (SMD=0.55, 95%CI[0.06, 1.03], p=0.03) and late luminal loss (SMD=-0.65, 95%CI[-1.07, -0.23], p<0.01). But HIIT had no prominent effect on improving heart rate (SMD=-0.04, 95%CI[-0.29, 0.21], p=0.73). Conclusions: HIIT program might be favorable for CAD patients after PCI by improving cardiopulmonary function, such as LVEF and VO2peak, as well as reducing late luminal loss in per stented arteries. Nevertheless, HIIT had no advantage for adjusting heart rate. More researches with rigorous methods are warranted to explore the controversy about lipid profiles.

19: Development and validation of a multiple-choice question-based delirium care knowledge quiz for critical care nurses
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Posted 20 Jan 2021

Development and validation of a multiple-choice question-based delirium care knowledge quiz for critical care nurses
667 downloads medRxiv nursing

Mu-Hsing Ho

Aims: To develop and psychometrically test a multiple choice questions (MCQs) based quiz of delirium care knowledge for critical care nurses. Design: Instrument development and psychometric evaluation study. Methods: The development and validation process including two phases. Phase I focused on the quiz development, conducted by the following steps: (1) generated initial 20 items pool; (2) examined content validity and (3) face validity; (4) conducted pilot testing, data were collected from 217 critical care nurses via online survey during 01 October to 07 November, 2020; (5) performed item analysis and eliminated items based on the item difficulty and discrimination indices. The MCQs quiz was finalised through the development process. Then, phases II emphasised the quiz validation, to estimate the internal consistency, split half and test-retest reliability, and construct validity using parallel analysis with the exploratory factor analysis (EFA). Results: A final 16 items MCQs quiz was emerged from the item analysis. The Kuder Richardson Formula 20 coefficient for the overall quiz showed good internal consistency (0.85), and the intraclass correlation coefficient with a 30 days interval also indicated that the questionnaire had satisfactory stability (0.96). The EFA confirmed appropriate construct validity for the quiz, four factors could explain the total variance of 60.87%. Conclusion: This study developed the first MCQs quiz for delirium care knowledge and it is a reliable and valid tool that can be implemented to assess the level of delirium care knowledge. Impact: This study offers an evidence based quiz designed for future research and education purposes in delirium care that has significant implications for knowledge test by using MCQs in clinical practice.

20: The enactment of compassionate leadership by nursing and midwifery managers: Results from an international online survey
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Posted 18 Sep 2020

The enactment of compassionate leadership by nursing and midwifery managers: Results from an international online survey
617 downloads medRxiv nursing

Irena Papadopoulos, Steve Wright, Runa Lazzarino, Christina Koulouglioti, Magdeline AAGARD, Ozlem AKMAN, Lise-Merete ALPERS, Paraskevi APOSTOLARA, Julieta ARANEDA, Sylvia BIGLETE-PANGILINAN, Orit ELDAR REGEV, Maria Teresa GONZALEZ-GIL, Christiana KOUTA, Radka KREPINSKA, Malgorzata LESINSKA SAWICKA, Miroslava LISKOVA, Lucero LOPEZ-DIAZ, Maria MALLIAROU, Angel MARTIN-GARCIA, Mara MUNOZ, Malgorzata NAGORSKA, Roinah Nkhensani NGUNYULU, Sara NISSIM, Line NORTVEDT, Florinda OCONER-RUBIANO, Cristina OTER-QUINTANA, Candan OZTURK, Katalin PAPP, Blanca PIRATOBA-HERNANDEZ, Elena ROUSOU, Maria Ymelda TOLENTINO-DIAZ, Valerie TOTHOVA, Akile ZORBA

Aim: To explore the views of an international sample of nursing and midwifery managers concerning attributes that they associate with compassionate management. Method: A cross-sectional online survey. Using a snowballing sampling method, 1,217 responses were collected from nursing and midwifery managers in 17 countries. A total of complete 933 responses to a question related to which actions and behaviours indicated that a manager was exercising compassionate leadership were analysed for this paper. Firstly, content analysis of the responses was conducted, and secondly a relative distribution of the identified themes for the overall sample and for each participating country was calculated. Results: Six main themes were identified describing the attributes of a compassionate leader: 1) Virtuous Support, 2) Communication, 3) Personal Virtues of the Manager, 4) Participatory Communication, 5) Growth/Flourishing/ Nurturing, and 6) Team Cohesion. The first three themes mentioned above collectively accounted for 63% of the responses, and can therefore be considered to be the most important characteristics of compassionate management behaviour. Conclusion: The key indicators of compassionate management in nursing and midwifery which were identified emphasise approachability, active and sensitive listening, sympathetic responses to staff members' difficulties (especially concerning child- and other caring responsibilities), active support of and advocacy for the staff team, and active problem solving and conflict resolution. While there were differences between the countries' views on compassionate healthcare management, some themes were widely represented among different countries' responses, which suggest key indicators of compassionate management that apply across cultures.

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