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Introduction Staff nurse attrition negatively impacts readiness of the warfighter and the health and wellbeing of all beneficiaries of the Military Health System (MHS). To promote the retention of a robust nursing workforce, a complete understanding of nurses' perceptions regarding their intent to leave is necessary. The purpose of this study was to explore the free-text responses of 1,438 nurses working among military medical treatment facilities for factors influencing their intent to leave, as an indicator of potential turnover, or attrition. Materials and Methods This study employed thematic analysis to investigate the qualitative responses from the 2016 and 2018 Military Nursing Practice Environment Surveys. The study was determined to be exempt from Institutional Review Board review through the Womack Army Medical Center's Human Research Protection Program. Results Findings indicate that leadership and management (n  = 647), staffing (n  = 353), career opportunities (n  = 345), staff outcomes (n  = 247), culture (n  = 153), quality of care (n  = 99), patient care barriers (n  = 86), non-patient care activities (n  = 79), lack of formal professional development (n  = 75), and area or care environment (n  = 67) were among the top factors influencing staff nurse intent to leave, respectively. Conclusions Our findings support the evaluation of retention strategies using implementation science for nurses and nurse resource personnel (e.g. nursing assistants, technicians, medics, and corpsman) to ensure a robust nursing work force throughout the MHS. Staff nurses and resource personnel working among military treatment facilities and embedded in units supporting combat and humanitarian missions ensure access to care and health promotion of the warfighter and all MHS beneficiaries. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion In the wake of an increasingly ageing population, Norway has a growing need for healthcare workers, especially in nursing homes. This study explored the employment experiences of migrant nursing assistants working in elderly care in Norway.A qualitative interview‐based study was carried out between March and August 2020. In‐depth, semi‐structured interviews were performed with 13 purposively selected immigrant nursing assistants working in a nursing home within Western Norway. Data were thematically analysed.Migrant nursing assistants working in Norwegian elderly care faced mixed experiences. On the one hand, study participants experienced several barriers in their workplace, resulting from insufficient command of the Norwegian language, heavy workload and mistreatment and discrimination by both patients and colleagues. On the other hand, participants cited the financial compensation from work, the meaningfulness derived from helping others and the flexible day‐off requests as workplace facilitators. Participants also made continuous efforts to learn the Norwegian language and to build good relations with their co‐workers.There is a need to enhance migrant nursing assistants' positive experiences in the Norwegian eldercare sector by making targeted workplace reforms and fostering a supportive and inclusive environment. [ABSTRACT FROM AUTHOR]

Introduction Design Methods Results Conclusion Non‐ventilator hospital‐acquired pneumonia (NV HAP) is a common complication for hospitalized patients. NV HAP develops when patients aspirate oral secretions containing pathogenic bacteria. Appropriate oral hygiene can help mitigate NV HAP development. Hospital staff, including nursing assistants, play an important role in ensuring that these cares are completed.A quasi‐experimental pre–post design was used to evaluate outcomes before and after implementation of a structured oral hygiene education program.A structured oral hygiene program was developed and implemented in a large quaternary hospital. Change in NA knowledge, attitudes, and behaviors before and after implementation of the oral hygiene program was evaluated. Retrospective patient outcomes before and after the intervention were analyzed to detect changes in NV HAP rates.Following the education, nursing assistant knowledge of recommended frequency of oral care for patients who are NPO increased (67.2% vs. 82.1%, p = 0.003). NAs were more likely to report oral hygiene tools including oral suctioning (80.8% vs. 90.2%, p = 0.005) and toothbrushes (89.3% vs. 95.3%, p = 0.031). The unadjusted incidence of NV HAP was significantly lower in the post‐intervention cohort (0.25%) compared to the pre‐intervention cohort (0.74%), p < 0.001. In the adjusted model, non‐invasive positive pressure ventilation increased the odds of NV HAP by nearly sevenfold (AOR = 6.88, 95% CI: 3.99, 11.39).Focused education for NAs is an effective strategy to increase knowledge related to oral hygiene. Implementing a structured oral hygiene program for NAs appears to be a promising practice to decrease NV HAP. [ABSTRACT FROM AUTHOR]

Aim and Objectives Background Design Methods Results Conclusions Relevance to clinical practice Reporting Method Patient of Public Contribution To provide an in‐depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care.As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation.A multi‐method qualitative study.Open‐ended questions of a survey study (N = 132) were supplemented with in‐depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis.Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient‐centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care.The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation.This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient‐centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing.Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Antimicrobial drug use (AMU) in veterinary medicine may contribute to antimicrobial resistant (AMR) infections in both animals and people. Efforts to improve AMU in companion animal medicine are underway and should include all members of the veterinary team, including veterinary support staff. Our objective was to describe knowledge and attitudes regarding AMU, AMR, and antimicrobial stewardship (AMS) in companion animal medicine among veterinary support staff professionals in the United States using an anonymous, online questionnaire. Additionally, we sought to explore veterinary support staff perceptions of their role in the antimicrobial drug (AMD) prescribing process. Veterinary technicians, nurses, assistants, client care representatives, and hospital managers (n = 337) considered AMR a global concern (83.4%), and 40% reported receiving AMR education from their employer. Few (18.3%) were aware of AMS, with only 6.4% indicating that their clinic had an AMS program. Frequent involvement in the AMD prescribing process was reported (43.4%), but only 19.7% perceived involvement with AMS interventions. Approximately one-third of participants (34.9%) said that advice regarding the need for AMDs was routinely provided by staff to pet owners prior to veterinary consultation. Participants estimated that 82.6% of all AMD prescriptions were filled at the clinic as opposed to an outside pharmacy. Given their direct involvement in the AMD prescribing process and frequent interactions with pet owners, AMS should be emphasized to all veterinary staff. Involving support staff in AMS interventions is necessary to improve AMU in companion animal medicine. [ABSTRACT FROM AUTHOR]

Objective: To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality. Data Sources and Study Setting: A national sample of nursing homes during 2017–2019 (pre‐COVID). Data included the Payroll‐Based Journal, Medicare Claims, Nursing Home Care Compare, and Long‐Term Care Focus. Study Design: Retrospective, regression analyses. We estimated separate linear models predicting six long‐term facility‐level outcomes. Independent variables included staffing hours per resident‐day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics. Data Collection/Extraction Methods: Hospital‐based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded. Principal Findings: We found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low‐census dementia facilities, although, high‐ and low‐dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome. Conclusions: These findings suggest that increasing staffing will improve outcomes by similar increments in both low‐ and high‐dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low‐ and high‐dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low‐ and high‐dementia census facilities. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the impact of health and well-being self-care interventions on nurses in an adult care medicine unit in an academic health system during the COVID-19 pandemic. The study outlines the Plan Do Check Act Quality Improvement framework and the results of weekly interventions that included exercise, conversations with nursing staff, mindfulness practices, sleep habits, teamwork, and burnout prevention and management.

BACKGROUND: The health of care workers in residential long-term care (LTC) is under pressure. Scholars emphasize the importance of gender-sensitive and intersectional approaches to occupational health. OBJECTIVE: To unravel how the health of nurses and nursing aides is shaped by gender, class, age, sexuality and race. METHODS: A qualitative participatory study. A participatory research team, consisting of academic scholars and nursing aides, conducted semi-structures interviews (N = 20) and one natural group discussion (N = 8 participants) to validate our findings. Thematic data-analysis was guided by gender and intersectionality theory. RESULTS: Empirical findings suggest that gendered norms limit possibilities for self-care for female nurses and nursing aides. Feeling uncared for by society and LTC organizations, paid care workers describe how they take care of each other. These relational health strategies require a feeling of sameness, limiting space for diversity and disability within care teams. Care workers seen as 'cultural other', or those who experienced (chronic) health issues, financial struggles or informal caregiving, risked being excluded from relational care within care teams, which negatively impacted their health. CONCLUSIONS: Care workers' relational health strategies are a gendered and care ethical response to the lack of societal and political care for LTC, but can become mechanisms of exclusion within care teams. This can be understood as a sign of exhaustion, shaped by adverse working conditions and leading to moral stress. The lack of societal appreciation needs to be addressed by occupational health physicians and LTC organizations, to counter mechanisms of exclusion among paid care workers. [ABSTRACT FROM AUTHOR]

Introduction: Since its creation in the 18th century, bedpan has remained more or less the same. Its unique material composition varies from one model to another, but its shape remains relatively similar. The environment is one of the four pillars of the nursing paradigm. It is therefore essential to question this device in the nursing discipline. Aim: To assess perceived patient comfort and ease of bedpan handling by nurses and their assistants. Method: A cross-sectional survey via an online questionnaire was conducted among nurses and nursing assistants, nursing students, and health executives using the bedpan for their patients to assess their feelings and their level of satisfaction. The questionnaire asks professionals about the ease of handling the bedpan and the patient's perceived comfort. Results: 431 responses were obtained out of 3007 persons interviewed (14.3%). 83.0% believe that the cause of poor elimination by the patient is often or very often due to physical discomfort on the bedpan. 62.6% find the installation of the bedpan rather tough or very difficult. 59.2% find the removal of the bedpan rather tough or very difficult. Discussion: Our study confirms our hypothesis and highlights a lack of comfort in the bedpan as perceived by professionals. This analysis is the first step in enabling the nurse researcher to support change in the transformation paradigm. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Reporting Methods Patient/Public Contribution To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities.Mixed‐methods explanatory sequential.In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web‐based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper‐and‐pencil questionnaire. Twenty semi‐structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays.Participants spent approximately one‐quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision‐making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care.Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions.This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills.MMR checklist.None. [ABSTRACT FROM AUTHOR]

Introduction This article reviews process and performance of an innovative effort leveraging virtual health to manage unmet demand for behavioral health and substance use disorder services across a large military region. This effort began in June 2022 and included nearly all of the Defense Health Agency Region—Europe's military behavioral health and substance abuse clinics participating. The two goals of improving access to behavioral health and substance use services for active duty service members and improving utilization of the military clinics were employed. Operational and remote locations with known care gaps could access services as well. Connecting services to the point of need is an established strength of virtual health delivery systems of care. Materials and Methods A team consisting of clinical leaders and Virtual Medical Center—Europe staff developed a centralized screening process and simple business rules. When a clinic was unable to meet its access-to-care standard of 28 days, the patient requesting or referral from a remote location, was offered a virtual video option with a provider from another clinic with availability. Centralized screening was created and staffed by three technicians. The Behavioral Health Integrated Support Network (BHISN) screening clinic assessed appropriateness of virtual care using established exclusion criteria. Once screened, the patient was scheduled for an appointment with one of the 31 therapists in 14 participating clinics in a 3- to 5-day window. The military health system's video connect platform was used. Results Between June 2022 and November 2023, 131 patients who were unable to find routine care in their home clinic were screened, scheduled, and completed a virtual visit with one of the 31 participating therapists from 14 behavioral health and substance use clinics. Seventy-eight (59%) participants were active duty empaneled to military treatment facilities in Europe and 53 (39%) were active duty enrolled in Tricare Prime Remote and deployed to remote locations with limited care. Forty-four percent of patients were recommended for continued virtual therapy or counseling kept their first follow-up demonstrating good follow-up care using a virtual option. The overall no-show rate was low at 7%. Care and consultation were successfully delivered using video visits to location in 18 countries in three geographic Europe, the Middle East and, Africa. Conclusion The Virtual Medical Center—Europe, Army Europe Behavioral Health, and Substance Use leadership work collaboratively to plan and optimize program performance. For BHISN to function as intended requires key dedicated support staff, such as mental health and social services assistants to screen and coordinate virtual care. Scheduling can be performed by a central cell requiring clinics to relinquish some local control in the interest of meeting patient demand in large and diverse area that covers three continents. BHISN shows promising initial success by providing a process of managing demand and connecting requests for behavioral health and substance use care leveraging capacity from all clinics using a virtual video service in a diverse operating environment. [ABSTRACT FROM AUTHOR]

Background: The new competency-based further training regulations (nWBO) for surgical training have been adopted by all German state medical associations. Methods: From May to June 2023 the Young Surgeons' Working Group (CAJC) conducted an anonymous online survey among the 5896 members of the German Society for General and Visceral Surgery (DGAV). Objective: The survey aimed to assess expectations regarding the nWBO and to develop strategies for enhancing surgical training. Results: With 488 participants (response rate 8.3%) the study is representative. The respondents consisted of 107 continuing education assistants (WBA 21.9%), 69 specialist physicians, and 188 senior physicians (specialist physicians 14.1% and senior physicians 38.5%), as well as 107 chief physicians (21.9%). The majority worked in regular care providers (44%), followed by maximum care providers (26.8%) and university clinics (20.1%). Only 22% considered the required operative spectrum of the new medical specialist training regulations (nWBO) to be realistic. Half of the respondents believed that full training in their clinic according to the new catalog will no longer be possible and 54.6% considered achieving the target numbers in 6 years to be impossible or state that they can no longer train the same number of continuing education assistants (WBAs) in the same time frame. Endoscopy (17.1–18.8%), fundoplication (15.4–17.7%) and head and neck procedures (12.1–17.1%) were consistently mentioned as bottlenecks across all levels of care. Rotations for balance were reported to be already established or not necessary in 64.7%. In 48% it was stated that the department had established the partial steps concept. The importance of a structured training concept was considered important by 85% of WBAs, compared to 53.3% of chief physicians (CÄ). If a structured training concept was present in the department, the achievability of the target numbers was significantly assessed more positively in the univariate analysis. In the multivariate analysis, male gender and the status of "habilitated/professor" were independent factors for a more positive assessment of the nWBO. Objective certification of training was considered important by 51.5%. Conclusion: Concerns surround the nWBO and the sentiment is pessimistic. Additional requirements and hospital reforms could exacerbate the situation. Collaboration and rotations are crucial but still insufficiently implemented. Quality-oriented certification could enhance the quality of training. [ABSTRACT FROM AUTHOR]

Aim: To investigate the correlation between job values, job stress, and job satisfaction among nursing assistants in a hospital setting. Design: A cross‐sectional study. Methods: Data were collected from nursing assistants working in a regional hospital and a medical center in Northern Taiwan. A self‐rated structured questionnaire was used to collect data on participants' demographic characteristics, job values, job stress, and job satisfaction. Descriptive statistics, t test, one‐way analysis of variance, Pearson's correlation coefficient, and stepwise regression were used for data analysis. Results: A total of 135 questionnaires were distributed; of them, 132 were returned, resulting in a response rate of 97.8%. The average age of the participants was 57.08 ± 5.86 years, with the majority being female, high school educated, and married. Most participants (70%) had >5 years of experience in working as nursing assistants. The average job satisfaction score of was 63.63, indicating a moderate level of job satisfaction. Job satisfaction exhibited a significantly positive correlation with job values but a significantly negative correlation with job stress. Job value was negatively correlated with job stress. Stepwise regression revealed that job values significantly explained the variance in job satisfaction among hospital nursing assistants. Conclusions: Nursing assistants are integral to clinical practice. To enhance their job satisfaction and professional development, health‐care institutions and policymakers should implement strategies such as providing continual training, offering recognition and rewards to enhance sense of accomplishment. Patient or Public Contribution: This study involves no patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Hospital patient‐care workers have high occupational injury rates. While physical hazards within hospital work environments are established determinants of injury, social exposures may also contribute. This study examined how reports of unfair treatment at work, a dimension of work‐related experiences of discrimination, were associated with injury among hospital‐based patient‐care workers. Methods: We used data from the Boston Hospital Workers Health Study, a longitudinal cohort of nurses and nursing assistants at two Boston‐area hospitals. In 2018, we conducted a worker survey asking about three types of unfair treatment at work and occupational injuries during the past year. We used mixed‐effects logistic regression models to evaluate associations between specific types, total load, and high‐frequency exposure of unfair treatment with injury, adjusting for age, gender, race and ethnicity, job title, and unit type. Results: Among 1001 respondents, 21% reported being humiliated in front of others at work, 28% reported being watched more closely than other workers, and 47% reported having to work twice as hard as others for the same treatment. For each type of unfair treatment, we observed a monotonic relationship with occupational injury wherein increasing frequency of exposure was associated with increased odds of injury. We also observed monotonic relationships between total load and high‐frequency exposure to unfair treatment and odds of injury. Conclusions: Work‐related unfair treatment is associated with injury among hospital workers. Programs and policies that focus on preventing unfair treatment may lessen injury burden in hospital workers. [ABSTRACT FROM AUTHOR]

Purpose: Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities. Method: A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state. Results: Four themes emerged from the data: Cultural Needs Expressed by Residents, Cultural Needs Expressed by Family Members, Accommodating Residents' Cultural Needs, and Organizational Responses to Cultural Competency Challenges. Conclusion: Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [Journal of Gerontological Nursing, 50(7), 35–41.] [ABSTRACT FROM AUTHOR]

Purpose: To explore the relationship among resilience, stress, and demographic factors in certified nursing assistants (CNAs) who worked in long-term care institutions during the coronavirus disease 2019 pandemic. Method: A cross-sectional correlation-based research design was used. Data were collected using a demographic questionnaire, Connor-Davidson Resilience Scale, and Occupational Stress Scale. CNAs from 21 long-term care institutions in Taiwan were recruited. Results: This study included 118 female and 26 male CNAs (response rate = 80%). Mean age was 46.8 years. A moderately negative correlation was found between workplace resilience and stress. Overall, being a woman and parent were found to be significantly correlated with CNAs' resilience. Furthermore, resilience and shift work were important predictors of stress. Conclusion: We suggest that leadership and management pay more attention to CNAs' basic demographic background information. Furthermore, timely, relevant strategies can be provided to enhance resilience and reduce workplace stress. [Journal of Gerontological Nursing, 50(7), 19–26.] [ABSTRACT FROM AUTHOR]

Background: There is a knowledge-to-practice gap regarding parent-delivered pain management, and few studies have investigated parents' and nurses' participation in and acceptance of combined parent-delivered pain-alleviating interventions such as skin-to-skin contact (SSC), breastfeeding, and parental musical presence. This study investigated parents' and nurses' perceptions of and reflections on experiencing combined parent-delivered pain management. Methods: This qualitative study applies a collaborative participatory action research design using ethnographic data collection methods such as focus groups, video observations, and video-stimulated recall interviews with parents and nurses. Results: The results concern three main categories, i.e., preparation, participation, and closeness, as well as various sub-categories. Preparations were central to enabling combined parent-delivered pain management. Participation was facilitated by parental musical presence, in which parents shifted their attention toward their infant. Closeness and presence during neonatal care helped parents become active during their infant's painful procedures. Parental lullaby singing created a calm and trusting atmosphere and after the procedure, both parents and nurses felt that they had successfully supported the infant through a potentially painful procedure. Conclusions: Mental and practical preparation is central to implementing combined parent-delivered pain management. When parents and nurses explored the interventions, they found the methods feasible, promoting self-efficacy and confidence in both parents and nurses. [ABSTRACT FROM AUTHOR]

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Background/Objectives: Transitions to and from Emergency Departments (EDs) can be detrimental to long‐term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC‐ED transitions and to verify the level of stakeholder agreement with this definition. Methods: The EXamining Aged Care Transitions study adopted an exploratory sequential mixed‐method design. The study was conducted in 2015–2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews (n = 25) and focus groups (n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Results: Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. Conclusions and Implications: To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents. Key points: Important dimensions in assessing transition avoidability include timely diagnostic testing availability, in‐facility assessment and treatment options, clear transfer purpose, risk/benefit analysis for resident well‐being, and recognition of advanced care goals and informal care preferences.Our findings highlighted essential differences between perceptions of unnecessary and avoidable transitions.Avoidable transitions were attributed to limited resources in long‐term care, insufficient preventive care, and resident or family wishes. [ABSTRACT FROM AUTHOR]

This article examines the perspectives of nursing home staff on the implementation of dementia-specific advance directives that include the option of no assistance with feeding once the ability to self-feed is lost. The study conducted qualitative interviews with 12 nursing home staff members and found that there are logistical challenges, such as language ambiguity and the fluctuating nature of dementia, as well as moral challenges related to harm. The study suggests that current directives may need to be defined more clearly and that policies are needed to effectively operationalize them in nursing homes. The article also includes a list of references and citations that cover a range of topics related to dementia and end-of-life care, making them a valuable resource for further research. [Extracted from the article]

Background: Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. Methods: In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. Results: Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. Conclusions: Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes. [ABSTRACT FROM AUTHOR]

Care aides in long-term care (LTC) institutions care for older disabled residents at high risk for COVID-19. However, they experienced many stressors during the COVID-19 pandemic. This study aims to explore the working experiences of care aides in LTC institutions following the relaxation of COVID-19 regulations in Taiwan. This qualitative descriptive study included 20 care aides who had cared for residents with COVID-19. Data were obtained via semi-structured interviews. Caring for residents with COVID-19 and the difficulties, resources and teamwork, and impact of care aides' work on their lives were discussed. Consequently, four themes were identified. First, difficulties in care, which included physical limitations by protection, workload, and impact of work schedule on the lives of the care aides. Second, psychological impact, such as worry, social isolation, and burnout. Third, interpersonal relationships with supervisors, colleagues, residents, and their families. Fourth, infection control policy from the institution and government. When infection control policies were relaxed, care aides had difficulties in caring for residents; furthermore, their family and social lives were also affected. They were required to learn knowledge of and skills for COVID-19 management. Institutions were required to provide support in materials, care processes, environment, and management. [ABSTRACT FROM AUTHOR]

The article deals with the legal aspects of recruiting and employing nursing professionals from third countries in Austria. It is pointed out that both employers and employees have to go through complex and time-consuming procedures. The article provides an overview of the necessary procedural steps and legal foundations. It also discusses the legal situation in Germany to demonstrate a simplification of the overall process. The article emphasizes the importance of recruiting foreign professionals to fill open positions in the nursing sector quickly and with qualified individuals. It is also noted that a team with employees from different cultural backgrounds can benefit from different experiences and ways of thinking. The article also mentions the complex legal framework for recruiting international professionals in Austria and the various laws that regulate this. It is noted that the process of recruiting, hiring, and integrating international professionals is a major challenge and requires enormous administrative effort. It is also pointed out that an accelerated skilled worker procedure, as already practiced in Germany, can increase efficiency and speed up the recruitment and hiring process. The text describes the requirements and procedures for applying for a Red-White-Red Card for foreign professionals in Austria. The required documents include proof of adequate accommodation, health insurance, livelihood, and German language skills. Individuals who have completed training in a nursing assistant profession or in advanced health and nursing care are exempt from the Foreign Employment Act. Applications are submitted to the locally competent provincial government and reviewed by the regional branch of the Public Employment Service. It is discussed whether this review could be waived for nursing professions, as they are in demand. The article describes the process of nostrification of foreign educational qualifications in the field of health and nursing care in Austria. It is explained that the completed education is extensively and detailedly examined and that the required language skills must be proven. Age plays a subordinate role. It also discusses the professional regulations of the Health and Nursing Care Act (GuKG) that regulate the activities of qualified nursing professionals. It is emphasized that nostrification should only be carried out in exceptional cases for further training purposes without having to go through a complex nostrification procedure. The required documents for the nostrification procedure are also listed. The certification of documents is required depending on the country of origin. Specific certification and translation guidelines apply to nursing staff from Tunisia recruited for the LKH-University Hospital Graz. All documents issued in the country of origin must have full diplomatic certification to be recognized in Austria. Certification can be done by the Austrian representation authority in the country of origin. The documents must be submitted in German or English translation, which must be made by an officially registered and sworn interpreter. The translations must be certified by the interpreter. The entire process [Extracted from the article]

• Exercise programs are effective in reducing low back pain for both nursing staff: nurses and nursing assistants. • Focusing on back and trunk exercises provide evidence based for low back pain relief for nurses and nursing assistants. • Exercise program for nurses and nursing assistants are more successful in those under 40 years old engaging in shorter exercise (20 sessions). Introduction : Nurses have a high prevalence of low back pain due to ergonomic hazards in healthcare workplaces. While exercise programs have been suggested as an intervention strategy, the effectiveness of low back pain programs has been inconsistent in the research literature. The purpose of study is to determine the effect of exercise programs to reduce low back pain among nursing staff. Methods : A systematic review and meta-analysis was conducted with five databases and systematically searched. Following the PRISMA guidelines, included studies evaluated low back pain relief among nurses or nursing assistants and described the exercise program. Two reviewers independently appraised, extracted, and synthesized all available studies. The study protocol was registered in PROSPERO (CRD42022359511). Results : A total of 296 articles with 1,355 nursing staff from nine countries were obtained. Nine randomized controlled trials with a moderate to low risk of bias quality were included. Exercise programs had a small but significant effect on low back pain of nursing staff (SMD = -0.48; 95% CI = -0.76 to −0.19; p = 0.03, I2 = 62%, p = 0.001). A subgroup analysis of nurses and nursing assistants showed moderate and small effects, respectively (I2 = 0% p < 0.0001, SMD −0.73 CI 95% [-0.97 to –0.48], p = 0.76, and I2 = 0% p = 0.002, SMD −0.23 CI 95% [-0.38 to −0.08], p < 0.88). Exercise for back and trunk exhibited a moderate effect on low back pain (SMD −0.56 CI 95% [-0.86 to −0.25], p = 0.01, I2 = 66%, p < 0.0004). A subgroup analysis comparing age, under 40 years old revealed a moderate effect size (SMD = -0.59; 95% CI = -0.83to −0.35; p = 0.06; I2 = 64%, p < 0.0001). Conclusions : Exercise programs are an effective treatment to reduce low back pain in nurses and nursing assistants, especially among younger staff. Practical application : Back and trunk exercise programs should be recommended for nursing staff with low back pain. [ABSTRACT FROM AUTHOR]

Aims: To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. Design: Mixed method explanatory sequential design. Methods: A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. Results: Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. Conclusions: Delegation is a two‐way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. Implications for the profession and/or patient care: Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. Impact: Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses.Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants.Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. Reporting method: Complied with the APA Style JARS‐MIXED reporting criteria for mixed method research. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014–2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work–life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides. [ABSTRACT FROM AUTHOR]

Background and Objectives Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. Research Design and Methods This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. Results Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). Discussion and Implications In this study, modifiable elements of organizational context (i.e. culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care. [ABSTRACT FROM AUTHOR]

Aim(s): To conceptualise and identify characteristics of clinical leadership in the nursing home setting. Design: A qualitative study using semi‐structured focus group interviews and a thematic analysis. Methods: Five semi‐structured focus group interviews were conducted with 41 healthcare professionals from nursing and other healthcare disciplines working in nursing homes (such as nurse assistants, licensed practical nurses, registered nurses (RNs), occupational therapists, recreational therapists, psychologists and gerontologists). Qualitative thematic content analysis of the gathered data was done. Results: Clinical leaders in nursing homes can be defined as passionate healthcare professionals providing person‐centred care with strong communication skills. They are clinical experts in their field and motivated to engage in lifelong learning. They are team players with informal leadership skills. They are visionary, committed, resilient and responsive. Awareness of the definition and the main characteristics of clinical leadership is necessary to facilitate the identification, support and development of healthcare professionals. Focussing on the development of competencies, training courses and monitoring and assessment methods is necessary to improve the evidence of clinical leadership in nursing homes. [ABSTRACT FROM AUTHOR]

To evaluate the moral distress (MD)in health professionals of pediatric and adult units to show how the complexity of care in the pediatric field causes the professionals who carry out their activity in these units to present a higher level of moral distress and a worse climate ethical. Design: Observational study with health professionals who currently work in Spanish Hospitals. Methods: A 58-item questionnaire was electronically distributed which included sociodemographic and employment characteristics, the Spanish version of the Measure of Moral Unrest for Healthcare Professionals (MMD-HP-SPA) and the Hospital Ethical Climate Survey (HECS). Results: A total of 169 health professionals completed the questionnaire. The moral distress was significantly higher among nurses than among physicians and nursing assistant care technicians. Focusing on the type of unit, moral distress it was only significantly higher for those physicians treating adult patients compared to those treating pediatric patients. Regarding the total score of the HECS survey, the medical group shows higher scores compared to the nursing group. Conclusion: Statistically significant differences have been found only in the medical group that treats adult patients, presenting a higher level of moral unrests than the pediatrician group. The MMD-HP-SPA questionnaire is a valid and useful instrument to detect MD in our hospital units in order to be able to implement strategies/interventions that improve the ethical climate and other factors that can mitigate and prevent this MD. [ABSTRACT FROM AUTHOR]

Background: Infection prevention and control (IPC) research has long neglected the home healthcare sector with its unique challenges. This study aimed to gain an understanding of the barriers to the implementation of infection prevention practices relevant to this setting, the related attitudes, perceived relevance and priorities from the home healthcare worker perspective in Switzerland. Methods: The mixed-method study involved semi-structured interviews (n = 18) and an anonymous web-based survey (n = 144) among nursing assistants and nurses from two home healthcare organizations in northwest Switzerland. Questions in both sub-studies focused on perceived challenges to infection prevention practices, perceived relevance, and related attitudes and mitigation strategies. Using an exploratory-sequential design, survey questions were designed to quantify and complement the findings from the interview study. Results: Healthcare workers in these two organisations felt adequately protected, trained and supported by their organisations regarding IPC (survey agreement rates > 90%). General challenges to IPC in the home environment most agreed on were lack of cleanliness, lack of space, and the priorities of the patient to be respected (survey agreement rates 85.4%, 77.1%, and 70.8%, respectively). Practices and perceived challenges in the case of colonisation with multi-drug resistant organisms (MDRO) and potentially infectious diarrheal or respiratory illnesses varied highly regarding information transfer, use of protective equipment, and use and disinfection practices of multi-use equipment. Challenges to hand hygiene, sharps safety, waste management and decontamination of equipment did not feature as a prominent concern. Conclusions: This study is the first to characterise the implementation of infection prevention practices and the related challenges in home healthcare in Switzerland. Home healthcare workers describe various challenges related to infection prevention practices as largely manageable in their work routine, and generally show satisfaction with the support provided by their organisations regarding IPC precautions. Key findings regarding challenges amenable to interventions include uncertainty and inconsistency regarding the management of MDRO colonisation and acute illnesses, and gaps in information transfer. Those challenges may benefit from both organisational interventions and further research into the level of precautions that are appropriate to the home healthcare setting. [ABSTRACT FROM AUTHOR]

Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions. [ABSTRACT FROM AUTHOR]

In 2023, the American Academy of Clinical Neuropsychology (AACN) faced both challenges and successes. They mourned the loss of a prominent leader in the field, Karen Postal, while also celebrating the contributions of other members. The AACN addressed controversy surrounding neuropsychology training guidelines and reaffirmed their commitment to diversity and inclusion. Despite these challenges, the AACN experienced growth in membership, financial reserves, and successful conferences. They also expanded collaborations with other organizations and increased their presence on social media. The American Board of Clinical Neuropsychology (ABCN) awarded board certification to individuals and made advancements in their examination process. The American Academy of Clinical Neuropsychology Foundation (AACNF) continued to support the AACN through fundraising and grant awards. The text also provides information on the current board members and encourages interested individuals to join the organization. [Extracted from the article]

Background: There is a growing recognition of multidisciplinary practices as the most rational approach to providing better and more efficient healthcare services. Pharmacists are increasingly integrated into primary care teams, but there is no universal approach to implementing pharmacist services across healthcare settings. In Norway, most pharmacists work in pharmacies, with very few employed outside this traditional setting. The home care workforce is primarily made up of nurses, assistant nurses, and healthcare assistants. General practitioners (GPs) are not based in the same location as home care staff. This study utilized the Normalization Process Theory (NPT) to conduct a process evaluation of the integration of pharmacists in a Norwegian home care setting. Our aim was to identify barriers and facilitators to optimal utilization of pharmacist services within a multidisciplinary team. Methods: Semi-structured interviews (n = 9) were conducted with home care unit leaders, ward managers, registered nurses, and pharmacists in Norway, in November 2022-February 2023. Constructs from the NPT were applied to qualitative data. Results: Findings from this study pertain to the four constructs of the NPT. Healthcare professionals struggled to conceptualize the pharmacists' competencies and there were no collectively agreed-upon objectives of the intervention. Consequently, some participants questioned the necessity of pharmacist integration. Further, participants reported conflicting preferences regarding how to best utilize medication-optimizing services in everyday work. A lack of stakeholder empowerment was reported across all participants. Moreover, home care unit leaders and managers reported being uninformed of their roles and responsibilities related to the implementation process. However, the presence of pharmacists and their services were well received in the setting. Moreover, participants reported that pharmacists' contributions positively impacted the multidisciplinary practice. Conclusion: Introducing new work methods into clinical practice is a complex task that demands expertise in implementation. Using the NTP model helped pinpoint factors that affect how pharmacists' skills are utilized in a home care setting. Insights from this study can inform the development of tailored implementation strategies to improve pharmacist integration in a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Aim: To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co‐design of new mealtime interventions. Methods: This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo‐elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. Results: Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. Conclusions: This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co‐design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. Practice Implications: Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co‐designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. Impact: What problem did the study address?: Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require.Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings?: Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re‐prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal.There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement.Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact?: The research provides a framework for multidisciplinary teams to begin co‐designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. Reporting Method: This manuscript is written in adherence with the Standards for Reporting Qualitative Research. Patient or Public Contribution: Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript). [ABSTRACT FROM AUTHOR]

Aims: To explore potential areas of low‐value home‐based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home‐based nursing care. Design: A quantitative, cross‐sectional design. Methods: An online survey with questions containing scaled frequencies on five‐point Likert scales and open questions on possible related influencing factors of low‐value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. Results: A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low‐value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're‐use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low‐value care. Conclusion: According to registered nurses and certified nursing assistants, a number of low‐value nursing practices occurred frequently in home‐based nursing care and they experienced multiple factors that influence the provision of low‐value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de‐implementation strategy. Reporting Method: STROBE checklist for cross‐sectional studies. Patient or Public Contribution: No Patient or Public Contribution. Implications for the Profession and/or Patient Care: Nursing care is increasingly shifting towards the home environment.Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low‐value.Reducing low‐value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the phenomenon of "overqualification" in the nursing personnel of a public general hospital, in relation to the existence of "professional boredom". METHOD A cross-sectional study was conducted in January--February 2022, on 146 nursing personnel, at the Public General hospital of Crete. Scale of Perceived Overqualification and Scale of Work-related Boredom were employed to collect the data. A convenience sampling method was applied. The Statistical Package for Social Sciences (SPSS), version 26.0, was used for the statistical analysis. RESULTS The rate of "overqualification" responses among nursing personnel was found to be low (20.5%) (p<0.05), as was the rate of "professional boredom" (8.2%) (p<0.05). A statistically significant association was found between "overqualification" and "professional boredom", with participants with boredom reporting a higher frequency of overqualification than those without boredom (83.3% versus 14.9%, p<0.001). Additionally, it was observed that the higher qualification surplus score is associated with the participants' higher levels of education (p=0.002) (objective qualification surplus), i.e. those with a master's/doctorate degree, versus those with a basic degree or school or two-year nursing assistant degree (47.4% versus 17.0% and 15.2%, respectively, p=0.017). CONCLUSIONS The present study identified two phenomena, overqualification and work boredom, that have a direct impact on the manifestation of low job satisfaction and poor work performance in the Greek health sector but have received insufficient attention. To investigate the relationship between these two phenomena and other parameters is necessary to enhance the leadership's role as a mediator and to conduct new studies on a larger scale. [ABSTRACT FROM AUTHOR]

Copyright of Health Bulletin / Zdravstveni Glasnik is the property of Faculty of Health Studies, University of Mostar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate). Methods: This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant. Results: Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€. Conclusions: Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents. Trial registration: clinicaltrials.gov, NCT02677272. [ABSTRACT FROM AUTHOR]

Purpose: Burnout has been well examined among physicians and other high-wage, high-autonomy healthcare positions. However, lower-wage healthcare workers with less workplace autonomy (e.g., medical assistants, nurses' aides) represent a substantial proportion of the workforce, but remain understudied. We aimed to examine the effects of burnout on psychotropic medication use and misuse and whether these effects differed by occupational level. Methods: In March 2022, we collected data from a diverse sample of US healthcare workers (N = 200) and examined the cross-sectional relationship between burnout and changes in prescribed psychotropic medication (i.e., starting, stopping, and/or having a change in the dose/frequency) during the COVID-19 pandemic. We also separately examined the relationship between burnout and psychotropic medication misuse (i.e., without a prescription, in greater amounts, more often, longer than prescribed, and/or for a reason other than prescribed). We stratified models by occupational level (prescribers/healthcare administrators vs. other healthcare workers). Results: Greater burnout was associated with higher odds of changes in prescribed psychotropic medication among prescribers/healthcare administrators (aOR = 1.23, 95% CI 1.01, 1.48), but not among other healthcare workers (aOR = 1.04, 95% CI 0.98, 1.10). Greater burnout was not associated with psychotropic medication misuse among prescribers/healthcare administrators (aOR = 0.96, 95% CI 0.82, 1.12) but was associated with increased odds of psychotropic medication misuse among other healthcare workers (aOR = 1.07, 95% CI 1.01, 1.14). Conclusions: Potential disparities in help-seeking and healthcare access might manifest in non-medical use of prescription drugs among some healthcare workers, which has implications for worker safety and well-being. [ABSTRACT FROM AUTHOR]

Background: Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual's needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings. Methods: We conducted a qualitative study to understand Sudanese refugee women's experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers' perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC. Results: Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected. Conclusions: Despite providers' commitment to offering person-centered care and women's generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform. [ABSTRACT FROM AUTHOR]

The Intelligent Nursing Assistant Robot (INA) emerged as an innovative solution with COVID straining the healthcare systems and over 180 million cases globally by April 2021. INA protects overworked and exposed staff by remotely monitoring patients in quarantine. This robot boasts features like a thermal camera for precise temperature readings and a high-definition camera for visual checks. Facial recognition aids in patient identification, while its mobile control via an Android app and Pixy camera with Arduino connection offers flexibility. Built with durable Cagebot materials, INA provides a safe and versatile tool for overwhelmed healthcare professionals during this critical time. [ABSTRACT FROM AUTHOR]

While mechanical vibration lessens discomfort associated with injection site pain (ISP), many local anesthetic injectors (LAIs) do not use vibratory anesthetic devices (VADs). Injector preference of vibration device is influenced by functional concerns, but qualitatively there is an element of adoption that is driven by visual feedback. We sought to capture operator preferences of vibration device design elements to further understand why injectors do not use these devices. We conducted a survey of image preferences among nurses and medical assistants employed at 8 dermatological clinics to investigate barriers to VAD use. Images were electronically modified with features distinct from the original device (a VAD commonly used in clinical practice). Participants rated their likelihood and comfort of use of each VAD represented in the images. Two-sample t-tests were used to compare the rating of the unmodified VAD to each modified VAD within participants. A response rate of 100% was achieved with 35 participants (average age, 38.5 years; 6 (17.1%) male, 29 (82.9%) female). Despite 28 (80%) participants knowing that mechanical vibration reduces ISP, only 16 (45.7%) endorsed ever using mechanical vibration as topical anesthetic. Images modified by pattern, color, and sterility covering were rated significantly lower than the original, unmodified VAD image (plain white VAD), confirming that visual feedback does impact adoption. Through independent comment categorization, aesthetics were found to be important to LAIs. Aesthetic preferences opposing functional concerns may factor into the lack of VAD use. Defining these visual preference barriers to adoption may help promote VAD use during dermatologic procedures. [ABSTRACT FROM AUTHOR]

Special issues (SIs) in nursing academic journals have many potential benefits, including increasing the output of high-quality content, attracting authoritative authors, and expanding the journal's scope and outreach. SIs focus on a particular contemporary topic and are curated by a team of specialists. The Journal of Advanced Nursing commissions SIs that cover trending and contemporary topics to meet the needs of their readership. SIs can attract more submissions and citations, but the choice of topic is crucial for their success. The journal follows ethical guidelines and has clear policies and protocols for handling SIs. [Extracted from the article]