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The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health.
This study aimed to examine the constructs associated with the conceptual model of distress, such as the work environment, specifically workload and the practice environment (quality of care, salary, staffing, time, and satisfaction) and associations with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using structural equation modeling.
This study was a cross-sectional survey design collected as part of the Nurse Worklife and Wellness Study (NWWS) using balanced stratified sampling methods.
A confirmatory factor analysis tested the factorial structure of the latent constructs using weighted least squares estimation with missing data (WLSMV) for the sample (n = 1170). A structural equation modeling approach examined the direct and indirect associations between workload, practice environment, health promotion behaviors, psychological distress symptoms, sleep disturbance, and health.
Based on the confirmatory factor analysis, the measurement model reported adequate model fit (CFI = 0.96; TLI = 0.95; SRMR = 0.048 and RMSEA = 0.039). The structural model showed that the workload was related to significantly increased psychological distress (β = 1.47, p < 0.001), sleep disturbance (β = 1.22, p < 0.01), and decreased overall health (β = −1.36, p < 0.01). Similarly, a positive practice environment was associated with significantly higher psychological distress (β = 1.61, p < 0.001), sleep disturbance (β = 1.31, p < 0.01), and lower overall health (β = −1.51, p < 0.01). Workload and the practice environment were associated with significantly increased health promotion behaviors such as interpersonal relations, spiritual growth, stress management, physical activity, and nutrition. A statistically significant indirect relationship was found between workload and psychological distress, mediated by health promotion behaviors. Psychological and physical health promotion had restorative effects in relation to decreasing the impact of distress and sleep disturbance while increasing overall health.
Our results highlight the need to improve the work environment by decreasing the nurses' workload and using health promotion behaviors to mitigate nurses' psychological distress. Future studies should focus on exploring distress in the context of non-pandemic work conditions and finding ways to promote coping behaviors in nurses. In addition, healthcare organizations should develop policies and strategies to incentivize nurses' participation in health promotion behaviors to promote their well-being and ultimately stabilize the nursing workforce.
Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.
Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.
A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.
Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.
The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.
The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.
Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital.
A cross-sectional design was used.
This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model.
The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care.
The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital.
Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.
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