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Growing numbers of clinicians are dealing with mental and behavioral health issues, including burnout, depression, and suicidal ideation. Prevalence of these conditions in pediatric critical-care (PCC) nurses is reported to be as high as 42%–77%.
The purpose of this evidence-based quality improvement project was to implement a cognitive behavioral skills-building (CBSB) program to improve well-being and resiliency in PCC nurses.
The 7-week MINDBODYSTRONG (MBS) program was implemented with two cohorts of neonatal/PCC nurses in a 222-bed academic, tertiary care pediatric hospital, using a virtual platform and offering 1 sequential session per week. Each participant was asked to complete an anonymous baseline and post-program survey that included the following measures: Generalized Anxiety Disorder (GAD-2), Perceived Stress Scale (PSS4), Patient Health Questionnaire (PHQ-2), and a Single Item Measure of Burnout. Post-program surveys also included a MBS program evaluation.
Fifteen RNs registered for and completed the MBS program. 93.3% completed both the baseline and post-program survey. Results demonstrated positive clinical effects across all four mental health measures with large effects noted in the GAD-2 and PSS-4, and small effects noted in the PHQ-2 and the Single Item Measure of Burnout. 100% of participants found MBS helpful and recommended that it be offered to a wider audience.
Implementation of the MBS CBSB program demonstrated clinical effectiveness on measures of anxiety, perceived stress, depression, and burnout in PCC nurses. The program was well received by participants. Strategies for broader implementation should be explored.
To present the process of establishing a Doctor of Nursing Practice (DNP) policy analysis project option at one nursing school, offering examples of diverse student and graduate analyses to guide other institutions.
Nurses are skilled patient advocates, and their advocacy forms a crucial foundation for influencing health policy. This, in turn, enhances population health and addresses health disparities, particularly for vulnerable groups. DNP students are educated to use innovative methods to integrate current evidence to inform practice and policy, yet some nursing schools lack resources to support comprehensive DNP policy analysis projects.
The article presents a case example of how one institution developed a pathway and instructional support to formally offer DNP students the option to perform a DNP policy analysis project.
Essential elements to support students' successful completion of a DNP policy analysis project include adequate faculty expertise in health policy and a structured institutional framework. Residency activities must deepen a student's understanding and knowledge about policy and the health problem trying to be solved with policy. Clear documentation of these unique residency activities is crucial. There is a strong emphasis on the need for clear communication and guidance between programme faculty, programme mentors and students. DNP policy analysis projects enrich students' knowledge, skills and networks, fostering future policy leaders and facilitating collaboration with clinical experts across diverse research fields.
Nurturing DNP students completing policy analysis projects is vital for translating evidence into practice, developing future nurse policy leaders and ensuring health equity and access to quality healthcare.
DNP policy projects can positively influence nursing practice and policy. Expanding upon previous DNP students' policy analysis projects also provides a unique opportunity to build and broaden nursing's impact on policy development.
To provide an in-depth description of an innovative Doctor of Nursing programme which prepares nurses for senior roles in healthcare and related organisations. This programme provides nurse leaders with the knowledge and skills to advance systems through healthcare innovation design, implementation, and evaluation.
A comparison of doctoral nursing programmes, highlighting the unique aspects of the University of Calgary Doctor of Nursing programme.
The University of Calgary Doctor of Nursing programme addresses key gaps that currently exist within nursing education. Few existing programmes directly support the development of nurses as healthcare leaders and innovators. This programme enables nurse leaders to leverage their front-line experience into senior system-level leadership roles. Each core course includes a building block assignment that develops key doctoral skills: framing research questions, appraising literature, selecting methods and data, planning ethically sound projects, and translating evidence into persuasive arguments for policy or system change.
Nurses play a vital role in healthcare around the world. The University of Calgary Doctor of Nursing programme recognises the value of investing in nursing leaders and emboldening them to leverage their frontline leadership experience to advance data-driven change, innovation, and policy development in the complex healthcare systems in which they work and lead.
Currently, there is a dearth of programmes available to prepare nurses for senior leadership roles in healthcare or related organisations, despite significant demand from prospective students and employers alike. The University of Calgary Doctor of Nursing programme meets the workforce demand for a programme focused on nursing leadership, to advance health systems through skill development in systems innovation, appraisal of evidence and implementation science, as well as quality assurance/quality improvement and programme evaluation. This programme focus also better equips students to examine and evaluate systemic inequities and challenges currently facing healthcare systems, practitioners and users.
To explore perceptions of healthcare professionals' psychological wellbeing at work and patients' experiences of care.
Narrative interviews were undertaken as part of a wider experience-based co-design study.
Interviews were undertaken March to December 2022 with 19 participants (healthcare professionals n = 13 and patients n = 6) from a community hospital and analysed for emotional touchpoints using reflexive thematic analysis.
Ten themes were synthesised into five categories: (1) What is psychological wellbeing at work? (2) Barriers to psychological wellbeing at work (‘Misaligned NHS Culture’ and ‘Pressurised System’); (3) How negative psychological wellbeing at work impacts on staff and patients' experiences of care (‘Staff Struggle to Survive’ and ‘Patients Suffer’); (4) Enablers of psychological wellbeing at work (‘Nurturing Culture’ and ‘Teamwork’); and (5) How positive psychological wellbeing at work impacts staff and patients' experiences of care (‘Staff Thrive’ and ‘Patients Benefit’).
Poor psychological wellbeing negatively impacted healthcare professionals' health and their ability to provide care. In response, patients deliberately withheld requests for help, risking their recovery. Conversely, when psychological wellbeing was supported, staff provided more relational care with improved patient experience.
A nurturing culture and teamwork are positive enablers of staff psychological wellbeing and can be used to improve staff and patients' experience.
This is one of the first studies to demonstrate that patients modify their behaviour in response to perceptions of staff wellbeing, with implications for their recovery.
COREQ.
Members of the public advised on the patient-facing materials and the overarching study design.
To describe symptom patterns in first-time mothers through 3 months postpartum.
Longitudinal, descriptive correlational.
Secondary analysis of data from a randomised clinical trial of first-time mothers. Symptoms were assessed at 1, 2 and 3 months postpartum using the Memorial Symptom Assessment Scale for dimensions of 32 symptoms.
New mothers (n = 114) reported an average of 7.0 (SD 4.7) symptoms at 1 month, decreasing to 5.3 (SD 4.3) at 3 months. Physical symptoms decreased to the greatest degree. Symptoms reported by over 33% of participants included lack of energy, worrying, pain, difficulty sleeping or concentrating and feeling irritable, sad or drowsy. The most distressing were lack of energy, feeling irritable, pain, nervousness and hair loss. Symptoms did not differ by type of birth or infant feeding. Older mothers (≥ 35 years) had significantly more symptoms and distress than younger mothers.
Most symptoms improved over time, yet some were still prevalent at 3 months. Symptoms not appraised as particularly distressing may still be of clinical concern for safety reasons. Frequent postpartum assessments and interventions are important, particularly for older mothers.
In the first 3 months, postpartum symptoms not perceived as distressing may lead to adverse health outcomes. These symptoms may threaten maternal–infant welfare beyond the first 3 months postpartum. Older first-time mothers merit particular attention by clinicians.
The authors complied with STROBE reporting guidelines.
No patient or public contribution.
To explore the views of community registered general nurses and directors of public health nursing on the current and future role of the community registered general nurse in the Republic of Ireland.
Anonymous cross-sectional descriptive survey.
Two questionnaires were developed; one targeted at community registered general nurses and one targeted at assistant directors of public health nursing or directors of public health nursing who were working with community registered general nurses. Social media was used to recruit participants. Descriptive statistics were used while data from open-ended questions were analysed using NVivo software.
A total of 97 community registered general nurses and 28 assistant directors of public health nursing or directors of public health nursing completed the surveys in 2023. There was consensus that community registered general nurses provide holistic care, including case management of adults with complex health needs living in the community. However, lack of promotional opportunities coupled with poor remuneration has resulted in job dissatisfaction. Respondents felt that community registered general nurses should focus on older adults, whereas public health nurses should focus on child health.
The role of the community registered general nurse needs to be clarified, and a promotional pathway developed to attract new graduates to this post.
This paper outlined the current role and vision for the future role of community registered general nurses.
CROSS guidelines.
No patient or public contribution.
This paper contributes to the challenges community nurses face regarding increased demand for community nursing, lack of career structure for some community nurses, and difficulties with staff retention within the community.
by Carolyn Tran, Debbie Kane, Dale Rajacich, Kathryn Lafreniere, Caroline Hamm
As cancer survival rates increase in Canada, a growing number of working-age individuals face challenges returning to work after treatment. This study examines the experiences of Canadian cancer survivors who remained in or returned to the workforce during the COVID-19 pandemic. Participants were cancer survivors aged 25−62 who had been employed prior to their diagnosis. They completed a brief online survey about their return-to-work (RTW) experiences and were invited to participate in a semi-structured interview. Seven participants took part in the interviews, which were transcribed and analyzed through inductive thematic analysis. Four overarching themes emerged: (1) The Perfect Storm of Systemic Challenges, highlighting healthcare barriers exacerbated by the pandemic; (2) You Are Not Alone, emphasizing the importance of social support in mitigating isolation; (3) One Size Does Not Fit All – Individual Journeys, reflecting the need for flexible workplace accommodations and patient self-advocacy; and (4) Creating a “New Normal,” illustrating how survivors reassessed priorities, work identities, and personal well-being. Participants described delayed treatments, lack of fertility options, and limited support during appointments due to pandemic restrictions. Workplace accommodations varied, with some survivors feeling supported while others faced inflexibility. Findings emphasized the need for improved healthcare responsiveness, personalized RTW accommodations, and improved employer training to support cancer survivors. The study also reveals how the COVID-19 pandemic exacerbated existing systemic gaps, underscoring the importance of preparing healthcare and employment systems to better support vulnerable populations during times of crisis.To test the feasibility and acceptability of a newly developed model of neonatal nurse-controlled analgesia to manage pain in the post-operative infant.
The study utilised a single-centre two-arm parallel, unblinded randomised controlled external pilot trial design.
The pilot trial was conducted in a surgical neonatal tertiary intensive care unit in Brisbane, Australia. Eligible infants were randomised to receive either post-operative pain management care via a model of neonatal nurse-controlled analgesia or standard care. Feasibility and acceptability were the primary outcomes. Seven feasibility outcomes were assessed by a traffic light system to delineate progression to a larger trial. Acceptability and clinical utility of the model of care by staff were assessed by feedback from an anonymous questionnaire that was administered at the completion of the trial period. Secondary outcomes included parental attitudes and perceptions of post-operative pain management to help establish primary outcomes for a larger randomised controlled trial.
Overall staff found the formalised model beneficial for managing post-operative pain but found the complexity of the model and ability to titrate analgesia based only on documented pain scores barriers requiring further consideration. Three of the seven feasibility outcomes failed to reach ‘greenlight’ targets to progress to a larger trial with adherence to the model, and the proportion of eligible infants not recruited was allocated a ‘redlight’. Secondary outcomes were comparable and support future study.
This pilot feasibility study has shown that a model of neonatal nurse-controlled analgesia can be safely implemented and utilised in the post-operative care of the surgical neonate. Further exploration of the barriers to model adherence and recruitment is warranted before a future larger trial is undertaken.
Though not all primary outcomes reached an acceptable range for further progression, this pilot feasibility study provided invaluable learning and has provided direction for future research into the provision of a family integrated and responsive model of analgesia.
This study is reported in line with the Consolidated Standards of Reporting Trials (CONSORT): Extension to randomised pilot and feasibility trial and the TIDieR Checklist (Template for Intervention, Description and Replication).
No patient or public contribution was utilised for this study.
Trial Registration: ACTRN12623000643673—the trial was prospectively registered
To implement strategies to improve the care of patients with acute pain in the emergency department (ED).
Pre–post implementation study using a Type 2 hybrid effectiveness–implementation design.
Implementation strategies were introduced and monitored through the Ottawa Model of Research Uses' assessment, monitoring and evaluation cycles, supported by focused and sustained facilitation.
Improvements in time-to-analgesia within 30 min (21%–27%), administration of nurse-initiated analgesia (NIA) (17%–27%) and measurement of pain (65%–75%) were achieved post-implementation. NIA was the strongest predictor of receiving analgesia within 30 min. Adoption of pain interventions into practice was not immediate yet responded to sustained facilitation of implementation strategies.
Collaboration with local clinicians to introduce simple interventions that did not disrupt workflow or substantially add to workload were effective in improving analgesia administration rates, and the proportion of patients receiving analgesia within 30 min. The assessment, monitoring and evaluation cycles enabled agile and responsive facilitation of implementation activities within the dynamic ED environment. Improvements took time to embed into practice, trending upward over the course of the implementation period, supporting the sustained facilitation approach throughout the study.
Sustained adoption of evidence-based pain interventions into the care of people presenting to the ED with acute pain can be achieved through sustained facilitation of implementation. NIA should be at the centre of acute pain management in the ED.
This study addressed the lingering gap between evidence and practice for patients with acute pain in the ED. Implementation of locally relevant/informed implementation strategies supported by focused and sustained facilitation improved the care of patients with acute pain in the ED. This research will have an impact on people presenting to EDs with acute pain, and on clinicians treating people with acute pain in the ED. Relevant equator guidelines were followed and the StaRI reporting method used.
No Patient or Public Contribution in this study.
To address the lack of accurate and accessible mental health medicines-information resources for children, young people and their parents/guardians using design thinking to co-design free-to-use, video resources tailored to this audience.
A multiphase qualitative case study using the Double Diamond model of Design Thinking: Discover, Define, Develop and Deliver. This included iterative prototyping, thematic analysis and public and patient involvement throughout.
Dublin, Ireland with online distribution of the final resources internationally through a free, open-access platform.
A multidisciplinary co-design team including two specialist mental health pharmacists, two academic pharmacists, five consultant psychiatrists, a psychiatric nurse, a youth content specialist, three youth activists and a parent representative.
26 co-designed, medicines-information videos were created, including versions for children (voiced by children), parents/guardians and young people. Videos feature storytelling formats with Bitmoji characters. Feedback from youth and parent collaborators guided design and content. Since launch, www.youthmed.info has had over 25 000 website views and more than 30 000 video views, with engagement from over 91 countries. The resources are also linked on national and international clinical and charity platforms.
Youth Med.Info addresses a gap in accessible, accurate mental health medicines-information by placing users – children, young people, parents/guardians and clinicians—at the centre of its design.
Background
Black adults have a higher risk for heart failure (HF) than others, which may be related to higher cardiovascular risk factors and also inflammatory dietary patterns. The Western diet is associated with inflammation and contributes to HF. Trimethylamine N-oxide is a diet-linked metabolite that contributes to inflammation and is associated with higher tumor necrosis factor-alpha (TNF-α) levels, especially in HF populations. The dietary inflammatory index score measures a diet’s inflammatory potential and food’s inflammatory effects.
Objective
The purpose of this pilot study was to explore associations between the Western diet, dietary inflammatory index, trimethylamine N-oxide, relevant covariates and variables, and TNF-α in Black persons with HF.
Methods
Thirty-one Black participants (mean age = 55 years, 68% women) with HF were enrolled. Trimethylamine N-oxide and TNF-α levels were analyzed using immunoassays. A food frequency questionnaire was completed, and dietary inflammatory index scores and food groups were calculated. Analyses included correlations and I-test statistics.
Results
Mean dietary inflammatory index score was −0.38, noting an anti-inflammatory diet with slightly higher inflammatory diet scores in men compared to women. The dietary inflammatory index score showed a negative association with dietary choline but not with trimethylamine N-oxide or TNF-α. Trimethylamine N-oxide and age were positively correlated, along with the correlation for TNF-α with a moderate effect size. No relationship was found among dietary inflammatory index, TNF-α, and trimethylamine N-oxide variables.
Discussion
A greater understanding of intake of inflammatory foods and relationships with immune factors is warranted to inform intervention development. In Black adults with HF, it is important to consider the intake of inflammatory foods as increased age may affect the retention of dietary metabolites. Metabolites may also increase the levels of inflammation. Knowledge about these relationships could lead to tailored dietary interventions based on diet, age, and culture patterns. 
FreshRSS 