Clinical Voices July 2024

Jul 09, 2024

Added to Collection

In this issue, read articles on job interview questions nurses should ask, finding stress relief through mindfulness, extended PTSS support for ICU patients, and more. Plus, read a new nurse Q&A and Jennifer Adamski's first President's Column.

Nurses Find Relief From Stress Through Mindfulness

Further research can help determine the optimal combinations of mindfulness activities.

Mindfulness activities help reduce stress and depression for nurses working in clinical settings, a finding that highlights the need for mental health support in personal and professional development plans.

Effects of Mindfulness-Based Interventions on Reducing Psychological Distress Among Nurses: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” in Journal of Nursing Scholarship, examined 16 studies (2004-2022) involving 1,372 nurses in North America, Europe and Asia

Nurses in experimental groups participated in mindfulness practices, such as yoga and meditation, stress management, music therapy, breathing, muscle relaxation and aromatherapy, from one day to 12 weeks. Their levels of stress, depression and anxiety were measured against those of nurses in control groups who performed their normal duties without receiving intervention.

According to the review, mindfulness activities led to meaningful decreases in stress levels (-0.50 standard deviation) and depression (-0.42 standard deviation). However, the review reveals no significant differences in anxiety levels between the experimental and control groups.

This inconsistency might be due to differences in the types of activities offered, the qualifications of instructors, or the length of intervention periods. Still, the review advocates that hospitals should implement mindfulness programs to support the mental well-being of nurses.

“To ensure that nurses have a sustainable work-life balance, it is necessary to provide mindfulness-based intervention training and practice that are sensitive and flexible to their needs,” the review notes.

The review adds that further investigation will help determine the optimal combinations of mindfulness activities, their effect on a larger sample size, sufficient follow-up durations, delivery modes and experimental designs.

“Future research may incorporate nurses’ work environment factors in studying the effects of mindfulness-based interventions (e.g., the work settings providing quiet areas for meditation-based practices, supporting aroma, or music therapeutic self-care).”

Posttraumatic Stress Calls for Extended ICU Patient Support

Future research could lead to less PTSS in specific patient groups.

For post-ICU patients, high levels of posttraumatic stress symptoms (PTSS) are most prevalent at 12 months after admission, a finding that suggests healthcare providers should be aware of specific patient groups and extend follow-ups beyond one year.

Patient Characteristics Associated With Posttraumatic Stress Symptoms in Intensive Care Unit Survivors During a One-Year Follow-Up: A Multicenter Study,” in Heart & Lung: The Journal of Cardiopulmonary and Acute Care, identifies patient groups who displayed a significantly higher risk of PTSS, based on preexisting health conditions, demographics and other clinical characteristics.

The study enrolled 603 adult patients at six ICUs in Norway from October 2018 to June 2020. PTSS symptoms — measured using the Impact of Event Scale-Revised psychological tool — were recorded for groups of patients before admission as well as three, six and 12 months later.

A comparison reveals high levels of PTSS reported by 14.9% of patients at three months, 16.7% at six months and 18.4% at 12 months. The study also identifies statistically significant links between increased PTSS levels and two patient groups:

  • At six months — male patients with a hospital stay of 11.5 days or more
  • At three, six and 12 months — patients ages 70 or older with lower education levels, higher Simplified Acute Physiology Scores II, and mechanical ventilation during their ICU stays

These patients could benefit from longer post-ICU follow-up to ensure continuity of care from the ICU to a hospital ward or other healthcare institutions, the study adds, suggesting that follow-up should exceed one year.

“Presumably, the percentage of older patients being admitted to ICU will continue to increase in the years to come, resulting in an even greater demand for safe and evidence-based care routines,” the study notes, adding that additional research could lead to decreased PTSS in specific patient groups.

Interview Questions for Nurses to Ask

Does the potential employer prioritize a collaborative workplace, continual learning and creative problem solving?

To thrive in their careers, nurses value organizations that prioritize relational leadership that fosters a sense of belonging through strong connections, open communication and support for their well-being.

“Leadership Style Matters: Use the Interview to Ensure Your Next Job Meets Your Needs,” in American Nurse, notes that 18% of newly licensed RNs leave the profession within the first year. However, research shows that positive work environments and supportive leadership can improve nurse retention, writes Kay Kennedy, an experienced nurse leader and CEO of uleadership, an educational program that advocates for a Human-Centered Leadership model.

Kennedy has partnered with colleagues on work regarding relational leadership in nursing. The article emphasizes the importance of using a job interview to assess whether a potential employer prioritizes a collaborative workplace with the ability to engage in continual learning and creative problem solving.

“Whether you’re entering the nursing workforce for the first time or moving from one position to another, your job interview offers an opportunity to ask for what you need and expect from the organization,” the article adds.

The article lists a series of sample questions nurses can ask in a job interview to help determine leadership style:

  • “What programs are offered to support the well-being and mental health of team members?
  • Can you provide a recent practice decision influenced by bedside nurses?
  • Can you describe this organization’s process for continual professional growth?
  • How would you describe the culture of this unit (or organization)? How do you see values, collaboration and communication shaping this culture?
  • How do you support work-life harmony for team members?”

“Recognize the power of your voice in shaping the changes needed in healthcare,” Kennedy adds in the article. “The current environment requires hiring leaders to listen. You’re in the driver’s seat, and change starts with you.”

Behavioral Therapy Benefits Shift Workers’ Sleep

Behavioral therapy led to fewer related mental health issues, including anxiety.

Behavioral therapy helped reduce insomnia, sleepiness and mental health issues incurred by healthcare workers with a range of jobs and whose shifts frequently included nights.

Behavioural Therapy for Shift Work Disorder Improves Shift Workers’ Sleep, Sleepiness and Mental Health: A Pilot Randomised Control Trial,” in Journal of Sleep Research, considered daytime and nighttime sleep separately for effective interventions, finding significant increases in daytime total sleep for participants. Behavioral therapy “is effective for improving insomnia severity and daytime sleep duration, and these improvements are significant, large and maintained over time,” the trial concludes.

Conducted in Quebec City, Canada, the trial included 43 participants who completed the process, 78% of them nurses, divided into a treatment group of 23 and a control group of 20, who received the same benefits after a delay. The treatment group received six individual sessions at a sleep laboratory that included education, sleep restriction therapy and stimulus control therapy.

Following the session cycle, 92% of the treatment group were no longer diagnosed with shift work disorder, and all were considered in remission. The participating night shift workers reported significant improvements in daytime insomnia and daytime total sleep and fewer intrusive thoughts before sleeping.

Participants experienced fewer related mental health problems, including depression and anxiety. “Further improvements are observed on daytime and nighttime insomnia severity, sleepiness, daytime and nighttime SE [sleep efficiency] and wake time, anxiety, depression and beliefs about sleep when the sample size is increased with participants who received treatment after the waiting period.”

Limitations include the small number of participants and a 32.6% attrition rate. The trial also lacked examination of objective sleep or generalizability to populations outside healthcare workers. “Although the attrition rate was high, those who received the treatment greatly benefitted from it.”

Telehealth Aids Transition From NICU to Home

Telehealth can offer benefits for neonatal patients across the care continuum.

Telehealth, which can help clinicians transition neonatal patients from hospital care to home, offers many potential benefits.

Perspectives on Telehealth Use With the Neonatal Population: Policy, Practice, and Implementation Considerations,” in Critical Care Nursing Clinics of North America, explains how nurse-led teams and specialists from neonatal intensive care units (NICUs) can continue to provide services to families during the critical post-discharge phase.

“For the neonatal population, telehealth can offer benefits across the care continuum through increased access to care, early intervention, increased convenience, reduced costs, and improved continuity of care, all of which may have a positive effect on quality outcomes,” the article notes.

Telehealth’s main advantages for NICU patients and their families include offering support from the initial transition to taking on primary responsibility for care, while facing challenges such as insurance coverage, access to specialty care and social determinants of health (SDOH). “Although caregivers may face multiple challenges with the transition of care, telehealth is a powerful tool to continue supporting dyad care during this critical period.”

The nurse-led Baby Steps model includes contacting caregivers 48 to 72 hours after a patient’s discharge with anticipatory “guidance, medication support, and nursing care.” The program reduces readmissions or visits to emergency departments and urgent care, and boosts caregiver satisfaction, the article adds.

The nurse-led Baby Steps model includes contacting caregivers 48 to 72 hours after a patient’s discharge with anticipatory “guidance, medication support, and nursing care.” The program reduces readmissions or visits to emergency departments and urgent care, and boosts caregiver satisfaction, the article adds.

AACN Tele-critical Care Nursing Practice: An Expert Consensus Statement Supporting Acute, Progressive and Critical Care 2022” provides hospitals, leaders and nurses with recommendations, clinical vignettes and a framework to implement, evaluate and improve evolving practice.

Heat-Related Illness Therapies

Complications of heat-related illness can impact practically every organ system.

Based on a steady increase in heat-related illnesses and injuries, a task force assessed the limited evidence for treating patients in critical care settings.

“Management of Heat-Related Illness and Injury in the ICU: A Concise Definitive Review,” in Critical Care Medicine, notes that hospitalizations from heat exposure rise as temperatures increase globally, and mortality rates increase by 3% for every degree (Celsius) increase in average daily temperatures and exposure duration. “Complications of heat-related illness can impact practically every organ system; prompt recognition and intervention are crucial determinants for survival,” the review notes.

Minimizing the risk of long-term damage or death from heat requires rapid response regardless of the setting, including first response or emergency departments, with the ideal time frame for lowering core body temperature to 38-40 C being within 30 minutes. “Survivors who were cooled at an inadequate rate had a 4.57 times risk of medical complications.”

The review indicates the ideal methods for cooling patients quickly are ice-water immersion, cold-water immersion and ice sheets, with adequate methods including temperate water with a fan, helicopter down draft with water, cold IV fluids and ice packs, and IV fluids with wet towels. Rated as inadequate were gastric lavage and cooling blankets.

Many common therapies to cool patients quickly require additional research, because there are limited high-quality studies on patients with heatstroke. “Existing clinical data are limited by small sample sizes and trials that were conducted in controlled environments or laboratory settings, specifically those assessing cooling methods.”

The task force recommends an array of questions for future research to improve decision-making with quality evidence. “Most data are either derived from case series, small retrospective studies, or extrapolations from alternative research models, given the ethical challenges of conducting studies in this environment.”

President’s Column: Courage to Soar

New AACN President Jennifer Adamski begins her term by exploring courage as a challenge and a gift, revealing AACN’s new theme, Courage to Soar, and opening up about her own vulnerabilities. “I want you to know the messiness of who I am. I want you to know where I’ve been and what I bring as we walk side by side, supporting each other with our individual courage during this coming year’s journey.”

Read Her Column

We Belong: Connecting Nurses With Communities

A PICU director and a nurse manager in a San Francisco Bay area hospital system created We Belong, a strategic staffing initiative focused on improving diversity in the system’s nursing workforce. Increasing diversity in the workforce improves racial concordance for patients as well as nurse recruitment and retention.

Read Their Conversation