This study examined the effects of a mindfulness-based psychoeducation program on mindfulness, self-compassion, and forgiveness in patients with bipolar disorder using a pretest-posttest randomized controlled experimental design. The study sample comprised of 40 patients (experimental group, n = 20; control group, n = 20). A mindfulness-based psychoeducation program was administered to the experimental group, while no intervention was administered to the control group. Data were collected using a personal information form, the Mindfulness Scale, the Self-Compassion Scale Short Form, and the Heartland Forgiveness Scale. The study revealed that the experimental group's mean scores on the mindfulness, self-compassion, and forgiveness scales following the intervention were significantly higher than those of the control group (p < .05). This study found that a mindfulness-based psychoeducation program increased mindfulness, self-compassion, and forgiveness in patients with bipolar disorder. The findings are limited to a small outpatient sample from a single CMHC and may not be generalizable to hospitalized patients with more severe clinical presentations. Mindfulness-based educational programs may enhance mental health, improve illness insight, support symptom management, and strengthen social functioning in individuals with bipolar disorder. The results emphasize the importance of integrating these programs into treatment processes and reveal the necessity for psychiatric nurses to actively implement mindfulness-based interventions. Psychiatric nurses should consider incorporating mindfulness-based techniques into their practice to improve the mental health of individuals with bipolar disorder, better understand the disorder, control symptoms, and improve social interactions.
This descriptive and correlational study investigated the relationship between exposure to obstetric violence and mother-infant attachment and postpartum depression (PPD) among women who had vaginal births. The sample comprised 292 mothers with infants aged 3 to 12 months who attended the outpatient clinics of a hospital in Konya between March and August 2024. Data were collected using a personal information form, an obstetric violence assessment form, the Maternal Attachment Scale, and the Edinburgh Postpartum Depression Scale. Independent samples t-tests and multiple linear regression analyses were conducted. The mean age of the participants was 29.50 ± 6.02 years. Emotional obstetric violence was reported by 32.9% of mothers, followed by verbal violence (19.5%), physical violence (7.9%), and sexual violence (6.2%). Mothers who reported exposure to any form of obstetric violence had significantly lower maternal attachment scores and significantly higher PPD scores (p < .001). Regression analyses indicated that verbal and sexual obstetric violence were significant predictors of both maternal attachment and PPD. Greater exposure to verbal and sexual violence was associated with weaker maternal attachment and higher levels of postpartum depressive symptoms. These findings highlight the detrimental impact of obstetric violence on maternal psychological well-being and early mother-infant attachment. Policies and clinical practices aimed at preventing obstetric violence and promoting respectful maternity care are essential to safeguard the health and well-being of both mothers and their infants.
Breastfeeding counseling is an effective public health intervention. However, there is a scarcity of studies detailing protocols, especially those applied during the dyad's stay in the Rooming-In Unit. Thus, this research aimed to describe a breastfeeding counseling protocol during the dyad's hospitalization in Rooming-in. A methodological development study was carried out from June to September 2022 in four stages: discovering from a bibliographical survey; defining the target audience, contexts, and answers to the research question; developing from the construction of the instrument; and delivering the final product after content validation by eight experts. The intervention components protocol includes items necessary for execution; intervention script; breastfeeding assessment instrument; adverse situations, solutions, and initial difficulties in breastfeeding; and counseling approach in the face of situations. For each item of the protocol, a Likert scale was applied, and the Content Validity Index was calculated to verify the agreement between the experts. Items with agreement above 80% were considered valid. Content validation was performed in a single evaluation round. The final version of the protocol consisted of 11 sections. It describes in detail the necessary conditions, expected and unexpected procedures, and how to intervene using the counseling approach in the initial difficulties presented during the hospitalization of the dyad in Rooming-in.
To reveal the effectiveness of the Benson's relaxation technique on the anxiety and hemodynamic parameters of patients with cardiovascular disease. A systematic review and meta-analysis of randomized controlled studies. Eight electronic databases were searched. The Cochrane Handbook 2023 and the preferred reporting items for systematic reviews and meta-analysis 2020 guideline were used to perform the study. A random effects model was used to calculate the combined effects of the interventions, and the robustness of the pooled estimates was assessed through sensitivity analyses. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Tool version 2. The Grading of Recommendations, Development, and Evaluation approach was used to evaluate the certainty of the evidence. This systematic review and meta-analysis included 8 trials with 538 patients. The Benson's relaxation technique had moderate-quality evidence for anxiety (Hedge's g = -0.662, p < .001) and saturation (Hedge's g = 0.657, p = .001), low-quality evidence for heart rate (Hedge's g = -0.507, p = .006), and diastolic blood pressure (Hedge's g = -0.280, p = .036) and very-low-quality evidence for systolic blood pressure (Hedge's g = -0.687, p = .002). No significant effect was observed on respiratory rate (Hedge's g = -0.578, p = .051) with very low-quality evidence. Sensitivity analyses showed variable robustness. An additional subgroup analysis of the Benson's relaxation intervention's effect on anxiety in surgical and nonsurgical patient groups revealed that this intervention significantly reduced anxiety in nonsurgical patient groups (Hedge's g = -0.603, p < .001) and systolic blood pressure (Hedge's g = -0.822, p < .001), but it was not effective in the surgical patient population (p = .072 and p = .097, respectively). This systematic review and meta-analysis indicate that, although the certainty of the evidence varies, Benson's relaxation techniques may offer potential benefits for certain outcomes. The current evidence supports cautious clinical interpretation and emphasizes the need for high-quality randomized controlled trials.
Personalized music interventions and earplugs have shown promise in preventing intensive care unit (ICU) delirium, but evidence on their combined effects is limited. To evaluate the feasibility and preliminary effects of personalized music intervention combined with earplugs (MUSE) and personalized music intervention (PMI) on delirium prevention and clinical outcomes in mechanically ventilated patients. In this randomized controlled trial, 63 participants were assigned to MUSE, PMI, or usual care (UC). Delirium was assessed during each nursing shift using the Intensive Care Delirium Screening Checklist, alongside measures of pain, sedation, sleep, and clinical outcomes. The delirium incidence was 50% in the UC group, 25% in the PMI group, and 33% in the MUSE group. The median number of delirium or coma-free days was 7 (interquartile range [IQR] = 4-7) in the PMI group, 5 (IQR = 4-7) in the MUSE group, and 5 (IQR = 3-7) in the UC group. No significant between-group differences in either primary or secondary outcomes were identified. The exploratory post hoc subgroup analysis indicates that age may influence the effects of treatment on delirium. In this pilot study, neither MUSE nor PMI had significant effects in reducing delirium incidence among patients undergoing mechanical ventilation when compared with UC. However, PMI appeared more effective at preventing delirium relative to MUSE and UC, and the potential additional benefit of earplugs remains uncertain in this study. This study is registered at www.clinicaltrials.gov. Trial registration number is NCT04065256.
This study explored the relationships among social vulnerability, perceived stigma, and multidimensional frailty among older people living with HIV (PWH) and examined the mediating roles of loneliness and perceived stigma in these relationships. A cross-sectional study was performed among older PWH, between December 2022 and October 2023. Data on sociodemographic characteristics, perceived stigma, social vulnerability (including social isolation and loneliness), and multidimensional frailty were collected and analyzed. Social vulnerability and perceived stigma were significantly positively correlated with multidimensional frailty. Social isolation directly affected multidimensional frailty (β = .239, p < .001) and had an indirect influence (β = .331, p < .001) through the mediating effects of loneliness and perceived stigma. Social isolation among older PWH is associated with multidimensional frailty, which is mediated by loneliness and perceived stigma. On the basis of these findings, interventions aimed at reducing social vulnerability and perceived stigma may help prevent or alleviate frailty among older PWH, thereby improving their overall well-being. The results highlight the critical need to assess loneliness and perceived stigma among socially isolated older PWH. Interventions should prioritize stigma reduction and foster meaningful social connections to mitigate their compounding effects on frailty progression.
Inadequate nutritional knowledge among hemodialysis (HD) patients can lead to poor fluid and dietary adherence, increasing the risk of complications. This study aimed to evaluate the effects of a nurse-led, animated video-based nutrition education program on dietary knowledge and fluid-diet adherence in individuals receiving HD. This experimental study employed a pretest-posttest control group design and included 107 HD patients, 48 in the intervention group and 59 in the control group. Data were collected using a patient information form, a nutritional knowledge survey, and the Dialysis Diet and Fluid Non-Adherence Questionnaire. Descriptive statistics and initial data entry were conducted using SPSS 24.0. The difference-in-differences (DiD) analysis was performed in Stata 18.0. The intervention group received nurse-led nutrition education supported by a 10-min animated video. Measurements were taken at baseline and 12 weeks after the intervention. There were no significant differences between groups in baseline nutritional knowledge or fluid-diet adherence scores. However, at week 12, the intervention group demonstrated a significant increase in nutritional knowledge and a decrease in fluid-diet nonadherence compared to the control group (p < .05). A DiD analysis revealed that the educational intervention resulted in a 4.4-point increase in knowledge scores, which was statistically significant (p < .05). Nurse-led animated video education significantly improved nutritional knowledge and fluid-diet adherence among HD patients. This approach may be an effective tool for supporting patient education and self-management of chronic kidney disease.
To respond to the local cardiovascular health literacy need through means of alternative forms of education utilizing serious games. A quality improvement project design utilizing pretest-posttest with in-depth literature review. A Cardiovascular (CV) BINGO game was developed, implemented, and analyzed for efficacy. Focus group participants (n = 10) were asked to recommend or advise against implementation of the serious game, then pilot study participants (n = 7) were asked to complete a five question Likert-scale survey along with one fill-in-the-blank action plan goal pre- and postgame implementation. Comparison between pretest and posttest surveys revealed an improved participant-perceived understanding and completion of personal action plans postimplementation. Overall, participants and instructors voiced satisfaction and lobbied for future use of this education tool. Literature supports the efficacy of serious games in knowledge and outcome improvement. The CV Bingo game applies alternative forms of education to establish deeper understanding of the material, spark health consumer interest, and open dialogue barriers. Application of serious games can be applied to any chronic disease process. The goal for the dissemination of this pilot study is to introduce new educational concepts and encourage fellow clinicians to utilize alternative forms of patient education.
Care transition is a strategy that aims to overcome the fragmentation of healthcare services, ensuring continuity of care. The review question was: What scientific evidence is available on care transition strategies for patients after hospitalization for COVID-19 and what are the opportunities and challenges of their implementation? Integrative literature review was guided by Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and carried out between March and June 2024 in the Medical Literature Analysis and Retrieval System Online, Web of Science, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cochrane Library, Scientific Electronic Library Online and Scopus databases, using Medical Subject Headings, Health Sciences Descriptors, and Entry Terms. Fourteen articles published between 2020 and 2023 were included, with 57% originating from the Americas, 28.6% using a qualitative approach, 78.6% addressing the transition from hospital to home, and 78.6% involving patients. The results were organized into four thematic categories: virtual care transition; patients' and healthcare professionals' experiences in care environments; patients' needs after hospital discharge; and care transition assessment through Care Transition Measure (CTM-15). Care transition strategies, including teleconsultations, videoconferencing, telerehabilitation, and discharge guidance, can reduce complications and readmissions and improve patient satisfaction, but challenges such as early discharge, poor communication, lack of protocols, variability in care transition strategies, and discontinuity of care still persist. The results of this review highlight the importance of structured, patient-centered transition planning, integration of telehealth and remote monitoring, and the use of systematic assessment tools, such as the CTM-15, to optimize post-hospital care for COVID-19 survivors.
Preoperative anxiety and pain can adversely affect recovery and satisfaction. Music is a safe, low-cost, non-pharmacological intervention that may enhance perioperative outcomes. This study evaluated the effects of patient-preferred music on anxiety, recovery, pain, satisfaction, and hemodynamics during unilateral knee arthroplasty under spinal anesthesia. In this prospective, randomized, controlled, single-blind trial, 80 patients were assigned to either a music group (Group M) or a control group (Group C). Group M listened to preferred music via headphones before and during surgery, while Group C received standard care. Anxiety (State-Trait Anxiety Inventory; state: STAI-S, trait: STAI-T), recovery (Quality of Recovery-15 [QoR-15]), pain (Numeric Rating Scale [NRS]), satisfaction, and hemodynamic parameters were measured. Minimal clinically important difference (MCID) analyses were used to assess clinical significance. Sixty-five patients (Group M: 32; Group C: 33) were analyzed. Postoperative STAI-S scores were significantly lower in Group M (p = .001), with a 6.18-point difference exceeding the MCID by 283%. QoR-15 scores were higher in Group M (p = .007), surpassing the MCID by 123%. Group M also showed lower systolic blood pressure at several perioperative points (p < .05), lower NRS pain scores at the 12th postoperative hour (p = .001), and reduced need for rescue analgesia (p = .035). Satisfaction was significantly greater in Group M (p = .001). No significant differences were found in heart rate (p > .05). Patient-preferred music significantly improved anxiety, pain, recovery quality, hemodynamic stability, and satisfaction. MCID analysis confirmed clinical relevance. Music may serve as an effective and feasible adjunct in perioperative care.
Family caregivers (FCGs) of cancer patients play a critical role in providing emotional and physical support. Mindfulness-based interventions (MBIs) have been increasingly explored as a potential approach to improving the psychological well-being of FCGs. However, the caregiving burden often results in significant psychological distress, including stress, anxiety, and depression. This systematic review and meta-analysis aims to evaluate the effects of MBIs on the stress, anxiety, and depression of FCGs of cancer patients. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines and was registered in PROSPERO. A comprehensive search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Library, ERIC, and Google Scholar to identify relevant studies published between 2010 and 2024. Randomized controlled trials (RCTs) and quasi-experimental (QE) studies assessing MBIs' impact on psychological outcomes in FCGs were included. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. A total of 10 studies (5 RCTs and 5 QE studies) met the inclusion criteria. Meta-analysis results demonstrated that MBIs significantly reduced anxiety and depression in FCGs of cancer patients compared to usual care or no intervention. Effect sizes varied across studies, with moderate to strong effects observed for anxiety, while depression showed smaller but significant improvements. However, the meta-analysis on stress yielded non-significant results with moderate-to-high heterogeneity. The heterogeneity across studies was moderate, suggesting variability in populations, measurements, intervention formats, duration, and delivery methods. MBIs are effectively improving the psychological well-being of FCGs by reducing anxiety and depression. Given the significant caregiving burden, integrating MBIs into caregiver support programs could enhance their resilience and overall mental health. Future research should explore culturally adapted mindfulness interventions to optimize their applicability in diverse caregiving populations.
Given the persistent use of antipsychotics during hospitalization and continued use post discharge, there is a need to consider alternative treatment options. The purpose of this study was to evaluate the use of antipsychotics in a sample of hospitalized older adults living with dementia and determine if exposure to Function Focused Care resulted in a decrease in antipsychotic use between admission, discharge, and 1 month post hospitalization. This was a secondary data analysis using data from the study Testing the Effectiveness of the Function Focused Care for Acute Care Study Using the Evidence Integration Triangle (FFC-AC-EIT). A total of 455 residents from 12 nursing homes in two states were included in the study. Sites were randomized to FFC-AC-EIT versus Education Only. The mean age of the participants was 82 years (Standard deviation [SD] = 8.5) and the majority was female (63%), White older adults (65%), married (36%), with high school or more education (81%), and moderate to severe cognitive impairment based on a Saint Louis University Mental Status Exam score of 7.5 (SD = 6.0). Overall, on admission, 17% were on an antipsychotic medication, at discharge, this increased to 21%, and at 1 month, it decreased to 19%. The repeated-measure analysis showed there was a significant difference in antipsychotic use between treatment groups over time (Pillai's Trace of .05, F = 8.9, p = .001). The intervention group increased in usage from 15% on admission to 23% at discharge and decreased to 18% at 1-month post discharge. Conversely, the control group remained essentially the same over time at 20% on admission and discharge and 21% at 1-month post discharge. The findings from this study confirm that there continues to be use of antipsychotics during hospital admissions, and individuals are still discharged on these medications and continued on these medications over time. There was no evidence to support the value of our FFC-AC-EIT in terms of decreasing the use of antipsychotics over time. Future research is needed to develop interventions focused on decreasing the use of antipsychotics.
Implementing early mobilization protocols can improve patient outcomes and accelerate postoperative recovery. This pre-test and posttest randomized controlled experimental study aims to evaluate the effects of early mobilization training on mobility, pain, comfort, and sleep quality in patients undergoing laparoscopic abdominal surgery. The study was conducted at a state hospital in Northern Cyprus between June and October 2022, and participant recruitment and follow-up were reported using the CONSORT 2010 flow diagram. The sample of the study comprised 78 abdominal surgery patients who were equally assigned to the intervention (n = 39) and control groups (n = 39). Perioperative information form and patient mobility scale were used for data collection. The mean ages of the intervention and control groups were 44.82 ± 12.37 and 44.41 ± 10.80 years, respectively. The total duration of mobilization in the intervention group (58.33 ± 11.20 min) was significantly higher than that of the control group (24.92 ± 5.64 min). Postoperative pain scores of the intervention group were significantly lower than those of the control group. Comfort and sleep quality scores of the intervention group were significantly higher than those of the control group. Finally, the length of hospital stay in the intervention group was significantly lower than that of the control group. The findings of this study imply that early mobilization training had a positive impact on reducing postoperative pain and increasing the duration of mobilization, comfort while turning in bed, and lying and the quality of sleep on the first postoperative day. This study provides practical insights for enhancing comfort, mobility, pain management, and sleep quality, while addressing a key gap in the literature and contributing to evidence-based clinical practice.
Food insecurity and obesity often coexist in older adults, leading to complex health issues. Standard obesity measures, such as Body Mass Index (BMI), do not adequately capture central adiposity, which is a more accurate predictor of metabolic risk. Newer anthropometric indices, such as the A Body Shape Index (ABSI) and the Body Roundness Index (BRI), offer improved precision in measuring central adiposity but are not commonly used in geriatric nursing assessments. To examine the associations between food insecurity and advanced anthropometric indices (BMI, ABSI, and BRI) in older adults, and explore implications for clinical nursing practice. A cross-sectional study was conducted with 152 older adults aged ≥65 from outpatient clinics at Assiut University Hospital, Egypt. Data were collected using the United States Department of Agriculture Food Security Survey and structured anthropometric measurements. BMI, ABSI, and BRI were calculated. Pearson correlations and multivariable regression identified predictors of food security status. Food insecurity was reported by 35.5% of participants. We found significant negative correlations between food security scores and BMI (r = -0.192, p = .018), BRI (r = -0.191, p = .019), and ABSI (r = -0.021, p = .023). This indicates that higher levels of adiposity and central obesity are associated with poorer food security. Regression analysis showed that gender, marital status, education, income, BMI, ABSI, and BRI were significant predictors of food security (p < .05 for all). Our findings demonstrate a significant association between central obesity, particularly as measured by ABSI and BRI, and food insecurity in older adults. We recommend that geriatric nurses integrate these advanced anthropometric indices into routine assessments to more accurately screen for food insecurity. This approach would allow for more effective and targeted nursing interventions for this vulnerable population.
Accidental falls are the second most prevalent adverse event within hospital settings, including U.S.'s Veterans Health Administration (VHA), often resulting in injury and prolonging patient recovery. The Morse Fall Scale (MFS) is widely used to assess fall risk within patient settings. Despite its known limitations, it remains a key tool for determining which patients are at risk for falls across healthcare institutions. Veterans with a completed MFS, Care Assessment Need (CAN), and Charlson Comorbidity Index (CCI), admitted to a VHA hospital from July 1, 2020, to June 30, 2022, were included in this retrospective analysis. MFS total scores were captured using electronic health record data from the VHA's national Corporate Data Warehouse. Veterans were identified as having a documented fall through clinical notes. Logistic regression models were used to evaluate the tool's performance at predicting falls. Among 440,771 Veterans, 14,458 (3.3%) had a documented fall during their inpatient stay. On average, those who experienced a fall had higher MFS scores. However, despite this trend, this tool exhibited poor discrimination in the likelihood of falls. Although incorporating patient demographics, the CAN, and CCI into the model improved performance, the model still performed poorly when assessing fall risk. Although the MFS is a required component of clinical workflow in many hospital systems, including VHA, its suboptimal discrimination of fall risk undermines its practical utility. Improved risk models are needed to assess fall risk and from which appropriate fall prevention measures can be initiated.
Transfemoral coronary angiography (TFA) is widely used for the diagnosis and treatment of coronary artery disease. Prolonged bed rest after TFA may lead to discomfort, groin and back pain, and delayed recovery. Gradual mobilization has been suggested to improve post-procedural outcomes and patient comfort. This study aimed to evaluate the effects of planned gradual mobilization on vital signs, post-procedural symptoms, and comfort levels in patients undergoing TFA. A randomized controlled experimental study was conducted with 40 patients in a single cardiology clinic. Participants were assigned to an intervention group (planned gradual mobilization) or a control group (standard mobilization) 12 hr post-angiography. Vital signs were recorded before and 20 min after mobilization. Post-procedural symptoms including dizziness, palpitations, and falling sensations-as well as complications such as bleeding or hematoma-were documented. Patient comfort was assessed using the General Comfort Scale Short Form 2 hr after mobilization. The intervention group experienced significantly lower rates of dizziness (15% vs. 70%, p < .001), falling sensations (5% vs. 85%, p < .001), and palpitations (25% vs. 65%, p = .011) compared to the control group. No significant differences were observed in systolic or diastolic blood pressure, pulse rate, or overall comfort scores. Minor post-mobilization changes were noted in respiratory rate, body temperature, and SpO(2), with a significant increase in SpO(2) within the intervention group (p < .05). No major complications, such as hematoma or significant bleeding, were reported in either group. Planned gradual mobilization 12 hr after TFA effectively reduced dizziness, palpitations, and falling sensations without adversely affecting vital signs or comfort. Implementing gradual mobilization in nursing care may enhance patient safety, comfort, and recovery outcomes.
Critically ill patients frequently require intrahospital transport (IHT) to diagnostic exams or procedures and must remain connected to life-sustaining medical lines. During IHT, the risk of tangled medical lines is unavoidable. The idea for a novel medical line securement device was inspired by a patient transport nurse due to frustrations and workflow inefficiencies managing tangled medical lines. The study aim was to explore the correlation between the utilization of a single-use securement device to manual or accidental disconnections of medical lines during IHT, and nurses' perception of efficiency, compared to the current practice of no utilization of a securement device. In 2019, a randomized, descriptive, correlational study was conducted on 142 progressive and intensive care hospitalized patients. Study coordinators measured the number of times either IV lines or monitor cords were accidentally or manually disconnected to detangle during or after transportation and the perception of transport efficiency. Results revealed fewer manual disconnections among intervention group compared to the control. Nurses' perception regarding the efficiency between the intervention and control group was statistically significant when the device was utilized to secure the lines and cords during transport. Nurses reported much higher satisfaction rates of transport efficiency when the device was used. This finding showed the device's utility for improving nurse satisfaction during IHT of critically ill patients. Utilization of the medical line securement device may be generalizable across other healthcare settings and disciplines where the complexity of medical lines may exist.
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease marked by symptoms such as dyspnea and fatigue, which negatively affect patients' quality of life. Self-efficacy influences patients' ability to manage symptoms, while medication adherence is crucial for effective disease control. This study aimed to examine the impact of dyspnea and fatigue on medication adherence and self-efficacy in individuals with COPD. A descriptive, cross-sectional, and correlational study was conducted with 171 COPD patients receiving treatment in a tertiary hospital in eastern Turkiye between November 2024 and April 2025. Data were collected using validated scales measuring fatigue, dyspnea, medication adherence, and self-efficacy. Statistical analyses included correlation and regression to examine relationships and predictors. The findings revealed high levels of dyspnea and fatigue, which were significantly and negatively correlated with self-efficacy (p < .001). Both dyspnea and fatigue significantly predicted decreased self-efficacy, accounting for over 60% of the variance. Medication adherence levels were generally high; medication adherence decreased when dyspnea increased, while no relationship was observed between fatigue and medication adherence. Dyspnea and fatigue are prevalent symptoms in COPD patients that adversely affect self-efficacy. Enhancing self-efficacy may be critical in improving symptom management and quality of life. The complex nature of medication adherence requires further in-depth investigation. Nurses should prioritize interventions that strengthen self-efficacy and address symptom burden to optimize COPD management and patient outcomes.
Registered nurses (RNs) and nursing assistants (NAs) play critical roles during crises. Understanding how the perceived work environment affects psychological distress among these healthcare workers is essential for developing interventions that support mental health and organizational outcomes. This study examined the association between perceived workplace environment and psychological distress, including stress, depressive, anxiety, and somatic symptoms, among inpatient RNs and NAs during the COVID-19 pandemic. A cross-sectional survey was conducted with 84 RNs and NAs employed at a large academic medical center between April and September 2021. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to measure the perceived workplace environment, while psychological distress symptoms were assessed using the Perceived Stress Scale, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7, and PHQ-15. Descriptive statistics and independent t-tests analyzed cohort characteristics. A stepwise approach with univariate and adjusted linear regression models assessed the relationship between workplace environment scores and psychological distress, incorporating demographic variables. Approximately one-third of participants reported moderate to severe psychological distress. No significant differences in distress symptoms were found between RNs and NAs; however, NAs rated Collegial Nurse-Physician Relations significantly lower than RNs (t = -3.84, 95% confidence interval [CI] [-1.15, -0.33], p = .001). Across all unadjusted models, higher PES-NWI total scores were associated with lower psychological distress. In adjusted models, unit-level Nurse Manager Leadership and Support subscale was significantly related to lower depressive (estimate: -2.03, 95% CI [-4.01, -0.04], p = .045) and somatic symptoms (estimate: -2.11, 95% CI [-4.16, -0.06], p = .044). These findings underscore the critical role of nurse managers in fostering supportive workplace environments and highlight the unique challenges faced by NAs. Targeted interventions at the unit and hospital levels can enhance RN and NA well-being, improve organizational outcomes, and build a resilient nursing workforce equipped to navigate future crises.
