Background and objective: The COVID-19 pandemic in 2020 increased the volume of patients seeking care in the Emergency Department (ED) for a respiratory crisis. Our community hospital experienced a filling of inpatient beds, leading to an overflow of admitted patients in the ED, where adequate staff (nurses, physicians, radiology, and laboratory staff), equipment, and rooms or places for patients were lacking. Times to obtain procedures that included cardiology, laboratory, and radiology performed and resulted significantly increased. Left without being seen (LWBS) is a challenge faced by EDs across the United States (US) and has become more prevalent since the COVID-19 pandemic. Best practice suggests an LWBS rate of less than 2%, but our hospital experienced an increasing rate of hitting over 5\% in January 2021. To reduce this rate, we implemented multiple rapid-cycle Plan-Do-Check-Act (PDCA) change interventions in triage and throughout the ED.Implementation/Methods: We implemented several rapid-cycle change interventions with a high-level action plan. These actions included hiring medical/surgical nurses to care for admitted patients awaiting beds, adding additional medical providers, implementing greeters, creating specialty chairs inside a major hospital thoroughfare, opening a 12-bed Admit Care Unit (ACU) adjacent to the ED, and more.Results: The rate of LWBS decreased from a high of 5.3% in January 2021 to 1.09% in January 2022.Conclusion/Implications to Practice: Patients in the ED recorded as LWBS are at higher risk for safety and quality transgressions. We continue to work toward excellent patient care by continuing to implement rapid-cycle changes in response to barriers as they arise. More research is needed to expand and rethink the process of ED throughput during pandemics and emergent national crises.

We examined the relationship between age, coping, and burnout during the peak of the COVID-19 pandemic with nurses in Texas (N = 376). Nurses were recruited through a professional association and snowball sampling methodology for the cross-sectional survey study. Framed in lifespan development theories, we expected that nurse age and experience would be positively correlated with positive coping strategies (e.g., getting emotional support from others) and negatively correlated with negative coping strategies (e.g., drinking and drug use). We also expected age to be negatively related to the emotional exhaustion and depersonalization facets of burnout and positively related to the personal accomplishment facet of burnout. Findings were largely supported in that age was positively associated with positive coping and personal accomplishment and age and experience were negatively correlated with negative coping and depersonalization. Age was not, however, associated with emotional exhaustion. Mediation models further suggest that coping explains some of the effect of age on burnout. A theoretical extension of lifespan development models into an extreme environment and practical implications for coping in these environments are discussed.

Background and objective: Three-dimensional immersive virtual reality (VR) provides the user with multiple sensory experiences involving both visual and auditory pathways. While VR-based applications have reduced procedure-associated pain in pediatric populations, there is little to no research to support the use of VR in adults. The objective of this study was to evaluate the efficacy of immersive VR for reducing pain in adult patients and to evaluate responses to the use of this technology during hospitalizations of two to four days.Methods: This was a prospective, self-controlled pilot intervention study of the feasibility of the use of immersive VR in ten patients ages 55-68 who had undergone robotic colorectal surgery.Results: Pain scores were positively correlated with the length of hospital stay. The use of immersive VR was also positively correlated with measures of distraction and entertainment.Conclusions: The results of this feasibility study support the use of VR for pain management in middle-aged to early-older adults.

Nurses report that they are required to work during their scheduled breaks and generally experience extended work times and heavy workloads due to staffing shortages. This study aimed to examine changes in personal, work-related, and overall stress, as well as biological responses and fatigue experienced by nurses during three consecutive 12 h workdays (i.e., the typical "three-twelves" schedule). We also considered the moderating effects of social resources. This prospective study of 81 medical/surgical nurses who completed questionnaires and provided saliva samples at four designated intervals (i.e., pre-shift and post-shift on workdays 1 and 3). Fatigue reported by night shift nurses increased significantly over three consecutive workdays (p = 0.001). Day shift nurses said they encountered more social support than those on the night shift (p = 0.05). Social support moderated the relationship between work-related stress at baseline and reported fatigue on day 3.

ObjectiveTo examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units.BackgroundProximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports—i.e., family and organizational support—moderated the relationship between nurse adaptability and COVID-related PTSD symptoms.MethodsA sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N = 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms.ResultsAdaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r = 0.51 and 0.56, respectively, p < 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r = −0.43, p < 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r = −0.30, p < 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for.ConclusionFindings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis.

Background: Food insecurity, the limited or uncertain availability of food, is reported in college students, but little is known about its prevalence in nursing students. Nursing students have extensive required clinical hours limiting their ability to work and spend money on academic and living expenses before spending on food. Purpose: To estimate the prevalence of food insecurity and characterize its relationship to social support and firstgeneration status among nursing students at a public university. Methods: A cross-sectional survey study design was used to assess food security and social support in full-time nursing students (n=55). Results: The prevalence of food insecurity reported by the survey respondents was 60%. Statistically significant correlations between food security and social support scores were found; as food security worsened, so did social support. Food-insecure students had lower grade point averages, and first-generation students (p=.001) reported food insecurity more frequently than did other participants. Conclusions: Findings support that food insecurity is negatively associated with academic performance, and level of social support may impact food insecurity in nursing students. Nursing programs should consider early assessments of cohorts to increase the potential for early intervention with food-insecure students. Collaboration with university-based food pantries and student engagement in hunger initiatives through the Student Nurses Association can support early interventions.

Objective: In today’s work environment, specifically in health care, mindfulness is a personal and professional strategy to improve performance and productivity. To influence the patient and care team hospital experience through the concepts of mindfulness and perception.Methods: This was a prospective observational project completed by medical/surgical nurses using an online survey pre- and post an educational program and an aggregate score of the 5 nurse-sensitive questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a survey based in the United States that is mailed to patients post discharge to home to measure patient satisfaction with their hospitalization. The HCAHPS survey is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals in the United States. The purpose of the HCAHPS survey is to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on their hospital care and hospital experience.Results: The aggregate nurse-sensitive HCAHPS scores increased from 85.5 to 89.8 over one month. For mindfulness, after the educational program, among the ten nurse survey questions the percentage went up as much as 0.57%.Conclusions: An educational program related to the benefits of mindfulness can positively effect nurses’ engagement in the workplace and positively increase HCAHPS scores. Continuing education on mindfulness should carry over month to month. In this research project, participants provided feedback to the researcher of feeling empowered to bring in new ideas, present different ways to grow, and tackle challenges.

Objective: High acuity and long work hours are significant contributors to nurses’ stress. Studies evaluating consecutive workdays with the use of biobehavioral methods are limited in the US. The aim of this study was to assess changes in and the relationship between stress, fatigue, and cortisol.Methods: In an observational within-subject design, we studied stress, fatigue and cortisol before and after 2 consecutive 12-hour day shifts in an acute care setting. Specifically, the study was designed to: (1) assess the effect of stress on fatigue; (2) examine the effect of stress on cortisol; (3) compare the levels of stress, fatigue, and cortisol; and (4) compare the responses of stress, fatigue, and cortisol between acute care, day shift staff nurses and nurse leaders.Results: Stress, fatigue, and cortisol increased significantly from baseline to Day 2 (p = .001, .004, and .010, respectively; paired t-test). In a comparison of nurses and nurse leaders, stress and fatigue at baseline were significantly higher in acute care nurses than in nurse leaders (p ≥ .00 and .05, respectively; independent t-test). At the end of 2 consecutive shifts, cortisol was significantly higher in staff nurses than in nurse leaders (p = .001).Conclusions: Competing initiatives pressure nurse leaders to work long hours to support organizational goals, sometimes at the expense of a healthy work environment. Nurses from direct care staff to executives should be educated in and demonstrate best practices in relation to endorsements from the American Nurses Association on fatigue and interventions to lessen the risks to patient safety.