Standardized blood pressure (BP) measurements for patients with chronic kidney disease (CKD) are paramount in the management of hypertension. Evidence shows nursing staff adherence to best practice guidelines for BP measurement are suboptimal. A pre-/posttest pilot study implementing a six-week hybrid educational intervention for nursing staff was conducted in an outpatient nephrology office. The Evidence-Based Practice (EBP) Beliefs Scale was administered to participants (n = 6) to assess individual beliefs about EBP and implementing EBP guidelines for BP measurement. One Likert-type question measured participant change in BP measurement. Improvement was noted in EBP beliefs and ability to implement EBP guidelines post-intervention. A favorable response was present for participant change in BP measurement per guidelines post-intervention. The intervention is a feasible method to improve staff adherence to EBP guidelines for BP measurement.

This exploratory interview study investigated nursing staff members\' perspectives on the fundamentals of end-of-life communication with older people as part of advance care planning in home care, nursing home, and hospital settings. Separate semi-structured interviews were conducted with 17 nursing staff members about their experiences, opinions, and preferences before, during, and after end-of-life conversations. Overall themes clustering the fundamentals include preconditions such as feeling comfortable talking about the end of life and creating space for open communication. Fundamentals related to the actual conversation-such as using senses and applying associative communication techniques (e.g., using understandable language), following conversation phases, and being aware of interprofessional collaboration-were also considered important. This study emphasizes the importance of moving along with the older person as well as connecting, adapting, and letting go of control over the conversation\'s outcome. Many fundamentals can be traced back to the basics of nursing and the humanity of conversation.

OBJECTIVE: Workplace health promotion (WHP) in Germany is receiving increasing support from health insurance funds. Nevertheless, there is hardly any knowledge on the process of how health outcomes are achieved, especially in nursing. The aim of the study was to find out how and what can be implemented in different care settings and to examine the reactions and interactions of the participants under routine conditions.
METHODS: Guided by a logic model, a holistic WHP approach was implemented in four acute care hospitals, seven inpatient care facilities and four outpatient care services from April 2021 to October 2022. Data on realized WHP interventions, participant assessment and topics of work design was collected and analyzed descriptively.
RESULTS: The realized WHP interventions were adapted depending on the content and context. Mainly short relaxation interventions were delivered or those with an event character were received by participants. The highest participation rate of planned participants was achieved in team building training. Participants predominantly assessed WHP interventions as useful, the quality as (very) good and were generally (very) satisfied with the intervention components. For work design topics, intentions for the design of work organization were mainly documented in action plans.
CONCLUSIONS: Cooperation with practitioners in research should be continued as a contribution to quality development. This could provide suggestions as to which content adjustments lead to greater acceptance by the target group in a specific context.
BACKGROUND: The project was registered in the German Clinical Trial Register (DRKS00024961, 2021/04/09).

The growth of mental illness has aroused the interest of the occupational health area in the study of the relationship between work and mental health. Among health workers, nursing represents the largest contingent of workforce in the sector and, due to frequent exposure to numerous stressors, they present a significant increase in work-related mental illness. The objective of this study was to identify the most frequent illness and mental distress processes among nursing professionals in Brazil and relate them to working conditions and coping strategies described in recent scientific literature. The integrative review was conducted in electronic health databases, in May 2020, and resulted in the selection and analysis of 17 studies. The results show that the hospital environment and its working conditions, overload of activities, precarious working conditions, short deadlines to carry out activities and conflicting relationship with the team and users constitute the main scenario of studies on illness and mental distress of nursing workers. The most frequent illness and mental distress processes involve the consequences of stress such as: anxiety, demotivation, bad mood, body aches, musculoskeletal disorders, irritability, alteration of menstrual flow, insomnia, attention and concentration deficit, gastric and duodenal ulcers, fatigue, migraines, among others. The strategies adopted by workers to minimize work stress are predominantly individual, pointing to a gap in studies, or in reality itself, about collective strategies.
O crescimento do adoecimento psíquico tem despertado o interesse da área de Saúde do Trabalhador no estudo da relação entre trabalho e saúde mental. Entre os profissionais da saúde, a enfermagem representa o maior contingente da força de trabalho no setor, e, devido à frequente exposição a inúmeros fatores estressores, esses trabalhadores apresentam um aumento significativo do adoecimento mental relacionado ao trabalho. O objetivo deste estudo foi identificar os processos de adoecimento e sofrimento mental mais frequentes entre profissionais da enfermagem no Brasil e relacioná-los às condições de trabalho e às estratégias de enfrentamento descritas na literatura científica recente. A revisão integrativa foi conduzida em bases de dados eletrônicas na área da saúde, em maio de 2020, e resultou na seleção e análise de 17 estudos. Os resultados mostram que o ambiente hospitalar, a sobrecarga de atividades, as condições de trabalho precárias, os prazos curtos para realizar as atividades e a relação conflituosa com a equipe e os usuários constituem o principal cenário dos estudos sobre o adoecimento e sofrimento mental dos trabalhadores de enfermagem. Os processos de adoecimento e sofrimento mental mais frequentes envolvem as consequências do estresse, como ansiedade, desmotivação, mau humor, dores no corpo, distúrbios osteomusculares, irritabilidade, alteração do fluxo menstrual, insônia, déficit de atenção e concentração, úlceras gástricas e duodenais, fadiga, enxaquecas, entre outros. As estratégias adotadas pelos trabalhadores para minimizar o estresse no trabalho são predominantemente individuais, apontando para uma lacuna de estudos ou da própria realidade acerca de estratégias coletivas.

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Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.

BACKGROUND: Aging populations and nursing workforce issues are causing challenges for long-term care globally, and therefore, improving the work-related wellbeing and retention of nurses is crucial. As such, gaining a further understanding of the factors that affect work strain in long-term care is important. Previously, the effect of job demands on the wellbeing of nurses has been researched principally by subjective instruments. In this study, we examined the relationship between indirectly measured workday characteristics and perceived stress and time pressure among nurses working in Finnish long-term care (assisted living facilities with 24-hour assistance).
METHODS: A total of 503 nurses from 44 assisted living facilities across Finland completed time measurement surveys and wellbeing questionnaires. The data were linked with client characteristics from the Resident Assessment Instrument register. The relationships between the measured number of care events during the workday, clients\' care needs, and the amount of breaktime and perceived stress and time pressure were analyzed using multivariate logistic regression.
RESULTS: Nurses who had more care events and clients with greater care needs were at higher odds of having high stress. More care events and reduced breaktime were associated with high time pressure. Disruptions during the workday were strongly associated with both high stress and time pressure. Last, nurses who were under high stress and time pressure worked more often in teams with lower team autonomy.
CONCLUSIONS: Our findings on indirectly measured job demands indicate that dividing the workload equally among nurses through better work division can help reduce the stress and time pressure of nurses in long-term care. In addition, ensuring sufficient breaktime and preventing unnecessary disruptions is important. To help recruit and retain the care workforce, fair management of work that accounts for varying client care needs and workload is needed. In addition, legislative and governance tools, such as staffing level regulation, and further consideration of job demands might aid in reducing the job strain of nurses.
UNASSIGNED: Patients or nurses were not involved in the design of the study, analysis, or interpretation of the results, or in the preparation of the manuscript.

UNASSIGNED: To understand direct care workers\' perceptions of the impact of implementing a person-centered communication tool, Preference for Activity and Leisure (PAL) Cards, into care.
UNASSIGNED: PAL Cards provide at-a-glance information about a nursing home (NH) resident\'s background and important preferences for activities and leisure. As a quality improvement project, 11 NHs implemented use of PAL Cards in their communities and provided feedback (N = 91 feedback forms received) on their perceptions of impact of PAL Cards on care communication and delivery.
UNASSIGNED: A variety of NH staff members, across disciplines, were a part of PAL Card implementation. The majority of staff (84%) perceived that PAL Cards helped them start a conversation with a resident and 64% indicated that PAL Cards helped them provide care for a resident.
UNASSIGNED: PAL Cards are an effective tool for communicating information about NH residents\' preferences to staff. [Journal of Gerontological Nursing, 50(8), 5-10.].

UNASSIGNED: This article aims to examine the impact of nursing workforce skill-mix (percentage of critical care registered nurses [CCRN]) in the intensive care unit (ICU) during a patient\'s stay.
UNASSIGNED: Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database and the Critical Health Resources Information System using real-time nursing workforce data.
UNASSIGNED: Fifteen public and 5 private hospital ICUs in Victoria, Australia.
UNASSIGNED: There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.
UNASSIGNED: Primary outcome: in-hospital mortality. Secondary outcomes: in-ICU mortality, development of delirium, pressure injury, duration of stay in-ICU and hospital, after-hours discharge from ICU and readmission to ICU.
UNASSIGNED: In total, 6563 (39.5%) patients were cared for in ICUs with >75% CCRN, 7695 (46.3%) in ICUs with 50-75% CCRN, and 2360 (14.2%) in ICUs with <50% CCRN. In-hospital mortality was 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%) respectively. After adjusting for confounders, patients cared for in ICUs with 50-75% CCRN (adjusted OR 1.21 [95% CI 1.02-1.45]) were more likely to die compared to patients in ICUs with >75% CCRN. A similar but non-significant trend was seen in ICUs with <50% CCRN (adjusted OR 1.21 [95% CI 0.94-1.55]), when compared to patients in ICUs with >75% CCRN. In-ICU mortality, delirium, pressure injuries, after-hours discharge and ICU length of stay were lower in ICUs with CCRN>75%.
UNASSIGNED: The nursing skill-mix in ICU impacts outcomes and should be routinely monitored. Health system regulators, hospital administrators and ICU leaders should ensure nursing workforce planning and education align with these findings to maximise patient outcomes.

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