Erik Franck

Mood-congruent attentional bias in dysphoria: maintained attention to and impaired disengagement from negative information.

Attentional bias to negative information has been proposed to be a cognitive vulnerability factor for the development of depression. In 2 experiments, the authors examined mood-congruent attentional bias in dysphoria. In both experiments, dysphoric and nondysphoric participants performed an attentional task with negative, positive, and neutral word cues preceding a target. Targets appeared either at the same or at the opposite location of the cue. Overall, results indicate that dysphoric participants show maintained attention for negative words at longer stimulus presentations, which is probably caused by impaired attentional disengagement from negative words. Furthermore, nondysphoric participants maintain their attention more strongly to positive words. These results are discussed in relation to recent developments in the pathogenesis and treatment of depression.

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey

AIM To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. BACKGROUND Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. DESIGN A cross-sectional design with a survey. METHOD In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. RESULTS Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. CONCLUSION Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.

Psychometric Properties of the Dutch Rosenberg Self-Esteem Scale

Interest in self-esteem has been fuelled by the suggestion that level of self-esteem is associated with psychological well-being. In the present study, we translated the Rosenberg Self-Esteem Scale (RSES) into the Dutch language and evaluated its psychometric properties in a sample of 442 adults. The results of both exploratory and confirmatory factor analyses confirmed that a single-factor solution provides the best fit. In addition, the Dutch RSES showed high internal consistency as well as high congruent validity. Overall, these findings support the usefulness of the Dutch RSES as a measure for global self-esteem.

Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modelling approach

AIM To investigate impacts of practice environment factors, nurse perceptions of workload and self-reported burnout at the unit-level on job outcomes and nurse-assessed quality of care in psychiatric hospitals. BACKGROUND Associations between practice environments and nurse and patient outcomes have been widely described in acute care hospitals in nursing research examining variables primarily at the respondent level. Research on this topic in psychiatric hospitals is sparse. DESIGN A cross-sectional design with a survey. METHOD Samples of registered nurses, licenced practical nurses and non-registered caregivers from 32 clinical units in two psychiatric hospitals were surveyed. Validated instruments were used to measure work environment, workload, burnout, job outcomes and nurse-perceived quality of care. Unit-level associations were examined using multilevel modelling techniques. RESULTS Multiple multilevel models identified depersonalization and nurse-physician relations as predictors of turnover intentions and quality of care of the interdisciplinary team. Ratings of nursing management at the unit level were predictors of all of the quality of care variables. Emotional exhaustion was predictive of quality of care at the unit level. While workload was correlated with burnout, it was not predictive of any of the outcomes examined in multiple multilevel models. CONCLUSION While relatively low levels of burnout and fairly favourable job and quality of care outcomes were reported by the mental health personnel surveyed, differences across units in ratings of practice environment factors such as nurse-physician relations and nurse management as well as levels of depersonalization were predictive of outcomes. While most findings are consistent with those from other studies of acute care settings, some (slight) differences were also identified.

Activation of latent self-schemas as a cognitive vulnerability factor for depression: The potential role of implicit self-esteem

To date, only two studies have investigated implicit self-esteem in depressed individuals. Surprisingly, both studies found evidence not in line with the cognitive theory of depression. We wanted to test whether these findings are replicable by investigating implicit self-esteem using the Implicit Association Test in currently depressed (CD), never depressed controls (ND), and formerly depressed individuals (FD). The latter two groups were tested before and after a negative mood induction. The results are in line with the previous two studies suggesting no difference in implicit self-esteem between CD patients and ND controls. Moreover, before mood induction, FD individuals evidenced a higher implicit self-esteem as compared to the two other groups. Compared to ND participants, FD individuals showed a significant drop in implicit self-esteem after the negative mood induction procedure, but this was due to the higher implicit self-esteem of FD before the mood induction. These results are discussed in the light of new perspectives on implicit self-esteem and depression.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.

Is the relationship between frontal EEG alpha asymmetry and depression mediated by implicit or explicit self-esteem?

A robust physiological finding is a higher relative left sided activity in the prefrontal cortex during the experience of positive approach related emotions and a higher relative right sided activity during the experience of negative withdrawal related emotions. Since self-esteem can be conceptualized within a framework of approach/withdrawal tendencies, the present study aimed at investigating if the relation between frontal EEG alpha asymmetry and depressive symptoms is mediated by implicit or explicit self-esteem. Self-esteem was measured by questionnaires (explicit) and in an indirect way (implicit). The mediation analyses showed that only explicit self-esteem acted as a partial mediator in the path from EEG alpha asymmetry to depression.

Turning the pink cloud grey: Dampening of positive affect predicts postpartum depressive symptoms

OBJECTIVE Maladaptive response styles to negative affect have been shown to be associated with prospective (postpartum) depression. Whether maladaptive styles to positive affect are also critically involved is understudied, even though anhedonia (a correlate of low positive affectivity) is a cardinal symptom of depression. The present study is the first to investigate the predictive value of cognitive response styles to both negative (depressive rumination) and positive affect (dampening) for postpartum depressive symptoms. METHODS During the third trimester of pregnancy, 210 women completed self-report instruments assessing depression (symptom severity and current and/or past episodes) and scales gauging the presence of depressive rumination and dampening. Of these women, 187 were retained for postpartum follow-up, with depressive symptoms being reassessed at 12 (n=171) and 24 (n=176) weeks after delivery. RESULTS Regression analyses showed that higher levels of dampening of positive affect during pregnancy predicted higher levels of depressive symptoms at 12 and 24 weeks postpartum, irrespective of initial symptom severity, past history of depression and levels of rumination to negative affect. Prepartum trait levels of rumination, however, did not predict postpartum symptomatology when controlled for baseline symptoms and history of major depressive episode(s). CONCLUSIONS The results of this investigation suggest that the way women cognitively respond to positive affect contributes perhaps even more to the development of postpartum depression than maladaptive response styles to negative affect.

Dissociative symptoms and sleep parameters — an all-night polysomnography study in patients with insomnia

BACKGROUND Dissociative disorders encompass a range of symptoms varying from severe absent-mindedness and memory problems to confusion about ones own identity. Recent studies suggest that these symptoms may be the by-products of a labile sleep-wake cycle. METHODS In the current study, we explored this issue in patients suffering from insomnia (N=46). We investigated whether these patients have raised levels of dissociative symptoms and whether these are related to objective sleep parameters. Patients stayed for at least one night in a specialized sleep clinic, while sleep EEG data were obtained. In addition, they completed self-report measures on dissociative symptoms, psychological problems, and sleep characteristics. RESULTS Dissociative symptom levels were elevated in patients suffering from insomnia, and were correlated with unusual sleep experiences and poor sleep quality. Longer REM sleep periods and less time spent awake during the night were predictive of dissociation. CONCLUSIONS This is the first study to show that insomnia patients have raised dissociative symptom levels and that their dissociative symptoms are related to objective EEG parameters. These findings are important because they may inspire sleep-related treatment methods for dissociative disorders.

Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study

BackgroundHigh levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses’ psychosocial work environment is necessary to respond to complex patients’ needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses’ and nurse managers’ perceptions and experiences of staff nurses’ workload; (3) To explain and interpret the two models by using the qualitative study findings.MethodThis mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models.ResultsThe two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents’ statements corresponded closely to the models’ associations.ConclusionA deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the softer work characteristics — such as decision latitude, social capital and team cohesion — more insight and knowledge of the hard work characteristic workload is essential.