Kihye Han

Job stress and work schedules in relation to nurse obesity.

Objectives: This study aimed to examine the relationship between job stress/work schedules (JS/WS) and obesity among nurses. Background: Job stress and shift work are known risk factors for obesity, yet comprehensive measures of JS/WS in relation to nurse obesity have been little investigated. Methods: Secondary data analysis used survey data from 2,103 female nurses. Obesity was measured using body mass index estimates. Binomial logistic regression models incorporated independent components of JS/WS and adjusted for demographics, nursing position, mental/emotional distress, health behaviors, and family-related covariates. Results: Approximately 55% of the sample was overweight/obese (OW/OB). When compared with underweight/normal weight nurses, OW/OB nurses reported that their jobs had less physical exertion (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.72-0.95, P = .01) and more limited movement (OR = 1.14, 95% CI = 1.02-1.28, P = .03). Long work hours (OR = 1.23, 95% CI = 1.08-1.40, P < .01) were significantly associated with being OW/OB as compared with underweight/normal. Conclusions: Findings suggest interventions to limit adverse work schedules. Access to healthy food and optimal meal breaks should be investigated.

Poststroke depression and emotional incontinence Factors related to acute and subacute stages

Objectives: To investigate the characteristics and prevalence of poststroke depression (PSD) and poststroke emotional incontinence (PSEI) and the factors related to these conditions at admission and 3 months after stroke. Methods: We evaluated 508 consecutive patients with acute ischemic stroke for PSD and PSEI at admission and 3 months later. PSD was evaluated using the Beck Depression Inventory, and PSEI was evaluated using Kims criteria. Blood samples were collected and genotyped for the promoter region of the serotonin transporter protein (5-HTTLPR) and the number of tandem repeats within intron 2 (STin2 VNTR). Perceived social support (the ENRICHD Social Support Inventory) was also measured. Results: PSD and PSEI were present in 13.7% and 9.4% of patients, respectively, at admission and in 17.7% and 11.7%, respectively, at 3 months after stroke. Multivariate analyses showed that PSD at admission was associated with the NIH Stroke Scale score at admission (p < 0.001), whereas PSD at 3 months was associated with the presence of microbleeds (p < 0.01) and perceived low social support (p < 0.001). In contrast, only lesion location (p = 0.022) was associated with PSEI at admission, whereas modified Rankin Scale score (p = 0.019), STin2 VNTR (p = 0.040), and low social support (p = 0.042) were related to PSEI 3 months after stroke. Conclusions: Diverse factors such as neurologic dysfunction, lesion location, microbleeds, genetic traits, and social support are differently related to acute and subacute emotional disturbances. Strategies to prevent or manage these problems should consider these differences.

A Comparison of Working Conditions Among Nurses in Magnet® and Non-magnet® Hospitals

Objectives: To compare working conditions (ie, schedule, job demands, and practice environment) of nurses working in American Nurses Credentialing Center-designated Magnet® and non-Magnet® hospitals. Background: Although nurse retention has been reported as more favorable among Magnet hospitals, controversy still exists on whether Magnet hospitals have better working conditions. Method: A secondary data analysis was conducted of the Nurses Worklife and Health Study using responses from the 837 nurses working in 171 hospitals: 14 Magnet and 157 non-Magnet facilities in the Wave 3 follow-up survey. Contingency tables and t tests compared working conditions by Magnet status. To accommodate clustering of nurses in hospitals, the Huber-White sandwich estimator was used to obtain robust SEs and variance estimates. Result: Nurses in Magnet hospitals were significantly less likely to report jobs that included mandatory overtime (P =.04) or on-call (P =.01), yet hours worked did not differ. They also reported significantly lower physical demands (P =.03), although the means for Magnet hospital nurses and non-Magnet nurses were quite similar (30.1 vs 31.0). Furthermore, comparison of the groups on nursing practice environment and perceived patient safety found no significant differences. Conclusion: Working conditions reported by nurses working in Magnet and non-Magnet hospitals varied little.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis

BACKGROUND In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. OBJECTIVES This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DESIGN Cross-sectional secondary data analysis. SETTINGS This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. PARTICIPANTS 2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. METHODS State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. RESULTS Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09-2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41-2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99-1.84). CONCLUSIONS Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover.

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

OBJECTIVES: The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. BACKGROUND: Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. METHODS: Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. RESULTS: Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. CONCLUSIONS: This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

Are Nursing Home Survey Deficiencies Higher in Facilities With Greater Staff Turnover

OBJECTIVES To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. DESIGN A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies. SETTING The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States. PARTICIPANTS This study focused on the 1151 NNHS facilities with complete deficiency data. MEASUREMENTS Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models. RESULTS High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10-2.13), Resident Behavior (OR 1.42, 95% CI 1.03-1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12-2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50-2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25-2.33). When both CNA turnover and licensed nurse turnover were included in the same model, high licensed nurse turnover was significantly associated with Quality of Care and total deficiencies, whereas CNA turnover was not associated with that category of deficiencies. CONCLUSION Turnover in nursing homes for both licensed nurses and CNAs is associated with quality problems as measured by deficiencies.

Factors associated with post‐stroke anger proneness in ischaemic stroke patients

Factors related to post‐ stroke anger proneness (PSAP) are poorly studied. The aim of the present study was to determine the frequency of, and the factors related to, PSAP in the acute stage of stroke. Serotonin transporter protein genes and monoamine oxidase A (MAO‐A) gene polymorphisms were also examined.

Comparison of job stress and obesity in nurses with favorable and unfavorable work schedules.

Objectives: To compare obesity-related factors between female nurses with favorable work schedules (WSs) and unfavorable WSs. Methods: In a cross-sectional study, 1724 female nurses were stratified by WS (favorable vs unfavorable). For each schedule type, the odds of obesity were related to health behaviors, home demands, and job stress using logistic regression models. Results: Among nurses with unfavorable WSs, healthy behaviors (exercise, sleep) were inversely associated with obesity, whereas for those with favorable WSs, obese nurses reported significantly more unhealthy behaviors (smoking, alcohol use; odds ratio [OR], 1.19; 95% confidence interval [CI], 1.02–1.38), more physical lifting of children/dependents (OR, 1.43; 95% CI, 1.06–1.93), having more nurse input into their jobs (OR, 1.21; 95% CI, 1.02–1.44), yet less boss support at work (OR, 0.83; 95% CI, 0.68–0.99). Conclusions: Considering impacts of WSs on obesity and potential obesity-related health outcomes, healthful scheduling should be provided to nurses.

Quality of Life after Epilepsy Surgery in Korea

Background and purpose Temporal changes in the quality of life (QOL) and the underlying factors after epilepsy surgery might be specific to Korea, where social stigma toward patients with epilepsy is still pronounced. Methods The seizure characteristics, number of antiepileptic drugs (AEDs), and the presence of stigma, anxiety, and depression were assessed before and after surgery (at 6 months and around 2 years) in 32 surgery patients and 32 nonsurgery patients. The QOL was compared between these groups using the Epilepsy Surgery Inventory-55 questionnaire. The factors affecting QOL were also evaluated. Results The scores in the mental, physical, and role-functioning domains were significantly higher at 6 months (all p<0.01) and around 2 years (all p<0.01) than at baseline in the surgery group but not in the nonsurgery group. The factors related to QOL differed at the two follow-up times, with seizure freedom being important at 6 months, and AEDs and depression being important at around 2 years. Conclusions A marked increase in QOL in our population was observed after epilepsy surgery. Although the small sample limits the interpretation of the results, the QOL change in our surgery patients shows similar trends to those reported in Western countries. A full understanding of underlying factors related to QOL might aid the development of optimal strategies for improving the long-term postsurgery QOL in this population.

Leadership education, certification and resident outcomes in US nursing homes: Cross-sectional secondary data analysis ☆

BACKGROUND Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. OBJECTIVES To examine associations of education and certification among NHAs and DONs with resident outcomes. DESIGN Cross-sectional secondary data analysis. SETTINGS This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). PARTICIPANTS 1142 nursing homes in the survey which represented 16628 nursing homes in the US. METHODS Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. RESULTS Nursing homes led by NHAs with both Masters degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelors degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. CONCLUSIONS Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.