Véronique De Gucht

Alexithymia and somatisation: A quantitative review of the literature

OBJECTIVE To present a quantitative review of the empirical literature on somatisation and alexithymia. METHODS Medline and PsycLIT searches for relevant studies were conducted. Meta-analytical techniques were applied to quantify the strength of the associations that were found. RESULTS A small to moderate relationship was found between general alexithymia and somatic symptom reporting. The alexithymia dimension measuring difficulty in identifying feelings showed the strongest association with symptom reports. The alexithymia dimension measuring externally oriented thinking was virtually unrelated to somatic symptom reports. Compared to healthy control populations, subjects suffering from a somatoform condition were significantly more alexithymic, with effect sizes ranging from moderate to large. The studies comparing somatoform to medical or psychiatric conditions yielded inconclusive results. CONCLUSIONS By means of quantitative procedures, an association between general alexithymia and somatic symptom reporting was established. Due to the use of questionnaires that can only check for symptoms, not whether these symptoms are medically explained or not, it is however not possible to draw conclusions on somatisation properly defined. The inconsistent results found when comparing somatoform conditions to medical and psychiatric controls may be attributed to confounding variables. In future studies, these variables should be statistically controlled to establish a more consistent pattern of associations between somatoform conditions and alexithymia. It is, however, equally feasible that this inconsistency reflects the nonspecific character of the association between alexithymia and somatisation. The presence of only one prospective study does not allow to draw conclusions on alexithymia as a predisposing factor for somatisation.

Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research

BACKGROUND Burnout is an important problem in health care professionals and is associated with a decrease in occupational well-being and an increase in absenteeism, turnover and illness. Nurses are found to be vulnerable to burnout, but emergency nurses are even more so, since emergency nursing is characterized by unpredictability, overcrowding and continuous confrontation with a broad range of diseases, injuries and traumatic events. OBJECTIVES This systematic review aims (1) to explore the prevalence of burnout in emergency nurses and (2) to identify specific (individual and work related) determinants of burnout in this population. METHOD A systematic review of empirical quantitative studies on burnout in emergency nurses, published in English between 1989 and 2014. DATA SOURCES The databases NCBI PubMed, Embase, ISI Web of Knowledge, Informa HealthCare, Picarta, Cinahl and Scielo were searched. RESULTS Seventeen studies were included in this review. On average 26% of the emergency nurses suffered from burnout. Individual factors such as demographic variables, personality characteristics and coping strategies were predictive of burnout. Work related factors such as exposure to traumatic events, job characteristics and organizational variables were also found to be determinants of burnout in this population. CONCLUSIONS Burnout rates in emergency nurses are high. Job demands, job control, social support and exposure to traumatic events are determinants of burnout, as well as several organizational variables. As a consequence specific action targets for hospital management are formulated to prevent turnover and burnout in emergency nurses.

Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.

Background Lifestyle modification programmes for coronary heart disease patients have been shown to effectively improve risk factors and related health behaviours, quality of life, reincidence, and mortality. However, improvements in routine cardiac care over the recent years may offset the incremental benefit associated with older programmes. Purpose To determine the efficacy of lifestyle modification programmes for coronary heart disease patients developed over the last decade (1999–2009) by means of a systematic review and meta-analysis. Results The study included 23 trials (involving 11,085 randomized patients). Lifestyle modification programmes were associated with reduced all-cause mortality (summary OR 1.34, 95% CI 1.10–1.64), cardiac mortality (summary OR 1.48, 95% CI 1.17–1.88), and cardiac readmissions and non-fatal reinfarctions (summary OR 1.35, 95% CI 1.17–1.55). Furthermore, lifestyle modification programmes positively affected risk factors and related lifestyle behaviours at posttreatment (M = 10.2 months), and some of these benefits were maintained at long-term follow up (M = 33.7 months). Improvements in dietary and exercise behaviour were greater for programmes incorporating all four self-regulation techniques (i.e. goal setting, self-monitoring, planning, and feedback techniques) compared to interventions that included none of these techniques. Conclusion The evidence summarized in this meta-analysis confirms the benefits of lifestyle modification programmes – over and above benefits achieved by routine clinical care alone.

Exploring the burden of emergency care: predictors of stress-health outcomes in emergency nurses.

AIMS This paper is a report of a study that examines (1) whether emergency nurses differ from a general hospital nursing comparison group in terms of job and organizational characteristics and (2) to what extent these characteristics predict job satisfaction, turnover intention, work engagement, fatigue and psychosomatic distress in emergency nurses. BACKGROUND The work environment and job characteristics of nurses are important predictors of stress-health outcomes. Emergency nurses are particularly exposed to stressful events and unpredictable work conditions. METHODS This cross-sectional study (N = 254) was carried out in 15 emergency departments of Belgian general hospitals in 2007-2008 by means of the Leiden Quality of Work Questionnaire for Nurses, the Checklist Individual Strength, the Utrecht Work Engagement Scale and the Brief Symptom Inventory. RESULTS Emergency nurses report more time pressure and physical demands, lower decision authority, less adequate work procedures and less reward than a general hospital nursing population. They report, however, more opportunity for skill discretion and better social support by colleagues. Work-time demands appear to be important determinants of psychosomatic complaints and fatigue in emergency nurses. Apart from personal characteristics, decision authority, skill discretion, adequate work procedures, perceived reward and social support by supervisors prove to be strong determinants of job satisfaction, work engagement and lower turnover intention in emergency nurses. CONCLUSION Emergency departments should be screened regularly on job and organizational characteristics to identify determinants of stress-health outcomes that can be the target of preventive interventions.

Psychological interventions for rheumatoid arthritis: Examining the role of self‐regulation with a systematic review and meta‐analysis of randomized controlled trials

To examine the efficacy of psychological interventions for rheumatoid arthritis (RA), and to determine whether self‐regulation interventions demonstrate efficacy superior to that of other psychological treatments.

The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey

BACKGROUND Emergency Nurses are routinely confronted with work related traumatic events and hectic work conditions. Several studies report a high prevalence of post-traumatic stress disorder (PTSD) in these nurses. Coping and social support seem to play an important role in the development of PTSD. OBJECTIVES This study examines (1) the frequency of exposure to and the nature of traumatic events in Emergency Nurses, (2) the percentage of nurses that report symptoms of PTSD, anxiety, depression, somatic complaints and fatigue at a sub-clinical level, and (3) the contribution of traumatic events, coping and social support to PTSD symptoms, psychological distress, somatic complaints, fatigue and sleep disturbances. DESIGN Cross-sectional data from 248 Emergency Nurses, from 15 Flemish (Belgian) general hospitals, were analyzed. RESULTS Emergency Nurses were found to be confronted frequently with work related traumatic events. Death or serious injury of a child/adolescent was perceived as the most traumatizing event. Almost one out of three nurses met sub-clinical levels of anxiety, depression and somatic complaints and 8.5% met clinical levels of PTSD. Levels of fatigue were high but not directly related to the frequency of exposure to traumatic events. Emotional coping was related to an increase in all outcomes; avoidant coping was related to more somatic complaints; problem focused coping was related to a decrease in psychological distress and perceived fatigue. Social support from colleagues and supervisor (head nurse) was found to have a protective effect on the occurrence of PTSD symptoms. CONCLUSION Emergency Nurses are especially vulnerable to post-traumatic stress reactions due to repetitive exposure to work related traumatic incidents. This not only personally affects the nurses, but can also impact quality of care. Hospital management should act on the findings of this study and invest in supportive, communicative, empathic and anticipatory leadership, and provide time-out facilities, cognitive-behavioral interventions and psychological counseling for Emergency Nurses on demand.

Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis

To examine physical activity and achievement of physical activity goals in relation to self‐reported pain and quality of life among patients with rheumatoid arthritis (RA).

Causes and consequences of occupational stress in emergency nurses, a longitudinal study.

AIM This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. BACKGROUND Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. METHOD The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). RESULTS Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. CONCLUSIONS Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions.

Quality of life after myocardial infarction: Translation and validation of the MacNew Questionnaire for a Dutch population

A wide range of instruments have been used in health-related quality of life (HRQL) assessment of patients with coronary artery disease. The MacNew heart disease health-related quality of life questionnaire (MacNew) is a disease-specific measure of HRQL, that has been found to have both good discriminative and evaluative properties. The objective of the present study was to translate the MacNew for a Dutch population, and assess its reliability and validity. Three hundred and thirty-nine cardiac patients, admitted to the hospital after a cardiac event, participated in the study. Questionnaires were filled out at baseline, at 3 months, and at 12 months. A clinically relevant three-factor solution, reflecting an emotional, physical, and social domain of HRQL, allowed us to explain 55% of variance. Angina pectoris was consistently found to be significantly associated with worse HRQL. The pattern of correlations between the subscales of the MacNew on the one hand, and between the subscales of the MacNew and two other, related questionnaires on the other hand, indicated only modest convergent and discriminant validity. The internal consistency was found to be fair to (very) good (ranging between 0.78 and 0.95). Finally, the Dutch MacNew was demonstrated to be substantially more responsive than two other instruments measuring physical and psychological well-being.

Interpersonal and Self-regulation Determinants of Healthy and Unhealthy Eating Behavior in Adolescents:

The purpose of this study was to investigate the influence of interpersonal and personal factors on (un)healthy eating in adolescents. The study sample consisted of 473 adolescents. Regression analyses were conducted to examine the effect of family climate, peer influence and self-regulation cognitions (goal commitment, efficacy and ownership) on healthy and unhealthy eating. Self-regulation cognitions are positively related to healthy eating and negatively to unhealthy eating. We conclude that different aspects of family climate and peer influence are significantly related to both healthy and unhealthy eating. Interventions should be directed at self-regulation cognitions as well as at family and peer influence.