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Although some research supports the maintenance of positive outcomes from cardiac rehabilitation Phase II (CR II) up to 12 months, the barriers to maintaining physical activity and risk factor management during CR maintenance (CR III) are well known.
To investigate participants' ability to sustain clinical, quality-of-life (QOL), and behavioral outcomes and share their experiences 6 months after CR II completion.
Longitudinal explanatory sequential pre-CR/post-CR study in a community hospital within a large health system. A convenience sample of 155 participants completed a reassessment of health outcomes. Participants also completed an online survey about barriers and facilitators during and after CR II. Analysis methods included MANOVA and summative content analysis.
The sample was mostly male, white, non-Hispanic, and college educated, with a mean age of 67.9 years. CR II participants sustained most behavioral outcomes, but not all clinical outcomes. Outcomes that improved/maintained were physical activity, tobacco status, diet, and QOL. Outcomes that worsened/returned to pre-CR II were weight, blood pressure, and depression. Participants described their motivation for staying healthy, top concerns, goals, barriers, and strengths/resources. Common responses included exercise, weight, diet, quality of life, family, and friends.
Our findings suggest the need for the implementation of innovative strategies during CR II that may extend past discharge into CR III. These include the introduction of digital technology and eHealth to provide value-added service to patients and a solid foundation for future maintenance and a structured, behavioral weight loss intervention. Establishing these tools, in addition to developing a support system will help patients to initiate maintenance care before program completion.
Nursing well-being is foundational to the specialties workforce and broader healthcare industry worldwide. Despite frequent reports and descriptions of activities that support nurses' well-being, most reports describe singular activities and programs that lack science-based structures contextualized within academic healthcare systems (AHS) with validated impact.
To evaluate and synthesize the existing national and international literature on nurse well-being initiatives offered in AHS.
Over 18 months, an 8-member interprofessional team conducted a scoping review adhering to PRISMA-ScR reporting guidelines. Five databases were searched, and results were screened in a multistep process by researcher pairs. Discrepancies were resolved by a third team member's review. Citations were reviewed uniquely three times to ensure methodological rigor. A final set of 54 articles was extracted for key data elements pertinent to the research question describing setting, population, study design, intervention, and other subsidiary fields. Reviewers additionally analyzed publication quality indicators and trends for additional implications for research and practice.
Among the 54 eligible articles, 72% were research and 28% were evidence-based practice, quality improvement, or doctoral dissertations. The concepts studied were psychosocial (e.g., resiliency) and physical (e.g., sleep). The number of instruments used per study ranged from 1 to 11. Thirty percent of studies utilized a framework from various disciplines that included nursing, social and behavioral sciences, and safety science principles. Nurses were included as authors 67% of the time, and 35% received funding from either the public or private sector.
Work-related stressors have been associated with physician suicide. Physician burnout and depression were exacerbated by the COVID-19 pandemic, remain unresolved and of national concern. Future pandemics are predicted. This study is the first to characterize professional and pandemic-related stressors in physician suicides during the COVID-19 pandemic.
This study aimed to evaluate whether there was a change in reported job-related stressors after the beginning of the COVID-19 pandemic.
Physician suicides were identified within the National Violent Death Reporting System dataset (March 1, 2020 to December 31, 2021). Free-text law enforcement and medical examiner notes for physician suicides were analyzed using reflexive thematic analysis.
Of 307 physician suicides, 70 included professional or pandemic-related stressors associated with death. Themes included pandemic-related dysregulation, financial distress, relationship issues, mental/physical/substance use problems, grief, and discipline.
While loss of employment, physical, mental health, legal, and substance use issues continue to be associated with suicide, grief and pandemic-specific stress were novel findings. Fear of disease, quarantine, and prolonged illness due to contracting COVID warrant psychological support. Psychological support is also indicated for recent discharge, grief management, transition into retirement, and during disciplinary processes. The stress of a pandemic may exacerbate previous risks. Proactive physician suicide prevention measures remain indicated.
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