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Work wellbeing, also known as workplace wellbeing, is a global concern for nurses, particularly because excessive stress and exhaustion contribute to burnout.
The Caring Science International Collaborative (CSIC), an international research network, empirically investigates nurse work wellbeing using the Profile of Caring, a psychometrically validated and reliable instrument.
The CSIC framework defines wellbeing intrinsically—as caring and clarity—and extrinsically—as the social and technical resources needed to work efficiently and effectively. The Profile of Caring explains 80% of work wellbeing in nursing without bias across 10 countries.
This research protocol describes an international multicenter observational study that measures nurse work wellbeing using the Profile of Caring and other concepts and outcomes measures.
The objective of this study was to test the validity, reliability and dimensionality of the Norwegian version of the Cardiff Wound Impact Schedule (CWIS), a measure for wound-specific health-related quality of life. The Norwegian CWIS and a 36-item short form health survey (SF-36) were completed by 204 patients with hard-to-heal wounds on the lower extremity. The questionnaires were filled in at three time points over 8–14 weeks (T0, T1, T2). The Patients Global Impression of Change (PGIC) was completed at T1 and T2. Demographic and clinical data were collected at T0 and T2. The three-factor model of the CWIS showed an acceptable fit to the observed data, and the dimensionality was clear as long as two correlated error terms were accepted and four items were removed (χ 2 = 426.64, p = 0.000, df = 204, χ 2/df = 2.09, RMSEA = 0.074, SRMR = 0.066, CFI = 0.900, TLI = 0.880). Correlation analyses showed significant associations between the CWIS and SF-36 (0.350**–0.766**), PGIC (−0.277**), wound size (−0.156**), general wound pain intensity (−0.371**) and pain intensity at wound change (−0.240**); all aligned with the expected directions. The intraclass correlations indicated good to excellent test–retest reliability (0.724**–0.951**). The internal consistency ranged from acceptable to excellent (α = 0.78–0.89, ρc = 0.79–0.89). While the questionnaires' ability to detect wound-related change was low, it was adequate for differentiating between healed and non-healed ulcers. The Norwegian version of the CWIS demonstrated good reliability and construct validity, making it suitable for evaluating HRQoL in patients with hard-to-heal wounds. However, some modifications were made to achieve an acceptable model fit.
The AMBulatoRy blOod preSsure In older Adults (AMBROSIA) study cohort was designed to determine whether ambulatory blood pressure (BP) monitoring (ABPM) is useful for identifying older adults with hypertension taking antihypertensive medication who are at increased risk for falls. The association of home BP monitoring (HBPM) with falls was assessed in an ancillary study (AMBROSIA-HOME).
AMBROSIA was a prospective observational study of adults aged 65 years and older taking antihypertensive medication for hypertension. Participants were recruited from Kaiser Permanente Southern California (KPSC), an integrated healthcare delivery system, and enrolled from May 2019 to November 2022. Demographic and clinical characteristics and geriatric assessments were collected over the course of two consecutive study visits. Participants completed a 24-hour ABPM and 1 week of HBPM. Over the following year, falls were assessed using a monthly falls calendar, and serious fall injuries were assessed from the KPSC electronic health record (EHR).
We enrolled 670 participants; 656 completed 24-hour ABPM and 536 also completed HBPM. The mean (SD) age of the AMBROSIA cohort was 75 (6) years, 16% were over 80 years of age and 56% were female. There were 13% non-Hispanic Asian or Pacific Islander, 22% non-Hispanic Black, 18% Hispanic and 44% non-Hispanic White participants. Nearly 72% had mild cognitive impairment, 50% were pre-frail and 4% were frail. Overall, 87% of participants returned all monthly calendars during follow-up.
The AMBROSIA cohort can be updated with longitudinal data from the EHR including antihypertensive medication to explore the relationship of fall risk and white coat effect, defined as the difference between clinic BP and out-of-clinic BP, BP variability over 24 hours and postprandial BP decline with antihypertensive medication intensification during follow-up. Additionally, the cohort can be updated to include outcomes data from the EHR such as cardiovascular events to examine BP phenotypes as potential predictors of cardiovascular events.
Global research on nurse work wellbeing (WWB) has produced internationally-informed outcome models, yet few studies examine how these models apply within specific countries. Understanding WWB in the national context is essential to shape effective, locally relevant nursing policies and practices.
To explore WWB characteristics among hospital nurses in the Middle East and North Africa (MENA) and identify country-specific opportunities to improve nurse WWB.
A secondary analysis was conducted using WWB data from nurses in Jordan, Israel, and Türkiye, extracted from a broader 9-country study (2022–2023) involving 2546 nurses. The original study employed the 35-item Profile of Caring instrument to measure a 9-factor model of WWB. This analysis used descriptive statistics and linear regression to examine country-specific patterns among MENA nurses (n = 429).
Data from Jordan (n = 136), Israel (n = 175), and Türkiye (n = 118) revealed statistically significant differences (p < 0.001) across five of nine WWB factors by country. Country, as a variable, predicted 33% of the variance of caring-for-self and 20% of caring-of-manager, with Türkiye and Jordan reporting the lowest scores, respectively. Country explained 18% of satisfaction with professional growth and 16% in autonomy, with Türkiye scoring lowest on both. Fifteen percent of participative management was predicted by country, with both Türkiye and Jordan having lower scores than Israel.
Findings inform country-specific policy and operational improvements to support nurse WWB: strengthening manager-staff engagement, fostering self-care among nurses and caring and communicative behaviors from managers, supporting professional development, and enhancing autonomy and role clarity.
Evidence-based interventions (EBI) can reduce nursing burnout and improve retention and healthcare quality. Nursing school is an ideal time to implement EBI to mitigate burnout and increase resilience in pre-professional populations.
The current study tested whether Mindfulness-Based Stress Reduction (MBSR) significantly improved stress, burnout, and wellness in a university-based nursing school.
Using a non-randomized clinical trial design, multilevel modeling for repeated measures tested intervention effects over time in MBSR participants (n = 73) and matched controls (n = 73), as well as potential moderation of intervention effects by modality (online vs. in-person MBSR) and subpopulation (students vs. faculty/staff).
MBSR effectively reduced perceived stress, exhaustion, and total burnout and increased positive affect and frequency of using two key mindfulness skills: observing and nonreactivity. No significant effects of the intervention were observed for disengagement from work, satisfaction with life, negative affect, or the mindfulness skills of describing, acting with awareness, and nonjudgment. Effects were similar across modality and subpopulation.
MBSR increases stress resilience and can be delivered effectively online and in person. Moreover, MBSR appears equally impactful for nursing students and faculty/staff. Implications for integrating EBI into schools of nursing to improve well-being are discussed.
Prior international collaborative studies indicated that job satisfaction, a factor of nursing work wellbeing (WWB), is closely linked to retention, with notable cross-country differences. However, limited regional comparisons, especially between Central and Eastern Europe (CEE), North America, and the Middle East and North Africa (MENA), restrict understanding of nurse wellbeing and retention regional impacts, limiting tailored strategy development.
This secondary analysis study compared the effects of region on nursing WWB and job satisfaction factors in CEE, MENA, and North America, aiming to identify those CEE region-specific predictors associated with and effects on job satisfaction and, in turn, WWB.
CEE (n = 1616), MENA (n = 1562), and North America (n = 1386) data were analyzed using descriptive and linear regression analytics (p < 0.001). The CEE sample included nursing staff from Croatian (n = 301), Polish (n = 215), Serbian (n = 489), and Slovenian (n = 611) nurses and nursing assistants. Six job satisfaction factors were examined: coworkers, patient care, participative management, autonomy, professional growth, and organizational rewards.
The CEE region reported statistically significant lower mean scores and negative effects across all six job satisfaction factors compared to MENA and North America. Satisfaction with coworkers had the largest effect within the CEE region when compared to MENA and North America (ϐ = −0.26), while satisfaction with participative management had the smallest regional effect (ϐ = −0.10). Findings informed operational discussions for CEE-targeted retention interventions.
Job satisfaction subscale factors facilitate the identification of empirically- and theoretically-informed operational actions to improve CEE nursing job satisfaction as an important factor of WWB and contribute to nursing retention.
This 2022–2023 study across nine countries builds on a 2019–2021 ten-country study exploring nurse work well-being (WWB) and its associated outcomes. WWB, as assessed using the Profile of Caring (PoC) survey, is conceptualized as a multifactorial construct encompassing caring for self, caring of manager, clarity of role/system, and job satisfaction.
To explore relationships between WWB and staff outcomes by evaluating the PoC construct validity within an international nursing population in the post-pandemic context.
Nursing staff (n = 2546) from 128 facilities participated. Mixed methods, including thematic analysis, descriptive statistics, regression analyses, and path analysis, were employed to develop a WWB outcome model. Reliability was assessed with Cronbach's alpha, and construct validity was assessed through exploratory factor analysis.
The final model had good model fit, explaining 76% of nurse WWB. Feeling rewarded for work well done, total direct effect had a positive relationship with job satisfaction (β = 0.415, p = < 0.001) and a negative effect on intent to leave (β = −0.242, p = 0.003). Job satisfaction total direct effect negatively related to intent to leave (β = −0.584, p = < 0.001). Relationship direction, strength, and significance varied by country. Caring of manager explained one-third of WWB. Job satisfaction subscales explained intent to leave (25.2%). The PoC showed high reliability (Cronbach's alpha ≥ 0.80), and robust construct validity was confirmed through exploratory factor analysis (KMO = 0.950, factor loadings ≥ 0.40).
Conclusions suggest that understanding job satisfaction and intent to leave predictors is complex, requiring complex models to globally and contextually explain nurse WWB outcomes.
by Alyssa M. Spomer, Benjamin C. Conner, Michael H. Schwartz, Zachary F. Lerner, Katherine M. Steele
BackgroundThere is growing interest in the use of biofeedback-augmented gait training in cerebral palsy (CP). Audiovisual, sensorimotor, and immersive biofeedback paradigms are commonly used to elicit short-term gait improvements; however, outcomes remain variable. Because biofeedback training requires that individuals have the capacity to both adapt their gait in response to feedback and retain improvements across sessions, changes in either capacity may affect outcomes. Yet, neither has been explored extensively in CP.
MethodsIn this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 years (12.5,15.26)) could adapt gait and retain improvements across four, 20-minute sessions using combined audiovisual and sensorimotor biofeedback. Both systems were designed to target plantarflexor activity. Audiovisual biofeedback displayed real-time soleus activity and sensorimotor biofeedback was provided using a bilateral resistive ankle exoskeleton. We quantified the time-course of change in muscle activity within and across sessions and overground walking function before and after the four sessions.
ResultsAll individuals were able to significantly increase soleus activity from baseline using multimodal biofeedback (p 0.11).
ConclusionsThis work suggests that individuals with CP have the capacity to adapt their gait using biofeedback, but responses are highly variable. Characterizing the factors driving adaptation to biofeedback may be a promising avenue to understand the heterogeneity of existing biofeedback training outcomes and inform future system optimization for integration into clinical care.
Hospitals are experiencing a nursing shortage crisis that is expected to worsen over the next decade. Acute care settings, which manage the care of very complex patients, need innovations that lessen nurses' workload burden while ensuring safe patient care and outcomes. Thus, a pilot study was conducted to evaluate the feasibility of implementing a large-scale acute care telenurse program, where a hospital-employed telenurse would complete admission and discharge processes for hospitalized patients virtually. In 3 months, almost 9000 (67%) of patient admissions and discharges were conducted by an acute care telenurse, saving the bedside nurse an average of 45 minutes for each admission and discharge. Preliminary benefits to the program included more uninterrupted time with patients, more complete hospital admission and discharge documentation, and positive patient and nurse feedback about the program. 
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