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10 Supporting the Health and Professional Well-Being of Nurses
Pages 301-354

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From page 301...
... Policy makers, employers of nurses, nursing schools, nurse leaders, pro fessional associations, and nurses themselves all have a role in ensuring the well-being of the nursing workforce. Nurses are committed to meeting the diverse and often complex needs of people with competence and compassion.
From page 302...
... The chapter examines aspects of nurses' physical, mental, social, and moral1 well-being and health, and concludes with a review of approaches for addressing nurses' health and well-being in various areas. THE FAR-REACHING IMPACT OF NURSE WELL-BEING Nurse well-being -- or the lack thereof -- has impacts on nurses, patients, health care organizations, and society (NASEM, 2019a)
From page 303...
... . Ensuring nurse well-being is not just good for nurses, then; it is essential for the health and safety of patients, the functioning of health systems, and the financial health of health care organizations.
From page 304...
... These factors are mediated by individual factors, such as personality, coping strategies, resilience, and social support, and ultimately impact the health and well-being of clinicians. While this framework was designed with the clinical environment in mind, it can be applied to nurses working in other environments, including communities, schools, and non–health care organizations.
From page 305...
... . These conditions -- stress, high-demand and low-control work environments, and long hours -- are common in nursing work environments, which may place nurses at risk of obesity.
From page 306...
... Chin (2020) discusses the necessity of aligning health care organizations' approaches and intentionality toward patient safety and equity.
From page 307...
... Smokinge,f • Around 7 percent of registered nurses (RNs) smoke tobacco, while almost 25 percent of licensed practical nurses do so.
From page 308...
... Burnout Burnout is an increasingly prevalent problem among clinicians, including nurses, and it has significant consequences for patients, organizations, teams, 2  The American Psychiatric Association defines PTSD as "a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury" (see https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd [accessed April 13, 2021]
From page 309...
... . COVID-19 is also highlighting the challenges that nurses and nurse leaders have in reporting staff safety issues and equity issues (Rangchari and Woods, 2020)
From page 310...
... Nursing students may experience academic and emotional burnout before they even enter the workforce (Ríos-Risquez et al., 2018)
From page 311...
... . Moral distress, the most well-researched form of moral suffering, occurs in response to moral adversity that threatens or violates an individual's professional values and integrity, and is associated with myriad negative consequences (Burston and Tuckett, 2013; Epstein and Delgado, 2010; Morley et al., 2019; Rushton et al., 2016)
From page 312...
... . Nurses working in communities or with people with complex health needs and social risks, such as SUDs and psychological and behavioral disorders, and those working in high-intensity settings or palliative care can experience moral distress due to the complex moral and ethical issues they confront (Englander et al., 2018; SAMHSA, 2000; Welker-Hood, 2014; Wolf et al., 2019)
From page 313...
... . Low levels of psychological safety in the culture of some health care organizations can undermine nurses' ability to contribute fully and to thrive in the workplace (Edmonson, 2002; Moore and McAuliffe, 2010, 2012; Newman et al., 2017; Ünal and Seren, 2016)
From page 314...
... These data paint a picture of work environments that are hostile to the psychological safety and well-being of nurses (Ulrich et al., 2019)
From page 315...
... fbclid=IwAR3jLV0DTBnIy_NK3322T4f WDjZhJaY9A6w05elGLG83bJZ47SVckBrPwKQ (accessed April 13, 2021)
From page 316...
... . There has been a call for both health care organizations and nursing schools to see beyond disability as a disqualifier for nursing practice, and instead value professionals with disabilities who can offer unique and different perspectives (Marks and Ailey, 2014; Marks and McCulloh, 2016)
From page 317...
... However, as noted by Melnyk and colleagues (2020) in a recent systematic review of interventions focused on improving physicians' and nurses' physical and mental well-being, more randomized controlled trials (RCTs)
From page 318...
... Physical Activity, Diet, and Sleep A recent systematic review of workplace interventions to address obesity in nurses found limited evidence of successful interventions. The authors recommend that interventions be tailored to the unique aspects of nurses' working lives (Kelly and Wills, 2018)
From page 319...
... In addition, health care organizations and employers have a responsibility
From page 320...
... . 9  See https://www.nursingworld.org/get-involved/share-your-expertise/pro-issues-panel/moral resilience-panel (accessed April 16, 2021)
From page 321...
... . In a recent systematic review, Melnyk and colleagues (2020)
From page 322...
... . Adopting systematic methods for building a culture that fosters ethical practice and integrity by investing in structural elements and processes in health care organizations will be essential to amplify interventions aimed at building individual capacities (Nelson et al., 2014; Pavlish
From page 323...
... . Systematic reviews have shown that these apps, including those focused on mindfulness and meditation (Huberty et al., 2019)
From page 324...
... and a multicomponent intervention that includes environmental changes, education, training, and changes in policies and procedures 10 These are health care organizations that are accredited through the American Nurses Credential ing Center. This model is considered to be the gold standard for nursing (Pfeiffer and Vessey, 2017)
From page 325...
... . There is a need for more research to examine how to ameliorate workplace violence among health care workers, and for replication and rigorous RCTs of promising interventions.
From page 326...
... This section describes how different stakeholders -- nurse leaders, educational institutions, employers, policy makers, and nursing associations and organizations -- can continue working toward improving nurse well-being, and provides several examples of action in these areas. 11 See https://nam.edu/clinicianwellbeing/case-studies (accessed April 13, 2021)
From page 327...
... . The leadership style and effectiveness of nurse leaders have been associated with outcomes including the health of the work environment, patient outcomes and mortality, job satisfaction, work engagement, burnout, and retention (Bamford et al., 2013; Boamah et al., 2018; Cummings et al., 2010a,b; Rushton and Pappas, 2020; Spence Laschinger and Fida, 2014; Spence Laschinger et al., 2012; Wei et al., 2018)
From page 328...
... . In a recent systematic review of resilience among health care professions, Huey and Palaganas (2020)
From page 329...
... Consistent with the recommendations of the National Academies report focused on addressing burnout (NASEM, 2019a) , educational institutions, like health care organizations, can invest in interventions that build individual resilience and well-being while dismantling the impediments within the system itself.
From page 330...
... For example, students who witness exhausted and overworked faculty who do not demonstrate investment in their own health and well-being experience dissonance when those same faculty urge them to adopt healthy habits and well-being practices. Nursing students' well-being can also be enhanced by advancing opportunities for interdisciplinary education and interventions aimed at fostering professionalism and interprofessional practice to support well-being (IOM, 2014)
From page 331...
... End users of these initiatives (front-line nurses) can be engaged proactively in designing a diversity of resources that they perceive to be valuable in fostering their well-being rather than having such resources 16  See https://nam.edu/initiatives/clinician-resilience-and-well-being (accessed April 13, 2021)
From page 332...
... Just as health care organizations provide PPE, schedule adequate staff, and ensure safety in the workplace, they are also responsible for providing "psychological PPE" to their employees (IHI, 2020)
From page 333...
... . Another ANCC initiative, the Pathway to Excellence program, recognizes health care organizations that demonstrate a culture in which a work environment that engages and empowers its workers is fostered.
From page 334...
... In the future, programs that recognize and incentivize health care organizations to distinguish their cultures as enabling the well-being of nurses have the potential to be expanded beyond acute care organizations to other settings where nurses work. Adopting standards and programs such as those described above offers organizations a roadmap for aligning efforts to produce meaningful and sustainable change.
From page 335...
... has an NBNA Affirmations webpage in which nurses can submit their favorite quotes or positive affirmations,19 and also has a Twitter campaign called #NBNAResilient. The National Association of Hispanic    For more information, see https://www.nursingworld.org/news/news-releases/2020/american 18 nurses-foundation-launches-national-well-being-initiative-for-nurses (accessed April 13, 2021)
From page 336...
... Improving the well-being of nurses will therefore require multilevel and multifaceted approaches that address their physical, mental, moral, and social health and create safe, supportive, and ethically grounded environments. Occupational health hazards, workplace violence, stress and mental health issues, moral suffering, compassion fatigue, burnout, and bullying and incivility all need to be addressed 20  See http://www.nahnnet.org/NAHN/Events/Webinars/NAHN/Content/Webinars.aspx?
From page 337...
... Nurses of color experience discrimination and bias within the workplace and educa tional systems, compounded by the lack of diversity among the nursing workforce and faculty. Nurses, educators, and health care leaders have a responsibility to address structural racism, cultural racism, and discrimination within the nursing profession across educational and practice settings, and to build structures and systems that promote in clusivity and health equity.
From page 338...
... Patient Safety Network. https://psnet.ahrq.gov/primer/nursing-and-patient-safety (accessed April 9, 2021)
From page 339...
... 2018. The impact of electronic health record systems on clinical documentation times: A systematic review.
From page 340...
... 2020. Compassion fatigue in healthcare providers: A systematic review and meta-analysis.
From page 341...
... 2010a. Leadership styles and outcome patterns for the nursing workforce and work environ ment: A systematic review.
From page 342...
... 2017. Interventions to promote or improve the mental health of primary care nurses: A systematic review.
From page 343...
... 2018. Effectiveness of mobile health application use to improve health behavior changes: A systematic review of randomized controlled trials.
From page 344...
... A synthesis of systematic reviews. The Medical Teacher 42(5)
From page 345...
... 2020. Ex amining relationships between resilience protective factors and moral distress among nursing students.
From page 346...
... 2020. Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review.
From page 347...
... 2017. Psychological safety: A systematic review of the liter ature.
From page 348...
... 2020. Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers.
From page 349...
... 2006. Defining and addressing moral distress: Tools for critical care nursing leaders.
From page 350...
... 2014. Assessing and addressing moral distress and ethical climate, part 1.
From page 351...
... 2017. Substance use among nurses and nursing students: A joint posi tion statement of the Emergency Nurses Association and the International Nurses Society on Addictions.
From page 352...
... 2020. Nurses' adherence to patient safety principles: A systematic review.
From page 353...
... 2019. Palliative care and moral distress: An institutional survey of critical care nurses.
From page 354...
... 2016. The effectiveness of nurse education and training for clinical alarm response and management: A systematic review.


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