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Background: Emergency room nurse triage entails complex clinical decision making under stress and time constraints. Workplace distractors, such as noise and task interruptions, have been pointed to as possible reasons for triage inaccuracy, though studies have not borne this out. To train nurses to perform the task, a serious game was developed to simulate the triage process and environment. A pilot study was undertaken to evaluate the acceptability and feasibility of the serious game and to collect preliminary data on the effects of two distractors—noise and task interruptions—on emergency room nurse triage accuracy. Methods: A 2 × 2 factorial randomized controlled trial was designed for the study. A sample of 70 emergency room nurses was randomly assigned to four groups: three experimental groups exposed to different distractors (noise, task interruptions, and both) and one control group exposed to none. The nurses in each group had two hours to complete a series of 20 clinical vignettes where they had to establish a chief complaint and assign an emergency level. Their responses were then compared against a gold standard predetermined by experts. Results: Among 70, 55 nurses completed about 15 vignettes each in the allotted time. No inter-group differences emerged in terms of triage performance. Only a few minor technical issues arose during the sessions. Nurses had a very favorable appreciation of the serious game on triage as measured through a semantic differential scale. Conclusions: Results show that both the structure of our study and the serious game on triage can be used to carry out a future RCT on a larger scale. Two minor technical bugs were identified and corrected, the series of vignettes to complete in two hours must be shortened to 15, and the test should be held during work hours to support recruitment and reduce the possible impact of nurse fatigue on triage performance. The absence of a distractor effect raises questions about whether distractors have an effect and at what frequency and intensity of noise and task interruptions might have an impact on triage performance and whether this dose is realistic.

During the COVID-19 pandemic, nurses were exposed to many stressors, which may have been associated with some mental health problems. However, most of the studies carried out on nurses’ quality of life and workplace wellbeing during the COVID-19 pandemic took a pathogenic approach. Given that current scientific knowledge in this field presented too many gaps to properly inform preventive and therapeutic action, the aim of this study was to explore whether protective factors (resilience, perceived social support, and professional identification) and stressors (perceived stress and psychosocial risks in the workplace) influenced the quality of life and workplace wellbeing perceived by Portuguese nurses during the COVID-19 pandemic. Data for this cross-sectional study was collected through online self-administered questionnaires. Linear regression models were used to analyze the relationships between variables. Results showed that perceived stress, resilience and job satisfaction were associated with quality of life and workplace wellbeing among Portuguese nurses. The study’s findings could serve to inform health policy and should draw the attention of nursing managers to the needs and difficulties reported by nurses, to the importance of providing them with emotional support, and to the relevance of promoting a good work environment.

Aim The aim of the study was to describe and compare feeling of competence regarding humanistic caring in Registered Nurses (RN) and nursing students (NS). Design A quantitative comparative cross‐sectional research design was used. Methods A convenience sample of 196 RN and 47 NS in a teaching hospital in Belgium completed a self‐administered questionnaire composed of a sociodemographic survey and the Caring Nurse‐Patient Interactions Scale (CNPI‐23) developed by Cossette et al. Results The four dimensions of the CNPI‐23 were compared using the Skillings–Mack test. Both groups scored higher on “humanistic” and “comforting” than on “clinical” and “relational” care and both scored lowest on this last dimension. Linear regressions showed that none of the variables had a statistically significant influence on the CNPI‐23 scores, except for NS “state of health,” which influenced their feeling of competence regarding “relational care.”

In recent decades, many countries modified their maternity and parental leave programmes, changing elements such as length, wage replacement levels, and eligibility criteria. We employ sequence ana...

Aim Despite its importance in nursing, perceived quality of the nurse–patient relationship has seldom been researched. This study sought to examine and compare the quality of caring attitudes and behaviours as perceived by haemodialysis patients and their nurses. Design This comparative descriptive study involved 140 haemodialysis patients and 101 nurses caring for them in ten haemodialysis units in the French‐speaking part of Switzerland. Methods Participants completed a sociodemographic questionnaire and the Caring Nurse‐Patient Interaction Scale (CNPI‐70). Results Both nurses and patients reported a high frequency of caring attitudes and behaviours. Patients gave higher ratings than nurses did on all the caring dimensions, except spirituality. Implications are discussed.

Background Nurses are trained to establish a trusting relationship with patients to create an environment promoting patients’ quality of life. However, in tech-heavy care settings, such as haemodialysis units, dehumanising practices may emerge and take root for various reasons to the potential detriment of both patients and nurses. For patients, this may lead to a deterioration of quality of life and, ultimately, of health status. For nurses, it may cause a deterioration of the work environment and, in turn, of quality of working life. Based on Watson’s Theory of Human Caring, we developed a brief educational intervention for haemodialysis nurses to strengthen their humanistic practice in the aim of improving the nurse-patient relationship and nurse quality of working life.. The intervention was tested by way of an experimental design. Methods One hundred and one haemodialysis nurses, recruited in ten hospitals in French-speaking Switzerland, were randomised into an experimental group that received the intervention and a control group. The nurse-patient relationship was measured with the Caring Nurse-Patient Interaction Scale (EIIP-70) and nurse quality of life at work was measured with the Quality of Work Life Questionnaire at four time points: pre-intervention, intervention completion, and six-month and one-year follow-ups. Random intercept regression analysis was used to evaluate change over time in the two variables under study. Results The intervention appeared to reinforce nurse attitudes and behaviours geared to a more humanistic practice. The effect seemed to fade over time but, 1 year post-intervention, six dimensions of the nurse-patient relationship (hope, sensibility, helping relationship, expression of emotions, problem solving, teaching) scored above baseline. Nurse quality of working life, too, seemed positively impacted. The cultural dimension of nurse quality of working life, that is, the degree to which everyday work activities attune with personal and cultural values, seemed positively impacted, as well, with improvement stable throughout the year following the intervention. Conclusions Results support a positive effect of the intervention over both the short term and the medium-to-long term. A brief intervention of the sort may constitute an effective means to improve the nurse-patient relationship by preventing or reducing dehumanising practices. Trial registration NCT03283891.

Hemodialysis patients constitute a vulnerable population. Their health needs are considerable and they often present psychological symptoms such as depression and anxiety. Empirical studies have demonstrated the efficacy of positive psychology interventions to enhance the well-being of patients and alleviate their depressive symptoms. One such intervention consists in identifying and mobilizing patient resources to activate their recovery. An intervention of the sort was implemented in Switzerland with hemodialysis nurses using AERES, a novel self-assessment instrument. AERES covers 31 domains under three dimensions: personal characteristics/qualities, hobbies/passions, and social/environmental resources. The aim of this qualitative study was to explore hemodialysis nurse perceptions of the use of this instrument. Sixteen hemodialysis nurses were recruited in six hospitals in French-speaking Switzerland and interviewed after delivering the intervention. A consensual qualitative research method was used to analyze the data. Results showed that the resources instrument was easy to administer and beneficial to patients and health professionals. Patient wellbeing became the top priority for the nurses and new interventions centered on patient resources were undertaken. Quality of patient care was improved. Nurses perceived this positive psychology instrument as a means of creating a positive relationship with patients and supporting them emotionally. Assessing the resources of this vulnerable population can provide health professionals with a powerful tool to understand patient intact resources, which can be used to alleviate symptoms and foster wellbeing.

IntroductionHemodialysis (HD) patients experience numerous physical and psychological symptoms on a daily basis. These symptoms have a heavy impact on their quality of life, which is a key indicator of their survival in the short term. Numerous empirical studies have shown that the quality of the nurse-patient relationship (NPR) is essential in promoting positive outcomes for patients. When patients receive caring, their autonomy and independence grows, their sense of hope increases, their quality of life improves, and their sense of satisfaction with nursing care received rises. Inversely, the presence of dehumanizing practices in hemodialysis settings can contribute to delay healing for patients. In light of the importance of the quality of the relationship between nurses and HD patients and of the benefits to be had from a quality relationship, an educational intervention based on Watson's Theory of Human Caring was delivered to HD nurses.ObjectiveThe purpose of this study was to explore qualitatively the perceptions of nurses working with HD patients in French-speaking Switzerland regarding changes to their clinical practice after receiving an educational intervention intended to reinforce caring attitudes and behaviors towards patients.MethodsThe method used was that of consensual qualitative research (CQR). Sixteen semi-structured interviews were conducted with hemodialysis nurses post-intervention.ResultsThe results evidence a transformation of clinical nursing practice illustrated by three core ideas: (1) caring practice was reinforced; (2) new practices emerged; and (3) some limitations appeared.ConclusionIn these times of global pandemic where the issue of the humanization of nursing care is front and center, this professional development activity helped reinforce caring-based practice. This practice needs to be developed within the various care units in order to guarantee and promote quality of care and patient safety.

Background The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/design A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A, noise; B, task interruptions; C, noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within 2 h. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion Study results will inform the design of large-scale investigations and will help identify teaching, training, and research areas that require further development.

Background: Patient safety is a top priority of the health professions. In emergency departments, the clinical decision making of triage nurses must be of the highest reliability. However, studies have repeatedly found that nurses over- or undertriage a considerable portion of cases, which can have major consequences for patient management. Among the factors that might explain this inaccuracy, workplace distractors have been pointed to without ever being the focus of specific investigation, owing in particular to the challenge of assessing them in care settings. Consequently, the use of a serious game reproducing a work environment comprising distractors would afford a unique opportunity to explore their impact on the quality of nurse emergency triage. Methods/Design : A factorial design will be used to test the acceptability and feasibility of a serious game created to explore the primary effects of distractors on emergency nurse triage accuracy. A sample of 80 emergency nurses will be randomised across three experimental groups exposed to different distractor conditions and one control group not exposed to distractors. Specifically, experimental group A will be exposed to noise distractors only; experimental group B to task interruptions only; and experimental group C to both types combined. Each group will engage in the serious game to complete 20 clinical vignettes in two hours. For each clinical vignette, a gold standard will be determined by experts. Pre-tests will be planned with clinicians and specialised emergency nurses to examine their interaction with the first version of the serious game. Discussion : This study will shed light on the acceptability and feasibility of a serious game in the field of emergency triage. It will also advance knowledge of the possible effects of exposure to common environmental distractors on nurse triage accuracy. Finally, this pilot study will inform planned large-scale studies of emergency nurse practice using serious games.

At patient intake in emergency departments, triage is a key step in ensuring optimal patient care and good use of hospital resources. Triage nurses must be able to make correct clinical judgements and triage decisions despite extremely stressful working conditions including noise and task interruptions. This article presents a new serious game designed to closely reproduce the conditions of a typical emergency department. Its purpose is to provide a generic testbed both for teaching and for research, notably in order to enable studying the impact of stressors on the quality of decisions made. A study involving 49 professional triage nurses shows that, despite its relatively modest technological requirements, this serious game is considered by the participants as highly attractive and very close to their professional experience.

Les patients hemodialyses representent une population fragile experimentant de nombreux symptomes (par exemple douleurs, fatigue) qui impactent leur qualite de vie. La presence et la severite de ces symptomes sont sous-estimees de facon importante par les professionnels de la sante. Le but de cette etude est de decrire et comparer les symptomes percus par les patients hemodialyses versus ceux detectes par les infirmieres et de discuter les possibles causes de disparite observees. Au total, 123 patients et 70 infirmieres œuvrant dans six centres d’hemodialyse ont ete inclus dans cette etude. Les resultats montrent que les infirmieres participantes ont detecte moins de 50 % des symptomes percus par les patients. La concordance entre les reponses des patients hemodialyses et celles des infirmieres sur la presence et la severite de tous les symptomes est tres faible (Kappa

The analysis of the Swiss labor market poses a methodological challenge. On the one hand, Switzerland is too diversified to be analyzed as a single socio-economic space. On the other hand, a high level of territorial fragmentation makes the use of administrative divisions methodologically weak. In this paper, we classify Swiss cantons into three types of labor markets: attractive, multicenter, and marginal. Our typology is based on a wide range of economic and labor market parameters, and can be a ready-to-use tool for further researches.

Background: Chronic kidney disease (CKD) is a fast-growing cause of morbidity and mortality worldwide. Patients suffering from CKD almost always develop end-stage renal disease (ESRD) that is often treated with haemodialysis (HD). In this context, the quality of the nurse-patient relationship (NPR) plays a major role in supporting the quality of life (QoL) of HD patients. This study examined the relationship between quality of nurse behaviours and attitudes as perceived by HD patients and QoL of these patients.Methods: The study used a cross-sectional correlational design. The sample consisted of 140 patients recruited in 10 HD units in French-speaking Switzerland. The Caring Nurse-Patient Interaction Scale (CNPI-70) was used to assess the NPR, and the French version of the WHOQOL-Bref was used to evaluate different dimensions of QoL. Random-intercept linear regressions adjusted for sociodemographic characteristics were used to study the relationship between patient-perceived quality of nurse caring attitudes and behaviours and patient QoL.Results: Patients reported a high frequency of caring attitudes and behaviours from their attending nurses, except relative to the dimension of spirituality. All the dimensions of patient QoL were positively influenced by the caring factor composing the CNPI-70. In particular, nurse attention to patient dignity when providing support for basic human needs seemed to be a major factor in patient QoL.Conclusions: Quality of NPR is essential to improving patient QoL. Interventions need to be developed to support quality of NPR.

Humanistic nursing practice constitutes the cornerstone of the nursing profession. However, according to some authors, such practice tends to fade over time in favour of non-humanistic behaviours. To contrast this tendency, an educational intervention (EI) based on Watson’s Theory of Human Caring was developed and tested in two pilot studies involving, respectively, rehabilitation nurses in Quebec (Canada) and haemodialysis (HD) nurses in Switzerland. In light of the positive results obtained in these, another study is being undertaken to examine more in depth the EI’s effects on both HD nurses and patients in French Switzerland. The EI is expected to have positive effects on quality of nurse-patient relationship (NPR), team cohesion, nurse quality of working life (QoWL), and patient quality of life (QoL). The study described in this protocol will use a mixed-method cluster randomised controlled trial design. For the quantitative component, nurse and patient data will be collected through questionnaires. The accessible population of 135 nurses and 430 patients will be clustered into 10 HD units. These units will be randomised into an experimental group (EG) and a waiting-list control group (WLCG). Measurements will be taken at baseline (pre-intervention) and repeatedly over time (post-intervention): immediately at EI completion and six and 12 months thereafter. For the qualitative portion of the study, 18 semi-structured interviews will be conducted with EG nurses picked at random two months after EI completion to explore perceived changes in nurse humanistic practice. Qualitative data will be analysed through the relational caring inquiry method, a phenomenological approach. Descriptive and inferential statistics will be computed from the quantitative data. The study described in this protocol will determine if and how the proposed EI promotes humanistic nursing practice and how this practice affects quality of NPR, nurse QoWL, and patient QoL. Moreover, it will lay the groundwork for offering the EI to nurses in other healthcare sectors. This clinical study was registered with ClinicalTrials.gov [ NCT03283891 , 14/09/2017].

Hemodialysis patients constitute a vulnerable population whose quality of life is affected by the many symptoms (e.g., pain, fatigue) they experience. The presence and severity of these symptoms are significantly under-assessed by health professionals. The purpose of this study was to describe and compare the symptoms perceived by hemodialysis patients versus those detected by nurses. A total of 123 patients and 70 nurses working in six hemodialysis centers were included in the study. The results show that participating nurses detected less than 50% of the symptoms perceived by patients. Agreement between hemodialysis patients and nurses regarding symptom presence and severity was slight to fair at best (kappa0.47). This suggests that improving the knowledge and skills of hemodialysis nurses for detecting the symptoms of the patients in their care could go a long way toward intervening more efficiently and improving the quality of the care they offer.

Under what conditions do citizens of nations and states comply with governmental requests to participate in public policymaking? Drawing on the dual pathway model of collective action (Stürmer & Simon, 2004) but with a focus on compliance with the status quo, rather than participation in collective protest, two studies examined citizens’ motivation to participate in public policymaking. Study 1 (N = 169) was an MTurk hosted survey that recruited participants from California, while Study 2 (N = 198) was a field experiment that recruited participants in Sardinia, Italy. Study 1 measured cost-benefit analyses, societal identification, and willingness to participate in public policymaking. Study 2 repeated the same procedures, with the exception that we manipulated costs of participation, and also measured participants’ trust in government. Study 1 confirmed our initial hypotheses – fewer costs predicted more willingness to participate, as did stronger state identification. However, Study 2 found an interactive effect of costs, identification, and trust on willingness to participate in public policymaking. Results confirm our hypotheses by showing that both costs and identification independently influence willingness to participate in public policymaking. Results also add to the literature by showing that these additive pathways can be influenced by trust in the source of governance.

Background: Dialysis patients experience multiple symptoms impairing their quality of life. A relationship seems to exist between the cultural context and the burden of symptoms. In this study, the prevalence and severity of 30 symptoms and their relationship with quality of life among hemodialysis patients in Switzerland is explored.Methods: A cross-sectional correlation design was used with a convenience sample of 119 patients from five dialysis units. Presence and severity of symptoms were assessed with the Dialysis Symptom Index and quality of life with the WHOQOL-Bref questionnaire. Multivariate linear regressions were used to examine the relationship between the prevalence and severity of symptoms, respectively, and quality of life. T-tests and Fisher’s tests were used for the international comparisons.Results: On average, patients reported 10 symptoms and often rated these as “somewhat bothersome”. The most frequent were: lack of energy, dry skin, trouble falling asleep, trouble staying asleep, and muscle cramps. Average symptoms prevalence and severity levels were both observed to decrease patients’ quality of life, items related to physical health and psychological state having the greatest impact. Prevalence and severity of psychological symptoms and prevalence of sex-related symptoms seem to be influenced by patients’ cultural context.Conclusions: These results demonstrate that patients on chronic hemodialysis present several symptoms that affect their quality of life. Healthcare professionals should develop strategies to identify more properly these symptoms, especially sex-related and psychological symptoms.