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Workload in the nursing profession is high, which is associated with poor health. Thus, it is important to get a proper understanding of the working situation and to analyse factors which might be able to mitigate the negative effects of such a high workload. In Germany, many people with serious or life-threatening illnesses are treated in non-specialized palliative care settings such as nursing homes, hospitals and outpatient care. The purpose of the present study was to investigate the buffering role of resources on the relationship between workload and burnout among nurses. A nationwide cross-sectional survey was applied. The questionnaire included parts of the Copenhagen Psychosocial Questionnaire (COPSOQ) (scale 'quantitative demands' measuring workload, scale 'burnout', various scales to resources), the resilience questionnaire RS-13 and single self-developed questions. Bivariate and moderator analyses were performed. Palliative care aspects, such as the 'extent of palliative care', were incorporated to the analyses as covariates. 497 nurses participated. Nurses who reported 'workplace commitment', a 'good working team' and 'recognition from supervisor' conveyed a weaker association between 'quantitative demands' and 'burnout' than those who did not. On average, nurses spend 20% of their working time with palliative care. Spending more time than this was associated with 'burnout'. The results of our study imply a buffering role of different resources on burnout. Additionally, the study reveals that the 'extent of palliative care' may have an impact on nurse burnout, and should be considered in future studies., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: The project was funded by the BGW - Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services). The BGW is responsible for the health concerns of the target group investigated in the present study, namely nurses. Prof. Dr. A. Nienhaus is head of the Department for Occupational Medicine, Hazardous Substances and Health Science of the BGW and co-author of this publication. All other authors declare to have no potential conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The aim of this study was to analyse the buffering effect of individual, social and organisational resources on health and intention to leave the profession in the context of burden due to quantitative job demands., Methods: In 2017, a cross-sectional survey was carried out anonymously among nurses in palliative care in Germany. One thousand three hundred sixteen nurses responded to the questionnaire (response rate 38.7%), which contained, amongst others, questions from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ). Moderator analyses were conducted to investigate the buffering effect of different resources on health ('self-rated health' and 'burnout') and 'intention to leave' in the context of quantitative demands., Results: 'Self-rated health' was significantly buffered by the resources 'recognition through salary' (p = 0.001) and 'good working team' (p = 0.004). Additionally, buffering effects of the resources 'workplace commitment' and 'good working team' on 'burnout' (p = 0.001 and p = 0.006, respectively) as well as of the resources 'degree of freedom', 'meeting relatives after death of patients', 'recognition from supervisor' and 'possibilities for development' on 'intention to leave' (p = 0.014, p = 0.012, p = 0.007 and p = 0.036, respectively) were observed., Conclusions: The results of our study can be used to develop and implement job (re) design interventions with the goal of reducing the risk of burnout and enhancing job satisfaction among nurses in palliative care. This includes for example adequate payment, communication training and team activities or team events to strengthen the team as well as the implementation of some rituals (such as meeting relatives after the death of patients). As our study was exploratory, the results should be confirmed in further studies.

The aim of this study is to obtain a better understanding of the association between the frequency of nurses' exposure to workplace aggression from patients and their levels of burnout. In particular, we seek to shed light on the role of the availability of follow-up counseling in organizations after critical incidents in mitigating the adverse relationships between physical and verbal aggression and nurses' burnout. A total of 582 nurses reported how frequently they had experienced physical and verbal aggression from patients in the last 12 months and whether they had the opportunity to receive follow-up counseling in their organization. In addition, nurses rated the extent to which they experienced each of the three dimensions of burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment). The results showed that both physical and verbal aggression were substantially related to the burnout dimensions. Furthermore, we found that the availability of follow-up counseling in organizations attenuated the relationships between physical aggression and all three burnout dimensions. While we found that the availability of follow-up counseling moderated the relationship between verbal aggression depersonalization, the moderating effects were not significant for emotional exhaustion and personal accomplishment. The findings indicate that the availability of follow-up counseling might help minimize the adverse impact of exposure to aggression from patients on nurses' mental health.

German hospitals are now confronted with major challenges from both shortages and fluctuations in the numbers of physicians and nurses. This makes it even more important that physicians and nurses do not prematurely leave patient care. The objective of the present study was to improve our understanding of the factors that trigger intentions to leave the profession. For this purpose, data from 1060 young physicians and nurses in hospital care were analysed. Intentions to leave the profession was assessed with the Copenhagen Psychosocial Questionnaire (COPSOQ). In the first step, the association was determined between intention to leave the profession and the factors of perceived quality of care and job satisfaction. In a second step, a mediation analysis was performed to determine the effect of perceived quality of care after correction for the possible mediator of job satisfaction. There were statistically significant negative associations between perceived quality of care and intention to leave the profession (beta: -2.9, 95% CI: -4.48--1.39) and job satisfaction and intention to leave the profession (beta: -0.5, 95% CI: -0.64--0.44). The effect of perceived quality of care on intention to leave the profession was partially mediated by job satisfaction. Thus, high perceived quality of care and high job satisfaction are both important factors that tend to prevent young physicians and nurses from leaving their professions.

In times of demographic change, most developed countries are increasingly looking to cover the growing domestic demand for healthcare by hiring nurses from abroad. The evidence concerning the health of immigrant care workers is inconsistent since studies report that it is either better or more impaired than that of their non-immigrant counterparts. This study compared the extent of occupational psychosocial stressors and resources affecting immigrant and non-immigrant homecare nurses. The cross-sectional survey was conducted in the homecare nursing service sector in Hamburg. Psychosocial distress, depressive symptomatology, generalized anxiety, somatic symptom burdens, homecare-specific qualitative stressors, as well as resources, have been measured using a standardized questionnaire. There was no significant difference in the extent of psychosocial distress experienced by immigrant and non-immigrant homecare nurses. Somatic symptom burdens most strongly predicted nurses' psychosocial distress, in general. For immigrant nurses, greater influence and freedom at work, as well as fixed-term employment, was related to increased levels of distress, while age, working full time, and working overtime predicted distress in non-immigrant nurses. A functioning relationship with colleagues and superiors had a declining effect on immigrant nurses' psychosocial distress, while shift work arrangements benefitted non-immigrant nurses. Even though the extent of psychosocial distress experienced by immigrant and non-immigrant nurses did not significantly differ, the nurse's individual explanatory model of psychosocial health should be considered in every occupational and political context.

Dialysis nurses face complex and demanding working conditions. Due to demographic changes, the number of dialysis patients has increased, while the number of skilled personnel is expected to decrease, leading to tremendous increases in quantitative demands in the near future. Against the background of increasing workload, focusing on the provision of job resources is considered a promising approach because resources can buffer the negative effects of job demands. The aim of this study is to investigate whether different job resources-in particular influence at work and feedback-play a buffering role in the relationship between job demands and employee well-being. The study used a cross-sectional paper-pencil survey design. Data were collected from 951 dialysis nurses working in dialysis facilities in Germany between October 2010 and March 2012 using validated measures of quantitative job demands, job-related resources (influence at work and feedback), and cognitive stress symptoms. To test the moderating role of resources, we applied hierarchical regression analyses. The findings indicate that feedback buffers the relationship between quantitative demands and well-being; that is, the positive relationship between quantitative demands and cognitive stress symptoms was weaker when feedback was high. However, we found no buffering role of influence at work. The results suggest that feedback is a promising resource that may buffer the negative impact of quantitative demands on well-being of dialysis nurses. The findings offer new approaches for training nurses and implementing a feedback culture.

Introduction: Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses' workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses' health., Materials and Methods: A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT)., Results: Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries., Discussion: Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.

Introduction: The evaluation of stress to the spinal column in the provision of care has mostly concentrated on the handling of loads. However, awkward body postures alone, without load transfer, can also be stressful for the spinal column. Therefore in this study all the body postures and movements of nurses were quantitatively measured within a working shift., Methods: The body postures were recorded with the CUELA measurement system (computer-assisted recording and long-term analysis of musculoskeletal loads), coupled to the individual, and this detected all movements of the trunk and the legs. These measurements were supported by video recordings, so that exact allocation of the measured data to the tasks performed was possible. In all, 24 shift measurements were carried out in 8 wards. Extent, frequency and duration of trunk postures were measured in three planes and assessed on the basis of several standards (DIN EN 1005-1, DIN EN 1005-4, ISO 11226)., Results: A mean of 1131 (+/-377) trunk inclinations of >20 degrees were performed in each shift. This corresponds to a frequency of 3.5 min(-1). A total of 237 of these inclinations lasted for >4 s. A total of 72 (+/-35) min was spent bending forward with an inclination of >20 degrees . However, the mean time spent in transferring patients (counting only the lifting process) and heavy materials was only 2 min per shift. Postures with trunk inclination of >60 degrees were adopted for a mean of 175 (+/-133) times. The main tasks responsible for this were 'bed making' (21%), 'basic care' (16%) and 'clearing up/cleaning' (16%)., Conclusions: It could be shown that many stressful trunk postures are assumed in nursing work during a shift. Future preventive measures should therefore consider not only load handling but also tasks with awkward postures.

Background and Objective Occupations involving repetitive movements of the wrists, activities that require a lot of force, and hand-arm swinging are particularly likely to contribute to the development of hand and wrist complaints. The daily setup and dismantling of dialysis machines as part of the dialysis treatment process can strain the wrists and fingers of nurses. However, evidence regarding the relationship between the work activities of dialysis nurses and the incidence of hand and wrist complaints is limited. This study aimed to investigate the prevalence and severity of hand and wrist complaints among dialysis nurses in Germany and to relate these to their work activities. Methods An online survey was created and sent to 836 dialysis centres in Germany. The Nordic Musculoskeletal Questionnaire was used in an online survey to assess the prevalence of musculoskeletal complaints in the hands and wrists. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess symptom severity. Dialysis nurses rated the effort required to set up dialysis machines using the BORG-CR10 scale. The analysis was descriptive. Results A total of 122 dialysis nurses (18 male, 104 female; mean age 45 ± 12 years) participated in the survey, and 59% of them reported developing hands or wrist complaints in the last 12 months. According to BCTQ, the average severity of these complaints is 2.0 ± 0.8 (N = 72). The severity of symptoms increased significantly with the number of setups performed by a dialysis nurse per day (r s = 0.35, P  = 0.003, N = 72). The nurses rated the effort required to set up the dialysis machines as 2.8 ± 1.8 on the BORG-CR10 scale (N = 101). Discussion The results of the online survey showed that dialysis nurses were more likely than the general population to experience hand and wrist complaints. The repetitive activities of the hands and wrists while setting up a dialysis machine are thought to be the cause. Conclusions Preventive measures are needed to reduce hand and wrist strain in dialysis nurses. [ABSTRACT FROM AUTHOR]

Introduction: The increase of multidrug-resistant organisms in hospitals causes problems in nursing homes. Staff in geriatric nursing homes are at greater risk of MRSA colonisation. The aim of the study was to describe the occupational exposure to MRSA among health personnel in geriatric nursing. Methods: A point prevalence survey was conducted among health personnel and residents of geriatric nursing homes within the greater Hamburg district. Nasal swabs and, where relevant, wound swabs were collected for the screening survey. Risk factors for MRSA colonisation were identified by means of a questionnaire and using the files held on the residents. Where tests on nursing staff were positive, a control swab was taken; when the results were confirmed positive, decolonisation was performed. The responsible general practitioners were notified of positive MRSA findings among residents. A molecular biological examination of the MRSA samples was performed. Results: A total of 19 institutions participated in the study. Nasal swabs were taken from 759 nursing staff and 422 residents. Prevalence of MRSA was 1.6% among staff and 5.5% among residents. MRSA colonisation among health personnel indicated a correlation with male gender (OR 4.5, 95% CI 1.4–14.1). Among the residents, chronic skin diseases (OR 3.2, 95% CI 1.0–10.3) and indwelling devices (OR 3.2, 95% CI 1.2–8.1) were identified as risk factors. No link between MRSA in residents and in health personnel could be established. Conclusion: The number of MRSA colonisations among nursing staff and residents of geriatric nursing homes in Hamburg was rather low at 1.6% and 5.5% respectively and equates to the results of other surveys in non-outbreak scenarios. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this review was to record systematically and assess the published literature relating to the occupational risk of influenza A (H1N1) infection among healthcare personnel during the 2009 pandemic. Methods: The literature search was performed in June 2015. An update was carried out in May 2016. It was applied to the electronic databases EMBASE, MEDLINE, PsycINFO, PubMed, CINAHL and Google Scholar. The quality assessment was conducted with a tool using eight criteria. A meta-analysis was carried out to compute pooled effect estimates for influenza A (H1N1) infection. Results: A total of 26 studies were included in the review, 15 studies met the criteria for the meta-analysis. After a sensitivity analysis the pooled analysis showed a significantly increased odds for influenza A (H1N1) infection for healthcare personnel compared to controls/comparisons (OR = 2.08, 95% CI = 1.73 to 2.51). The pooled prevalence rate for healthcare personnel alone was 6.3%. Conclusions: This review corroborates the assumption that healthcare personnel were particularly at risk of influenza A (H1N1) infection during the 2009 pandemic. Healthcare facilities should intensify their focus on strategies to prevent infections among healthcare personnel, especially during the first period of pandemics. [ABSTRACT FROM AUTHOR]

Background Work-related musculoskeletal pain- particularly back pain - is an important individual and socioeconomic problem. The Back College for the insurance holders of the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) is based on a multimodal concept and has been evaluated with respect to pain relief and continuing in the nursing profession. Methods In a retrospective cohort study, the participants in the Back College from 2009 to 2011 were surveyed in writing. Besides demographic data, the survey covered information on qualification, length of employment, institution, employment status, periods of inability to work, applicability of working techniques and continuation in the profession. Back pain was recorded at three time points - T1 (before the Back College), T2 (directly after the Back College) and T3 (at the time of the survey). Pain changes were submitted to tests for paired samples. Multivariate logistic analysis was applied to determine potential factors influencing unfavourable changes in pain or leaving nursing due to back pain. Results The survey covered 1,282 insurance holders, with a response rate of 80%. Statistically significant reductions in pain were found for the whole group and for all subgroups. For persons who predominantly worked in old people's homes and who did not take part in refresher services, an increased odds ratio was found for unfavourable changes in pain (OR: 1.9 or 1.4, respectively). Persons with a qualification in geriatric nursing or in intensive care/OP/anaesthesia had an increased risk of leaving nursing due to back pain (OR: 2.5 in each case). An increased risk of leaving was also found for persons who did not take part in workplace support (OR: 2.9). Conclusion Within the context of the study design, the multimodal concept of the Back College is clearly related to relief of back pain. The Back College appears to be less successful for geriatric nurses and persons with qualifications in intensive care/OP/anaesthesia. Further studies are needed to ascertain why some participants experience less relief in stress from the working techniques they have learnt. [ABSTRACT FROM AUTHOR]

Objectives: To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion. Methods: Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for ‘computer-assisted recording and long-term analysis of musculoskeletal loads’) measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion). Results: If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P < 0.001). Bathroom tests: compared with the standing work method, the kneeling and sitting work methods led to a significant increase in the proportion of time spent in an upright posture, by 19.4% points (P = 0.003) and 25.7% points (P < 0.001), respectively. The greater the proportion of time spent in an upright position, the lower the Borg rating (P < 0.001) awarded. Conclusions: The higher the proportion of time that nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-adjustable beds are provided in healthcare institutions. [ABSTRACT FROM AUTHOR]

Manual patient handling commonly induces high mechanical load on the lower back of healthcare workers. A long-term research project, the ‘Third Dortmund Lumbar Load Study' (DOLLY 3), was conducted to investigate the lumbar load of caregivers during handling activities that are considered ‘definitely endangering’ in the context of worker’s compensation procedures. Nine types of handling activities in or at a bed or chair were analysed. Measurement of action forces via specifically developed devices and posture recording by means of optoelectronic marker capturing and video recordings in order to quantify several lumbar-load indicators was previously described in detail. This paper provides the results of laboratory examinations and subsequent biomechanical model calculations focused on lumbar load and the potentials of load reduction by applying biomechanically ‘optimized’ transfer modes instead of a ‘conventional’ technique and, for a subgroup of tasks, the supplementary usage of small aids such as a sliding mat or a glide board. Lumbosacral-disc compressive force may vary considerably with respect to the performed task, the mode of execution, and individual performance. For any activity type, highest values were found for conventional performance, lower ones for the improved transfer mode, and the lowest compressive-force values were gathered when small aids were applied. Statistical significance was verified for 13 of these 17 comparisons. Analysing indicators for asymmetric loading shows that lateral-bending and torsional moments of force at the lumbosacral disc may reach high values, which can be reduced considerably by implementing an improved handling mode. When evaluating biomechanical loads with respect to age- and gender-specific work-design limits, none of the analysed tasks, despite execution mode, resulted in an acceptable load range. Therefore, applying a biomechanically adequate handling mode combined with small aids to lower the friction between patient and surfaces is highly recommended, especially to prevent overload in older caregivers. [ABSTRACT FROM PUBLISHER]

Background A prospective study of a cohort of nursing staff from nursing homes was undertaken to validate the Nurse-Work Instability Scale (Nurse-WIS). Baseline investigation data was used to test reliability, construct validity and criterion validity. Method A survey of nursing staff from nursing homes was conducted using a questionnaire containing the Nurse-WIS along with other survey instruments (including SF-12, WAI, SPE). The self-reported number of days' sick leave taken and if a pension for reduced work capacity was drawn were recorded. The reliability of the scale was checked by item difficulty (P), item discrimination (rjt) and by internal consistency according to Cronbach's coefficient. The hypotheses for checking construct validity were tested on the basis of correlations. Pearson's chi-square was used to test concurrent criterion validity; discriminant validity was tested by means of binary logistic regression. Results 396 persons answered the questionnaire (21.3% response rate). More than 80% were female and mostly work full-time in a rotating shift pattern. Following the test for item discrimination, two items were removed from the Nurse-WIS test. According to Cronbach's (0.927) the scale provides a high degree of measuring accuracy. All hypotheses and assumptions used to test validity were confirmed: As the Nurse-WIS risk increases, health-related quality of life, work ability and job satisfaction decline. Depressive symptoms and a poor subjective prognosis of earning capacity are also more frequent. Musculoskeletal disorders and impairments of psychological well-being are more frequent. Age also influences the Nurse-WIS result. While 12.0% of those below the age of 35 had an increased risk, the figure for those aged over 55 was 50%. Conclusion This study is the first validation study of the Nurse-WIS to date. The Nurse-WIS shows good reliability, good validity and a good level of measuring accuracy. It appears to be suitable for recording prevention and rehabilitation needs among health care workers. If, in the follow-up, the Nurse-WIS likewise proves to be a reliable screening instrument with good predictive validity, it could ensure that suitable action is taken at an early stage, thereby helping to counteract early retirement and the anticipated shortage of health care workers. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to quantify the total duration per shift in which nurses work in a forward bending position over 20°. Furthermore, the influence of several factors on the occurrence of sagittal trunk inclinations in nurses was investigated. Methods: Trunk postures were recorded for nine nursing home nurses from four German nursing homes and 18 hospital nurses from seven hospitals using the CUELA measurement system. A total of 79 shifts, 27 in nursing homes and 52 in hospitals, were analysed. All measurements were supported by video recordings. Specially developed software (WIDAAN 2.75) was used to synchronize the measurement data and video footage. Results: The total duration of inclinations per shift was significantly affected by the working area (nursing home or hospital) with an increase of 25.3 min in nursing homes (95% confidence interval 2.4–48.2; P = 0.032). Another factor was the extent of personal basic care tasks performed by the nurses (P < 0.001). Nursing home nurses worked about twice as long per shift in a forward bending position compared with hospital nurses (112 versus 63 min; P < 0.001) and they assumed almost one-third more inclinations per shift (1541 versus 1170; P = 0.005). Conclusions: Nursing staff perform a large number of inclinations. The amount of time spent by nurses working in a forward bending position was highly dependent on the working area and the extent to which patients were in need of help. It is very likely that future preventive measures, focussing on reducing the huge amount of inclination, would reduce the physical stress in everyday nursing work substantially. [ABSTRACT FROM PUBLISHER]

Background and objectives: The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany. Methods: 1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians. Results: Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86). Conclusions: Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease. [ABSTRACT FROM AUTHOR]

Background: A dialysis nurse's work is complex and demanding. Based on the results of a systematic review and a survey study, we developed a health-promoting intervention for dialysis nurses. The aim of this study is to evaluate this intervention. Methods: Before the intervention, the dialysis facilities were surveyed, and an analysis workshop was conducted. The intervention incorporated activities at the individual and organizational levels and included three half-day training sessions for dialysis nurses. The evaluation was based on pre-post-follow-up data from the intervention group (N = 33) and pre-post data from the control group (N = 44) gathered using validated scales. The measurement of change was conducted using repeated measures analysis of variance (ANOVA) and t-tests. Results: In the intervention group, we found small to medium effect sizes for all measures. However, only sense of community and burnout improved significantly between the pre- and post-tests. Compared to the control group, sense of community increased significantly only in the intervention group. This strengthens the result that the intervention had a particular effect on enhancing the sense of community. Conclusions: The systematically developed intervention for dialysis nurses offers a promising approach for workplace health promotion in the dialysis setting. [ABSTRACT FROM AUTHOR]