Nurse workforce scheduling: A qualitative study of Indonesian nurse managers’ experiences during the COVID-19 pandemic

Background: The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources. Objective: This study aimed to explore the experiences of nurse managers in managing staff nurses’ work schedules during the COVID-19 pandemic. Methods: A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study. Results: Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff. Conclusion: The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.

Nurses’ experiences and preferences around shift patterns: A scoping review

Objective To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature. Data sources Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021. Methods Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work. Results 30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses’ personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience). Conclusions Shift patterns are often organised in ways that are detrimental to nurses’ health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses’ preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns.

Blood Pressure Response in Miners Exposed to Chronic Intermittent Hypoxia in Chile

Introduction: Limited information is available on blood pressure (BP) behavior in workers exposed to chronic intermittent hypoxia (CIH), and even less is known regarding effects of CIH on 24-h ambulatory BP in those affected by arterial hypertension at sea level (SL). The aims of this study were to assess clinic and 24-h ambulatory BP at SL and at high altitude (HA; 3,870 m above SL) in workers exposed to CIH, and to compare BP response to HA exposure between normotensive and hypertensive workers.Methods: Nineteen normotensive and 18 pharmacologically treated hypertensive miners acclimatized to CIH were included, whose work was organized according to a “7 days-on−7 days-off” shift pattern between SL and HA. All measurements were performed on the second and seventh day of their HA shift and after the second day of SL sojourn.Results: Compared to SL, 24-h systolic BP (SBP) and diastolic BP (DBP) increased at HA [+14.7 ± 12.6 mmHg (p < 0.001) and +8.7 ± 7.2 mmHg (p < 0.001), respectively], and SBP nocturnal fall decreased consistently (−4.1 ± 9.8%; p < 0.05) in all participants, with hypertensives showing higher nocturnal DBP than normotensives (p < 0.05) despite the current therapy. Also, heart rate (HR) nocturnal fall tended to be reduced at HA. In addition, the 24-h SBP/DBP hypertension threshold of ≥130/80 mmHg was exceeded by 39% of workers at SL and by 89% at HA. Clinic HR, SBP, and DBP were significantly higher on the second day of work at HA compared with SL, the increase being more pronounced for SBP in hypertensives (p < 0.05) and accompanied by, on average, mild altitude sickness in both groups. These symptoms and the values of all cardiovascular variables decreased on the seventh day at HA (p < 0.05) regardless of CIH exposure duration.Conclusion: Long history of work at HA according to scheduled CIH did not prevent the occurrence of acute cardiovascular changes at HA during the first days of exposure. The BP response to HA tended to be more pronounced in hypertensive than in normotensive workers despite being already treated; the BP changes were more evident for 24-h ambulatory BP. Twenty-four-hour ABP monitoring is a useful tool for an appropriate evaluation of BP in CIH workers.

Cloud Masks Derived from the Mars Daily Global Maps and an Application to the Tropical Cloud Belt on Mars

An image processing technique is used to derive cloud masks from the color Mars Daily Global Maps (MDGMs) that are composed from the Mars Reconnaissance Orbiter (MRO) Mars Color Imager (MARCI) wide-angle image swaths. The blue channel of each MDGM is used to select cloud candidates and the blue-to-red ratio map is compared with a reference ratio map to filter out false positives. Quality control is performed manually. The derived cloud masks cover 1 Mars year from the summer of Mars year (MY) 28 to the summer of MY 29. The product has a 0.1° longitude by 0.1° latitude resolution and is available each day. This makes it possible to characterize the evolution of the tropical cloud belt from several new perspectives. The tropical cloud belt steadily builds up during northern spring and early summer, peaks near the early- to mid-summer transitional period, and rapidly declines afterward. From the perspective of cloud occurrence frequency and time mean, the cloud belt appears meandrous and zonally discontinuous, with minima in the Amazonis Planitia and Arabia Terra longitudinal sectors. A pronounced cloud branch diverges from the main cloud belt and extends from the Valles Marineris towards the Noachis and Hellas region. The cloud belt exhibits noticeable oscillatory behavior whereby cloud brightening alternates between the western and eastern hemispheres near the equator with a periodicity between 20 and 30 sols. The cloud belt oscillation occurred each Mars year around Ls = 140°, except for the Mars years when intense dust storms made disruptions. The phenomenon appears to be associated with an eastward propagating equatorial Kelvin wave with zonal wavenumber 1. This wave has a much longer wave period than the diurnal and semidiurnal Kelvin waves discussed in most of the previous studies and may be an important factor for the intra-seasonal variability of the tropical cloud belt. The convolution of clouds’ local time variation with MRO’s orbit shift pattern results in a seemingly highly regular 5-day traveling wave in Hovmöller diagrams of cloud masks.

Experimental Investigation of Rossiter Modes for an Open Box Cavity With Adjustable Depth

Resonance in aerospace is a phenomenon that engineers have been trying to predict and avoid for a long time. Acoustic resonance is only a part in this field. When it was previously studied, it was mostly in connection with long slender gaps at the fuselage of aircrafts. Lately it has become a focus in the development of highly efficient aero engines. Bleed systems in the compressor part of engines are needed but not easy to place aerodynamically. Additionally, these bleed systems have complex geometries. These geometries coupled with the operational range of modern aircraft from low to high subsonic Mach numbers can create unwanted acoustic resonances. This paper is part of project study of these resonances. Here the bleed geometry is simplified to an open box cavity that is studied experimentally in order to measure its acoustic behavior in low to high subsonic flow. The experimental data is compared to theoretical prediction models to create a baseline for future studies. The results show a good agreement between Rossiter prediction and experiments for a shallow cavity of L/D = 4. Deeper cavities with a length to depth ratio of one and 0.5 represent more organ pipe resonance phenomena. This is especially governed by the geometry of the cavity itself and the height of the test section. All cavities experience a shift in modes depending on the operating point. This mode shift pattern is similar for deeper cavities. However, the operating range can be divided into four sections in which a mode shift occurs for all cavities.

Partial Dependency of Vowel Reduction on Stress Shift: Evidence from English -ion Nominalization

While classic theories utilize the comparison between cómp[ɛ]nsate going to comp[ə]nsátion and cond[ɛ́]nse going to cond[ɛ]nsátion to argue that stressed vowels are immune to reduction in multiple affixations (e.g., SPE), this paper presents a corpus-based case study that looks into this quantitative interaction between vowel reduction and stress shift during English -ion nominalization and offers discoveries that go against the classic claim. After analyzing 1,047 verb-noun target pairs extracted from the CELEX2 dictionary corpus, this study claims that vowel reduction only partially depends on its stress-bearing feature and that the suffix type, the stress shift pattern, vowel tenseness, and crucially some lexically specific constraints also predict vowel reduction. This finding is further supported by an OT analysis and a statistical model. As a quantitative study that relies on an exhaustive list of English samples to derive theoretical analysis, this research not only provides new insights into this long-lasting debate but also aims to highlight the significance of incorporating large data samples for a complete understanding of phonological phenomena.

Trainee burnout: when does the fire start?

Purpose of the studyBurnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors.Study designPost Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift.ResultsIn a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R2 0.442, p=0.026), and also during On-call shifts (R2 0.564, p=0.012). Higher SGS scores were inversely related to lower SIs (coefficient −32.52, 95% CI −45.881 to 19.154, p=0.001).ConclusionStress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.

Simulation of realistic nephrology case scenarios to facilitate intra-professional team learning

Background Learning in the workplace maximises relevance to clinical practice and facilitates the education of the whole multiprofessional team. Provision of structured teaching is becoming increasingly challenging with shift pattern working and staff shortages. This article describes a simulation course designed to facilitate team learning to improve the care of nephrology patients, and presents outcome data over 2 years. Methods A full-day course, using high fidelity manikins, was designed for nephrology specialty trainees and nurse specialists. Nineteen learners (eleven specialty trainees and eight nurse specialists) and nine multidisciplinary team faculty members attended. Evaluation used pre- and post-course assessments, with a 1-year follow-up questionnaire. Results Following the course, improved knowledge scores, 56% to 72% (P<0.05), and confidence scores, 57% to 71% (P<0.005), were demonstrated. Qualitative analysis found ‘intra-disciplinary interaction’, ‘reflection’ and ‘practical skills’ were the greatest enablers of learning. In the 1-year follow-up questionnaire, specialty trainees reported that the course improved clinical practice and helped preparation for consultant roles. Conclusions This course improved knowledge and confidence in managing nephrology scenarios across the multidisciplinary learning group, and the model could be used in other hospital specialties.