Does Postural Feedback Reduce Musculoskeletal Risk?: A Randomized Controlled Trial

Background: There is a high prevalence of musculoskeletal disorders among personnel working in the healthcare sector, mainly among nursing assistants and orderlies. Objective: The objective is to analyze the effectiveness of a multi-component intervention that included postural feedback in reducing musculoskeletal risk. Method: A total of 24 nursing assistants and orderlies in a hospital setting were randomly assigned to an intervention group or a control group. After collecting sociodemographic information, a selection of tasks was made and assessed using the REBA (rapid entire body assessment) method. A multi-component intervention was designed combining theoretical and practical training, including feedback on the postures performed by the professionals involved, especially those involving high musculoskeletal risk. This program was applied only to participants in the intervention group. Subsequently, eight months after the first assessment and intervention, the second assessment was carried out using the same method and process as in the first evaluation. Results: The results indicate that the musculoskeletal risk in the second assessment in the intervention group was significantly reduced. However, no significant changes were observed in the control group. Conclusion: The multi-component intervention applied can significantly reduce the musculoskeletal risk of nursing assistants and orderlies. In addition, it is a low-cost intervention with great applicability.

Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities

Background and Objectives Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. Research Design and Methods Descriptive qualitative study using framework analysis applied to open-ended semi-structured interviews (n=28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from three SNFs in the Eastern U.S. (Massachusetts and North Carolina). Results Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. Discussion and Implications Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.

The art of delegation: integration of the veterinary nursing assistant into New Zealand veterinary practice

Background: In 2016 veterinary nursing assistants (VNAs) were introduced as an additional tier to New Zealand veterinary practice. Aim: This study explores the utilisation of VNAs in New Zealand veterinary practices to ascertain the impact of an additional staffing layer to patient outcomes, workload management and staff wellness. Method: Through focus groups and semi-structured interviews with 30 participants, three themes emerged allowing evaluation of the Allied Veterinary Professionals Regulatory Council (AVPRC) Scope of Practice (SP) (AVPRC, 2020) and development of delegation guidelines (DG). Results: Analysis identified weak processes in delegation. The practice-based perspectives of VNA staff utilisation supports the AVPRC SP. Conclusion: Effective communication of the SP and DG for veterinary practice utilisation could contribute to reducing workload pressure. Additionally, individual practice staff discussions regarding own and colleague job expectations, along with review of contractual job descriptions, could further evolution of multi-tiered practices leading to improved patient outcomes, team wellness and business success.

Use of antidepressants in the clinical nursing team: a prospective transversal observational study

Currently, with the perspective of becoming the second leading cause of disease in the world, depression is seen as a disease of modern society, affecting even health professionals such as nurses, nursing technicians, and nursing assistants. Based on this, this work aims to survey data on the use of antidepressants in the clinical nursing staff – nurses, technicians, and assistants who work at night at the ABHU. A questionnaire was designed to understand the reason for using antidepressants in the clinical nursing staff – nurses, technicians, and assistants. In addition, the questionnaire also aims to confirm hypotheses such as, whether the use of antidepressants by health professionals is related to the length of experience in the area, the use of antidepressants is related to stress, physical and emotional exhaustion, the length of treatment with antidepressants with a perception of improvement, it is related to the time of use, whether there is a relationship between the use of antidepressants and gender and whether the treatment with antidepressants is carried out with monitoring of professionals.

Burnout, Compassion Satisfaction, and Personality Among Nursing Assistants: Who is at Risk?

Nursing assistants often experience high rates of turnover and burnout, which may lead to poor resident care outcomes and quality of life, as well as continued staff shortages and increased workload for nursing assistants. This study examined personality correlates of burnout and compassion satisfaction among 100 nursing assistants employed as nursing assistants in long-term care (LTC) and hospitals throughout the United States. Participants completed the Professional Quality of Life Scale 5 (ProQOL 5) and the Big Five Inventory – 2 Short (BFI-2-S). There was a significant positive correlation between compassion satisfaction and agreeableness, and extraversion, and between burnout and neuroticism. Additionally, there were significant negative correlations between compassion satisfaction and neuroticism, and between burnout and agreeableness, and extraversion. These results indicate which nursing assistants may be more likely to experience burnout and may be at an increased risk of turnover. Specific interventions may be developed for such individuals to increase compassion satisfaction, reduce burnout, and reduce staff turnover. Furthermore, information regarding personality types of individuals at greater or lesser risk for burnout may be helpful for LTC administrators in the recruitment and hiring of nursing assistants, and thus may reduce rates of turnover. Resident care outcomes may also improve as nursing assistant hiring efforts are focused more on individuals who are less likely to experience burnout. Future researchers might investigate potential risk and protective factors for burnout and compassion satisfaction in nursing assistants.

Nurse Staffing in Nursing Homes During Hurricane Irma

Little is known about the effect of hurricanes on nurse staffing in nursing homes. Hurricane Irma made landfall on September 10th, 2017 in Florida. This study examined daily nurse staffing levels from September 3rd-24th, 2017 in 653 nursing homes; 81 facilities evacuated and 572 facilities sheltered-in-place. Data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida’s health providers’ emergency reporting system were used. Among all facilities, we found significant increases in staffing for licensed practical nurses (p=.02) and certified nursing assistants (p<.001), but not for registered nurses (p=.10) before Hurricane Irma made landfall. In comparison to facilities that sheltered-in-place, evacuating facilities increased staffing levels of all nurse types (all p<.001). From one week before landfall to two weeks after landfall, an additional estimated $2.41 million was spent on nurse staffing. Policymakers attempting to reduce the burden of natural disasters on nursing homes should reimburse staffing-related expenses.

Nursing Homes and COVID-19: Staff Experiences

Nursing homes (NHs) faced an unprecedented crisis during the rapid spread of COVID-19. This pandemic has had a devastating impact on both NH residents and workers who are often on the frontlines providing hands-on care. These workers are vulnerable to the health risks of COVID-19 due to daily exposure to residents with COVID-19, residence in areas with high infection rates, and challenges specific to low-income workers (e.g. reliance on mass transportation). Research has highlighted the experiences of NH workers during the pandemic to learn how to better support them now and during future pandemics. This symposium will add to this research and present new findings from studies conducted in the United States to capture the unique experiences of NH employees. First, Bryant illustrates specific COVID-19-related challenges that NH frontline workers faced and how these workers’ experiences compare to workers in other long-term services and support settings. Reinhardt reports findings from a qualitative study examining the multi-level challenges experienced by nursing assistants during the pandemic. Cimarolli examines if quality of employer communication and workers’ perceived COVID-19-related preparedness mitigate the impact of work-related stress on NH workers’ decision to resign. Franzosa shares recommendations based on priorities identified by nursing assistants and administrators to build future resilience based on lessons learned. Finally, Simpson identifies factors associated with states’ decisions to adopt COVID-19 testing mandates for workers in NHs. Dr. Zimmerman discusses study findings and their contributions for creating supportive NH work environments to ensure most optimal NH worker and resident quality of life.

It Was Trial by Fire: Recommendations for Building a Stronger Nursing Home Workforce After COVID-19

The COVID-19 crisis showed the urgent need for a unified, well-supported nursing home workforce. The objective of this qualitative study was to examine the lived experience of certified nursing assistants (CNAs) and administrators during COVID-19 to identify best practices moving forward. Six administrator interviews and 10 remote focus groups with CNAs at 5 nursing homes (N=56) were examined through directed content analysis. Based on priorities identified by CNAs and administrators, the following practices may be most impactful: 1) ongoing and responsive staff training; 2) transparent, direct, and two-way communication channels; 3) prioritizing hiring permanent staff to avoid shortages and reliance on agency staff; 4) building collaborative staff-management relationships; 5) providing flexible job benefits; 6) providing staff-centered emotional support resources; and 7) appraising COVID-19 innovations. Our results suggest that rather than returning to “business as usual,” nursing homes can draw on these lessons to build a more sustainable workforce and industry.