Dr Fiona Yu

Background: Nursing shortages have profoundly impacted hospitals and consequently increased financial expenditure, resulting in work overload, thus augmenting nurses¿ stress and burnout levels. Studies have found that resilience helps nurses reduce the effects of stress and burnout. However, the factors associated with nurse resilience are yet to be determined. Objectives: This systematic review aims to identify the associated personal and work-related factors of nurse resilience. Design: This systematic review has been registered in the international prospective register of systematic reviews (Registered Number: CRD 42018094080). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Data sources: The systematic search was undertaken between March and April 2018 in five databases: CINAHL Plus, MEDLINE (Ovid), PsycINFO, EMBASE, and Scopus. The searched terms combined in each database were: resilience, hardiness, work, employ, occupation, job, and nursing. Review methods: Full-text English articles published between 2000 and 2018 were included. Studies were also included if they involved: (1) nurses who provided direct patient care, (2) resilience and its associated factors, (3) an empirical quantitative study, and (4) a quality assessment grade of ¿good¿ or ¿fair¿. Two authors carried out the study eligibility and quality assessment independently. A narrative synthesis was utilised following the Job Demands-Resources model to identify the factors of job demands and resources, which were associated with nurse resilience. Results: A total of 38 articles met the criteria and were systematically reviewed and narratively synthesised. Various resilience scales utilised in these studies made it unfeasible to synthesise the evidence using a meta-analysis. Inconsistencies exist when examining personal and work-related factors. Job demands (stress, burnout, posttraumatic stress disorder, and workplace bullying) were negatively associated with resilience, while job resources (coping skills, self-efficacy, social support, job satisfaction, job retention, and general wellbeing) were positively related to resilience. Using a quality assessment tool, 23 studies were rated as ¿Good¿ 15 were assessed as ¿Fair¿ and 20 were found to have a risk of bias. Conclusions: Understanding nurse resilience can proactively help nurses identify or prevent potential problems, thus fostering job resources and ultimately achieving personal and professional growth. Increased nurse resilience can help nurses reduce emotional exhaustion, increase work engagement, and enhance function when facing workplace challenges. This can assist nurses to establish strategies to deal with adversity and attenuate the effects of job demands. Further research is needed to explore nurse resilience and develop a consistent instrument for measuring resilience.

Aim: To assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors. Background: Literature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels. Methods: A cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses. Results: 57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (¿ = 0.03, r2 = -0.28), number of family dependents (¿ = 0.03, r2 = -0.27), and years of nursing experience (¿ = 0.03, r2 = -0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (¿ = 0.01, r2 = -0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (¿ < 0.01), age group (¿ = 0.03), shift schedule (¿ = 0.02), and nursing experience (¿ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals. Conclusions: More than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.