Tracey Joy Weiland

Aim: To evaluate a community‐based psychological health and well‐being programme for nurses and midwives.Design: Mixed methods programme evaluation.Methods: Four studies were included: observational descriptive study (cross‐sectional survey) of the health, well‐being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well‐being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross‐sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted.Results: One‐hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe‐to‐extremely severe category; 22% (n = 25) reported psychological distress in the moderate‐to‐severe category. Thirty‐one programme participants were followed in Study 2: the effect of the programme on participant well‐being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty‐nine broader stakeholders participated in a cross‐sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being ‘by nurses and midwives, for nurses and midwives’ critical to the programme's success and value.Conclusions: The community‐based psychological health and well‐being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource.Impact: Levels of stress and burnout in the health workforce are high. A community‐based psychological health and well‐being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success. Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians. Implications for the Profession and Patient Care: Quality and safety in patient care is directly impacted by the well‐being of nurse and midwives. A community‐based psychological health and well‐being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives.Reporting Method: Survey findings were reported according to STROBE (von Elm et al. in Lancet, 370:1453–1457, 2007) and qualitative findings according to COREQ (Tong et al. in International Journal for Quality in Health Care, 19(6):349–357, 2007).Patient or Public Contribution: No patient or public contribution.

Aim: To determine prevalence, predictors and change over time of nurses' and student nurses' mental health and well‐being, and explore nurses' perceptions, barriers and enablers of well‐being.Design: Longitudinal mixed‐methods survey.Methods: Forty‐nine students and registered nurses participated from Victoria, Australia. Data were collected from December 2019 to July 2020. Validated psychometrics and free‐text response questions were employed. Analysis used latent growth curve modelling, Pearson product‐moment correlations and thematic analysis.Results: A strong positive correlation was found between self‐determination and work well‐being, and a strong negative correlation between work well‐being and flight risk. Several moderate relationships were found; a moderate positive correlation between work well‐being and nurse manager ability, leadership and support, and a moderate negative correlation between burnout and staffing and resource adequacy. Collegial nurse–physician relationships deteriorated. Three themes, physical health, psychological well‐being and social connection, were identified as important for nurses' well‐being.

BACKGROUND Modification of lifestyle-related risk factors for multiple sclerosis (MS) has been associated with improved health outcomes when compared with standard medical management alone. Based on an existing evidence-based lifestyle education program offered as a residential workshop, the MS Online Course (MSOC) was developed to translate the face-to-face program into an online educational intervention. We performed a preliminary small randomised controlled trial (RCT), to quantitatively and qualitatively assess the feasibility of the MSOC. This paper reports qualitative aspects of participant involvement in this preliminary study. OBJECTIVE As part of an assessment of feasibility, to explore participants’ motivations, expectations, and experiences of the MSOC. METHODS MSOC trial participants were recruited via online advertisements through MS society websites of Canada, New Zealand, and the United States, and an Australian MS Facebook group. Consenting participants were randomised to one of two arms: the MSOC standard care course, containing material relating to MS and lifestyle sourced from public facing MS websites; or the MSOC intervention course, based on a face-to-face lifestyle modification program. Following completion of the respective courses, participants were invited to undertake semi-structured interviews. Reflexive thematic analysis of interviews was performed to identify themes related to participants’ motivations, expectations, and experiences of the MSOC. RESULTS Of 31 eligible participants, 17 people completed the MSOC feasibility RCT and 14 agreed to be interviewed. Four themes were identified: 1) “Wanting to help others” (helping through volunteering, contributing to knowledge base and spreading the word; 2) “Obtaining knowledge to help better manage MS” (reassurance and confirmation of existing knowledge; new credible knowledge and evidence); 3) “Doing whatever I can to help myself” (understanding lifestyle modification, changing my lifestyle, and remaining well and high-functioning); and 4) “Developing new attitudes” (finding positivity and feeling more confident and in control). CONCLUSIONS Participants were motivated to undertake the MSOC to help others with MS through participation in research, to help themselves by improving their knowledge and to find ways in which they could manage their own MS. Expectations included the obtaining of credible, reliable information to substantiate their existing knowledge, and to further understand lifestyle modification. Participants’ experiences varied from experiencing little to no impact, to confirming existing knowledge, obtaining new knowledge, and early implementation of new or modified lifestyle behaviours. Although not identified as an expectation prior to undertaking the MSOC, some participants experienced improved positivity, confidence, and a greater sense of control. These insights surrounding participants’ motivations, expectations and experiences may assist in recruitment strategies, course redevelopment and outcome measures for future studies. Identification of participants’ changing attitudes, which they considered a high priority in their lives, suggests outcome measures should include measures of confidence and agency CLINICALTRIAL This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12621000245897).

Background: Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition. Objective: This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS—digital health interventions that were intended to support a program of engagement over a defined period—and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs). Methods: We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators. Results: There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively. Conclusions: This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.

Background Several modifiable lifestyle factors have been associated with the onset and health outcomes of multiple sclerosis (MS), including clinically significant fatigue. A combined lifestyle score approach represents one method of assessing their relationship with clinical outcomes. Objectives To examine the association of two lifestyle scores with clinically significant fatigue and change thereof over 2.5 years’ follow-up using inverse probability treatment weighting (IPTW). Methods We used data on sociodemographic, lifestyle and clinical characteristics surveyed from an international cohort of people with MS at baseline and 2.5-year follow-up. Fatigue was defined by Fatigue Severity Scale (FSS>5), healthy lifestyle by the Healthy Lifestyle Index Score (HLIS) and the Smoking, Nutrition, Alcohol, Physical Activity (SNAP) score. Analyses were by IPTW accounting for age, sex, MS type, disability, treated comorbidity number, immunomodulatory medication use, prescription antifatigue medication use, and ongoing relapse symptoms. Results 1,268 participants completed the FSS at both timepoints, approximately 62% had fatigue. Using doubly robust IPTW, high (>11/20) HLIS (OR=0.90, 95% CI: 0.81-0.98) and high (>3/5) SNAP (OR=0.82, 95% CI: 0.73-0.90) were each associated with lower risk of fatigue at follow-up. Evaluating change in fatigue, higher SNAP score was associated with lower risk of fatigue (OR=0.89, 95% CI: 0.80-0.97) but that for HLIS did not reach statistical significance (OR=0.93, 95% CI: 0.85-1.01). Conclusion These results suggest a robust role for key lifestyle factors in preventing clinically significant fatigue and may represent a place for lifestyle modification in improving clinical outcomes in MS.

BACKGROUND Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition. OBJECTIVE This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS—digital health interventions that were intended to support a program of engagement over a defined period—and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs). METHODS We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators. RESULTS There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively. CONCLUSIONS This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.

Aim: To synthesize Registered Nurses’ self‐reported perceptions and experiences of psychological well‐being and ill‐being during their first year of practice.Design: Qualitative meta‐synthesis.Data sources: Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Qualitative studies were considered for inclusion if published in English, from 2009–2019, reporting primary data analysis including psychological well‐being and ill‐being experiences of graduate nurses in first year of practice.Review methods: Qualitative studies were systematically identified and critically appraised. A meta‐synthesis was applied using an open card sort technique to organize empirical data into a matrix of graduate nurses’ voices of psychological well‐being and ill‐being.Results: Twenty‐two studies were included. Analysis revealed patterns of positive experiences and emotions. These included feeling valued and part of the team and learning from and feeling supported by other nurses. Negative experiences and emotions such as feeling overwhelmed, stressed, alone and inadequately prepared were also identified.Conclusion: Graduate nurses’ perceptions and experiences of their psychological well‐being and ill‐being revealed both positive and negative dimensions during this transition period. Specific examples of strategies that may promote transition nurses’ well‐being and prevent ill‐being were identified such as social connection and support.Impact: Increasing the numbers of new nursing graduates world‐wide is required to strengthen health systems. Developing strategies to retain these graduates in the workforce is paramount. This review found some graduate nurses experience the transition period as a time of personal growth and fulfilment, for others this period was a stressor. These findings were illustrated in a model of ‘ways to well‐being’. The potential for knowledge translation of this model extends from graduate nurses as individuals, to nurse entry to practice programs and graduate nurse programs, to organizational policy targeting future health workforce.Systematic review registration number: CRD42020148812.