Intensive care nurse conceptions of work well-being are fundamental for future measures of work well-being and future interventional studies and initiatives.

Background: Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses' ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses' workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective. Aims and objectives: Identify intensive care nurses' perspectives of strategies that strengthen their workplace well-being. Design: An inductive descriptive qualitative approach was used to explore intensive care nurses' perspectives of strengthening work well-being. Method: New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being. Findings: Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems' strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other. Conclusions: Strengtheners of intensive care nurses' workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change. Relevance to clinical practice: Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.

Context. Accurate assessment of a patient's palliative care needs is essential for the timely provision of treatment and support. The Integrated Palliative Care Outcome Scale (IPOS) is an ordinal measure possessing acceptable psychometric properties, but its ability to discriminate precisely between individual symptom levels has not been rigorously investigated.Objectives. The study aimed to conduct Rasch analysis of the IPOS to evaluate and enhance precision of the instrument.Methods. Responses of 300 community-dwelling palliative care patients were subjected to Rasch analysis using the partial credit model.Results. Initial analysis supported the use of the Rasch model and acceptable reliability (person separation index ¼ 0.77) was observed; however, unsatisfactory model fit was found. Local dependency between items was resolved through the creation of super-items, which increased model fit, reliability (person separation index ¼ 0.80), and unidimensionality. There were no misfitting super-items or differential item functioning by age, rater, sex, or ethnicity. The IPOS showed satisfactory coverage of symptoms within the present clinical sample, with the ability to assess higher severity patients.Conclusion. The modified IPOS showed excellent reliability for a clinical measure in assessing the overall palliative care needs of a patient. The provided ordinal-to-interval conversion table accounts for unique contribution of each symptom to the overall symptom burden and easy to use without the need to modify the original IPOS format. J Pain Symptom Manage 2019;57:290e296. Ó

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Background A major problem in quantifying symptoms of schizophrenia is establishing a reliable distinction between enduring and dynamic aspects of psychopathology. This is critical for accurate diagnosis, monitoring and evaluating treatment effects in both clinical practice and trials. Materials and methods We applied Generalizability Theory, a robust novel method to distinguish between dynamic and stable aspects of schizophrenia symptoms in the widely used Positive and Negative Symptom Scale (PANSS) using a longitudinal measurement design. The sample included 107 patients with chronic schizophrenia assessed using the PANSS at five time points over a 24‐week period during a multi‐site clinical trial of N‐Acetylcysteine as an add‐on to maintenance medication for the treatment of chronic schizophrenia. Results The original PANSS and its three subscales demonstrated good reliability and generalizability of scores (G = 0.77‐0.93) across sample population and occasions making them suitable for assessment of psychosis risks and long‐lasting change following a treatment, while subscales of the five‐factor models appeared less reliable. The most enduring symptoms represented by the PANSS were poor attention, delusions, blunted affect and poor rapport. More dynamic symptoms with 40%‐50% of variance explained by patient transient state including grandiosity, preoccupation, somatic concerns, guilt feeling and hallucinatory behaviour. Conclusions Identified dynamic symptoms are more amendable to change and should be the primary target of interventions aiming at effectively treating schizophrenia. Separating out the dynamic symptoms would increase assay sensitivity in trials, reduce the signal to noise ratio and increase the potential to detect the effects of novel therapies in clinical trials.