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Smith LM, McNulty B, Scroggs E, Yorke AM. Collaboration in the midst of chaos: perspectives of inpatient occupational and physical therapists during the COVID-19 pandemic. J Interprof Care 2024; 38:632-641. [PMID: 38743046 DOI: 10.1080/13561820.2024.2351007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
The COVID-19 pandemic has affected over 700 million people globally, straining healthcare systems and highlighting the need for interprofessional collaboration. The aim of this study was to describe interprofessional collaborative practice (IPCP) experiences from the perspectives of occupational therapists (OTs) and physical therapists (PTs) who were employed in a medical center both before and during the COVID-19 pandemic. This qualitative study, conducted from July 2020-November 2021, delved into the lived experiences of occupational and physical therapists in an inpatient setting during the pandemic through analysis of semi-structured interviews and journal entries. The pandemic prompted fear, uncertainty, and ethical dilemmas among therapists, affecting patient-centered care. Roles expanded, and teamwork challenges emerged in defining boundaries, while communication dynamics were transformed by virtual technologies. The pandemic affected therapists' values and ethics, and evolving roles brought expanded tasks. The crisis showcased both collaboration potential and the need to address team disparities. This study highlights the significance of values, roles, teams, and communication for occupational and physical therapists during the COVID-19 pandemic providing valuable insights into interprofessional collaboration's effect on healthcare delivery in times of crisis and beyond.
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Affiliation(s)
- Leslie M Smith
- Physical Therapy, University of Michigan - Flint, Flint, MI, USA
| | - Ben McNulty
- Occupational Therapy, University of Michigan - Flint, Flint, MI, USA
| | - Emily Scroggs
- Physical Therapy, University of Michigan - Flint, Flint, MI, USA
| | - Amy M Yorke
- Physical Therapy, University of Michigan - Flint, Flint, MI, USA
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Mladenović-Ranisavljević I, Stefanović V, Urošević S, Ilić-Stojanović S. Multiple-criteria analysis of the employee satisfaction level at healthcare facilities during the pandemic. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:571-578. [PMID: 38504493 DOI: 10.1080/10803548.2024.2325792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/28/2024] [Indexed: 03/21/2024]
Abstract
Due to the pandemic, the entire staff employed in healthcare institutions were directly exposed to longer working hours and unstable working conditions. Based on these facts, the research in this article aims to find out more about employees' satisfaction with working conditions and management's engagement in preserving their health and safety. Thus, a multiple-criteria decision analysis (MCDA) model based on the analyzed attitudes and opinions of employees was formed to reveal the interdependencies between working conditions resulting from the undertaken management activities, employee satisfaction and workplace safety. The results show that both nurses and drivers were least satisfied with working conditions during the pandemic while indicating those workplaces to be the most endangered. Additionally, the proposed model can be successfully applied to any type of organization to identify insufficiently effective management activities, address them accordingly and thereby improve the level of employee satisfaction.
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Liljas AEM, Morath LP, Burström B, Schön P, Agerholm J. The impact of facility and staff characteristics on infection control of COVID-19: Perceptions of elder care home managers in Stockholm, Sweden. Nurs Open 2024; 11:e2169. [PMID: 38783555 PMCID: PMC11116467 DOI: 10.1002/nop2.2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
AIM To examine the perceptions of managers of elder care homes on the impact of facility and staff characteristics on infection control of COVID-19. DESIGN Case study. METHODS Six purposively sampled care home managers in the city of Stockholm were interviewed. Through content analysis, three categories and nine subcategories were identified. RESULTS According to the interviewed care home managers, a home-like environment that allows for isolation of residents and possibilities for staff to get changed and store personal protective equipment outside each resident's room was considered ideal. Experienced employees were reported as invaluable when facing an infectious outbreak. A mix of permanent and temporary staff was considered essential although some thought that temporary staff who work in multiple care homes might negatively influence the spread of infection. Language barriers among staff were considered an obstacle when trying to disseminate information.
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Affiliation(s)
- Ann E. M. Liljas
- Department of Global Public HealthKarolinska InstitutetSolnaSweden
| | - Lenke P. Morath
- Department of Global Public HealthKarolinska InstitutetSolnaSweden
| | - Bo Burström
- Department of Global Public HealthKarolinska InstitutetSolnaSweden
| | - Pär Schön
- Department of Global Public HealthKarolinska InstitutetSolnaSweden
| | - Janne Agerholm
- Department of Global Public HealthKarolinska InstitutetSolnaSweden
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Tingsvik C, Bergman L, Falk AC, Larsson IM. Long-term impact of COVID-19 on nursing and care delivery: A national survey among anaesthetic and critical care nurses. Aust Crit Care 2024:S1036-7314(24)00055-9. [PMID: 38600008 DOI: 10.1016/j.aucc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has put an exceptional strain on intensive care delivery and has significantly impacted nursing practice in the intensive care unit, consequently affecting nurses' working environment and health. Little is known about the long-term impact on the nursing workforce and care delivery in intensive care and anaesthetic departments. AIM/OBJECTIVE This cross-sectional study aimed to describe the long-term impact of the COVID-19 pandemic on the nursing profession and nursing care from the perspectives of anaesthetic and critical care nurses. METHODS In this study, an online questionnaire with open- and close-ended questions was distributed to registered nurses working in anaesthesia and intensive care between February 8 and March 7, 2022. The data were analysed using content analysis and descriptive statistics. RESULTS Of the 514 registered nurses who responded to the questionnaire, 256 (50%) worked in anaesthesia care and 215 (42%) in intensive care. The long-term impact of COVID-19 was expressed in three categories: nursing care on hold, insights and experiences forming a new professional identity, and the impact of organisational conditions on the profession. Critical care nurses considered nursing care comparable to that before the COVID-19 pandemic. Nurse anaesthetics experienced changes in nursing tasks and activities compared to that before the COVID-19 pandemic. CONCLUSIONS Nursing care is still influenced by the pandemic due to the lack of resources and persistent high workload and needs to be reclaimed and prioritised. Re-establishing high-quality nursing care is a shared responsibility of the organisation and nursing profession, and the organisation needs to create prerequisites for this. Furthermore, nurses' views and insights into their profession developed both positively and negatively during the pandemic, which must be further considered, including the profession's values.
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Affiliation(s)
- Catarina Tingsvik
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, SE-551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, SE-55185 Jönköping, Sweden.
| | - Lina Bergman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
| | - Ann-Charlotte Falk
- Department for Health Promoting Science Sophiahemmet University, Sweden.
| | - Ing-Marie Larsson
- Anesthesia and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Kaşıkçı M, Yıldırım Z. Interventions to improve ethical decision-making skills in nursing students: A systematic review. Nurs Ethics 2024:9697330241239917. [PMID: 38576333 DOI: 10.1177/09697330241239917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Interventions to improve ethical decision-making are available in nursing education. Evidence of its effectiveness is essential. OBJECTIVE This review examined the effectiveness of interventions to improve nursing students' ethical decision-making skills. METHODS A structured search was performed in Google Scholar, Web of Science, Science Direct, Pubmed, Scopus, Cochrane Library, Elsevier, CINAHL EBSCO, and ULAKBIM. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) was used to assess the quality of studies. ETHICAL CONSIDERATIONS Ethical approval was not required for this systematic review. FINDINGS The final review was composed of six studies of published between January 2013 and 2023. Nine different teaching methods applied to students. Although the importance of ethical decision-making skills in solving ethical problems that nurses may encounter at any time is known, it is thought that there is a lack of data in the literature in the last 10 years. The last 10 years were chosen as this aims to provide a review based on the most current, relevant and quality information. The review indicated that all of the teaching methods improved ethical decision-making. CONCLUSION Different teaching methods can be used in the nursing education curriculum to meet the learning needs of nursing students in ethical decision-making.
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Azimi H, Rezapour-Nasrabad R, Borhani F, Sadat Hoseini AS, Bolourchifard F. Ethical care in patients with Covid-19: A grounded theory. PLoS One 2024; 19:e0300156. [PMID: 38547233 PMCID: PMC10977892 DOI: 10.1371/journal.pone.0300156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/16/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Providing ethical care during the Covid-19 pandemic has become an inevitable challenge due to facing limitations such as fear of contracting the disease, lack of equipment and emergence of ethical conflicts; So that there is no clear picture of how to provide ethical care for patients with Covid-19. The study aimed to explain the ethical care process of patients with Covid-19. METHOD This qualitative study was conducted in 2021-2023 using the grounded theory research method. Data were collected through conducting 21 semi-structured interviews with 19 participants (16 staff nurses, and 3 supervisor). Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. RESULTS The results indicated that starting the process with a problem means a challenge of how to do the right or correct thing for the patient. This process is driven by the feeling of duty and inner commitment to do the right thing. The sense of responsibility or commitment is directly related to the degree of faith in a person. The actions that a nurse takes to fulfill her sense of commitment is called the faith-based behavior process. The process of behavior based on faith is done through two steps. Attaining the satisfaction of God and as well as the satisfaction of one's conscience is the nurses' ultimate goal of doing the right work and being committed. CONCLUSION The process of ethical care of patients with Covid-19 can be different according to the degree of faith and environmental conditions. A higher level of faith and more helpful environmental conditions, the greater the nurse's inner commitments in the first and second steps, as a result, the satisfaction of God and conscience will be greater.
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Affiliation(s)
- Hamideh Azimi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rafat Rezapour-Nasrabad
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Borhani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Sadat Sadat Hoseini
- Pediatrics and NICU Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Bolourchifard
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Çiriş Yıldız C, Yildirim D, Ergin E, Korkmaz I, Coşkun Z. Development of ethical conflict scale for nurses in extraordinary circumstances and psychometric testing. J Adv Nurs 2024; 80:1132-1143. [PMID: 37705425 DOI: 10.1111/jan.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/23/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
AIM The aim of this study was to develop and psychometrically test the Ethical Conflict Scale for Nurses in Extraordinary Circumstances (ECSNEC). DESIGN This study is designed to develop and validate an instrument. METHODS There are four basic steps in the development process of ECSNEC: (1) establishment of the conceptual framework, (2) creation of the item pool, (3) preliminary evaluation and (4) psychometric evaluation. The data were gathered from 519 nurses who worked in two different hospitals operating in Istanbul between June 2022 and October 2022. RESULTS The scale had good content validity. The exploratory factor analysis revealed a three-factor construct which explained 47.31% of the total variance in the measured variable. The corresponding construct was confirmed by the confirmatory factor analysis. The Cronbach's alpha coefficients were greater than .60 for all dimensions. The test-retest reliability coefficient value of the scale was 0.90. CONCLUSION ECSNEC is a valid and reliable tool to determine the ethical conflict experienced by nurses in extraordinary circumstances. IMPACT The established scale allows the identification of factors influencing the ethical challenges nurses face in extraordinary circumstances. Thus, policies can be developed to prevent such ethical conflicts. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Cennet Çiriş Yıldız
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Dilek Yildirim
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Emine Ergin
- Department of Midwifery, Public Health Nursing, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
| | - Irem Korkmaz
- Emergency Service, Istanbul Provincial Directorate of Health Istanbul, Prof. Dr. Cemi̇l Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Zeynep Coşkun
- Patient Care Services, I.A.U. VM Medical Park Florya Hospital, Istanbul, Turkey
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Rushton CH, Hanson GC, Boyce D, Holtz H, Nelson KE, Spilg EG, Robillard R. Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers. J Adv Nurs 2024; 80:1177-1187. [PMID: 37772644 DOI: 10.1111/jan.15873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023]
Abstract
AIM To refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity. BACKGROUND Healthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues. Moral resilience is a resource that may mitigate negative consequences. To better understand mechanisms for doing so, a valid and reliable measurement tool is necessary. DESIGN Cross-sectional survey. METHODS Participants (N = 1297) had completed ≥1 items on the RMRS as part of the baseline survey of a larger longitudinal study. Item analysis, confirmatory factor analyses, reliability analyses (Cronbach's alpha), and correlations were used to establish reliability and validity of the revised RMRS. RESULTS Item and confirmatory factor analysis were used to refine the RMRS from 21 to 16 items. The four-factor structure (responses to moral adversity, personal integrity, relational integrity and moral efficacy) demonstrated adequate fit in follow-up confirmatory analyses in the initial and hold-out sub-samples. All subscales and the total scale had adequate reliabilities (α ≥ 0.70). A higher-order factor analysis supports the computation of either subscale scores or a total scale score. Correlations of scores with stress, anxiety, depression and moral distress provide evidence of the scale's validity. Reliability of the personal integrity subscale improved. CONCLUSION AND IMPLICATIONS The RMRS-16 demonstrates adequate reliability and validity, particularly the personal integrity subscale. Moral resilience is an important lever for reducing consequences when confronted with ethical challenges in practice. Improved reliability of the four subscales and having a shorter overall scale allow for targeted application and will facilitate further research and intervention development. PATIENT/PUBLIC CONTRIBUTION Data came from a larger study of Canadian healthcare workers from multiple healthcare organizations who completed a survey about their experiences during COVID-19.
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Affiliation(s)
- Cynda H Rushton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ginger C Hanson
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle Boyce
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heidi Holtz
- School of Nursing, Barnes College of Nursing, St. Louis, Missouri, USA
| | - Katie E Nelson
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edward G Spilg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Dost A, Sezgin D, Esin MN. The association between the work environment and the fear of Covid-19 experienced by nurses. Work 2024:WOR230121. [PMID: 38427519 DOI: 10.3233/wor-230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The conditions in the workplace have a critical influence on the mental health of nurses and their attitudes toward their job, which may impact patient care. OBJECTIVE This cross-sectional study aimed to investigate the association between perceptions of the work environment and fear of COVID-19 experienced by nurses. METHODS The data were collected using a demographic data form, the Work Environment Scale (WES), and the Fear of COVID-19 Scale. The study was completed with 183 nurses who provide care to COVID-19 patients. RESULTS The mean scores for the WES and Fear of COVID-19 Scale were 63.59±12.35 and 21.98±8.36, respectively. There was a positive correlation between the points acquired from the "employee fears" section of the WES and the Fear of COVID-19 Scale mean ranks (r = 0.22). There was a weak negative correlation between the Fear of COVID-19 score and the WES "job satisfaction" score (r = -0.214). There was a weak negative correlation between the scores of the Fear of COVID-19 Scale and perceived support at work (r = -0.33) and between the WES scores and weekly working hours (r = -0.27). However, there was a weak to moderate positive correlation between the WES scores and number of days off per week (r = 0.45). CONCLUSIONS Nurses experience a high fear of COVID-19, and a decrease in their attitudes of the work environment was associated with an increased fear of COVID-19. The fear of COVID-19 may be reduced by various interventions to provide support at work and increase nurses' job satisfaction.
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Affiliation(s)
- Ayse Dost
- Department of Nursing, Health Sciences Faculty, Bezmialem Vakif University, Eyüp, Istanbul, Turkey
| | - Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Melek Nihal Esin
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ford NJ, Gomes LM, Brown SB. Brave spaces in nursing ethics education: Courage through pedagogy. Nurs Ethics 2024; 31:101-113. [PMID: 37493023 PMCID: PMC10898193 DOI: 10.1177/09697330231183075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. RESEARCH OBJECTIVE The aim of this research is to explore the influence of a structured self-assessment tool called the ESA "Engagement Self-Assessment" on the alignment and creation of a brave space in a nursing ethics course. RESEARCH DESIGN This study used an exploratory, cross-sectional survey design. PARTICIPANTS AND STUDY SETTING Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. ETHICAL CONSIDERATIONS Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). FINDINGS The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual "commitment to others." CONCLUSION A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space.
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Mohammadi F, Masoumi SZ, Khazaei S, Hosseiny SMM. Psychometrics assessment of ethical decision-making around end-of-life care scale for adolescents in the final stage of life. Front Pediatr 2024; 11:1266929. [PMID: 38318315 PMCID: PMC10839055 DOI: 10.3389/fped.2023.1266929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Healthcare professionals have a critical role in ethical decision-making around end-of-life care. Properly evaluating the ethical decision-making of health care professionals in end-of-life care requires reliable, tailored, and comprehensive assessments. The current study aimed to translate and assess psychometrically a Persian version of the ethical decision making in end-of-life care scale for Iranian adolescents in the final stages of life. Methods The present study investigates the methodology and multicenter research. 310 healthcare professionals who treat/care for adolescents at the end of life were selected from 7 cities in Iran. The original version of the end-of-life care decision-making scale was translated into Persian using the forward-backward translation method, and its psychometric properties were evaluated using COSMIN criteria. Results Exploratory factor analysis revealed that the factor loadings of the items ranged from 0.68 to 0.89, all of which were statistically significant. Furthermore, three factors had eigenvalues greater than 1, accounting for 81.64% of the total variance. Confirmatory factor analysis indicated a proper goodness of fit in the hypothesized factor structure. The internal consistency reliability of the tool was assessed in terms of its homogeneity, yielding a Cronbach's alpha coefficient of 0.93. Conclusion The Persian version of the End-of-Life Care Decision-Making Scale demonstrates satisfactory validity and reliability among healthcare professionals working with adolescents in the final stages of life. Therefore, nursing managers can utilize this tool to measure and evaluate ethical decision-making in end-of-life care for adolescents in the final stages of life and identify the most appropriate strategies, including educational interventions, to improve ethical decision-making in end-of-life care if necessary.
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Affiliation(s)
- Fateme Mohammadi
- School of Nursing and Midwifery, Chronic Diseases(Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Health Sciences Research Center, Health Sciences & Technology Research Institute, Hamadan University of Medical Science, Hamadan, Iran
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Miller J, Young B, Mccallum L, Rattray J, Ramsay P, Salisbury L, Scott T, Hull A, Cole S, Pollard B, Dixon D. "Like fighting a fire with a water pistol": A qualitative study of the work experiences of critical care nurses during the COVID-19 pandemic. J Adv Nurs 2024; 80:237-251. [PMID: 37515348 DOI: 10.1111/jan.15773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
AIM To understand the experience of critical care nurses during the COVID-19 pandemic, through the application of the Job-Demand-Resource model of occupational stress. DESIGN Qualitative interview study. METHODS Twenty-eight critical care nurses (CCN) working in ICU in the UK NHS during the COVID-19 pandemic took part in semi-structured interviews between May 2021 and May 2022. Interviews were guided by the constructs of the Job-Demand Resource model. Data were analysed using framework analysis. RESULTS The most difficult job demands were the pace and amount, complexity, physical and emotional effort of their work. Prolonged high demands led to CCN experiencing emotional and physical exhaustion, burnout, post-traumatic stress symptoms and impaired sleep. Support from colleagues and supervisors was a core job resource. Sustained demands and impaired physical and psychological well-being had negative organizational consequences with CCN expressing increased intention to leave their role. CONCLUSIONS The combination of high demands and reduced resources had negative impacts on the psychological well-being of nurses which is translating into increased consideration of leaving their profession. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The full impacts of the pandemic on the mental health of CCN are unlikely to resolve without appropriate interventions. IMPACT Managers of healthcare systems should use these findings to inform: (i) the structure and organization of critical care workplaces so that they support staff to be well, and (ii) supportive interventions for staff who are carrying significant psychological distress as a result of working during and after the pandemic. These changes are required to improve staff recruitment and retention. REPORTING METHOD We used the COREQ guidelines for reporting qualitative studies. PATIENT AND PUBLIC CONTRIBUTION Six CCN provided input to survey content and interview schedule. Two authors and members of the study team (T.S. and S.C.) worked in critical care during the pandemic.
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Affiliation(s)
- Jordan Miller
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Ben Young
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Louise Mccallum
- Nursing & Health Care School, University of Glasgow, Glasgow, UK
| | - Janice Rattray
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Lisa Salisbury
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Teresa Scott
- Critical Care Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Alastair Hull
- Institute of Medical Sciences, University of Dundee, Dundee, UK
| | - Stephen Cole
- Anaesthesia & Intensive Care Medicine, NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Beth Pollard
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Diane Dixon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
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Vonderschmitt J, Wöhlke S, Schicktanz S. Scarce resources, public health and professional care: the COVID-19 pandemic exacerbating bioethical conflicts - findings from global qualitative expert interviews. BMC Public Health 2023; 23:2492. [PMID: 38093218 PMCID: PMC10717036 DOI: 10.1186/s12889-023-17249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Since spring 2020, the SARS-CoV-2 virus has spread worldwide, causing dramatic global consequences in terms of medical, care, economic, cultural and bioethical dimensions. Although the resulting conflicts initially appeared to be quite similar in most countries, a closer look reveals a country-specific intensification and differentiation of issues. Our study focused on understanding and highlighting bioethical conflicts that were triggered, exposed or intensified by the COVID-19 pandemic in low and middle-income countries (LMICs) and high-income countries (HICs). METHODS We conducted qualitative interviews with 39 ethics experts from 34 countries (Argentina, Australia, Austria, Brazil, Canada, Colombia, Denmark, Ecuador, Ethiopia, France, Germany, India, Italy, Israel, Japan, Kyrgyzstan, Mexico, Nigeria, Oman, Pakistan, Paraguay, Poland, Romania, Russia, Singapore, South Korea, Spain, Sweden, South Africa, Tunisia, Türkiye, United-Kingdom, United States of America, Zambia) from November 2020 to March 2021. We analysed the interviews using qualitative content analysis. RESULTS The scale of the bioethical challenges between countries differed, as did coping strategies for meeting these challenges. Data analysis focused on: a) Resource scarcity in clinical contexts: Scarcity of medical resources led to the need to prioritize the care of some COVID-19 patients in clinical settings globally. Because this entails the postponement of treatment for other patients, the possibility of serious present or future harm to deprioritized patients was identified as a relevant issue. b) Health literacy: The pandemic demonstrated the significance of health literacy and its influence on the effective implementation of health measures. c) Inequality and vulnerable groups: The pandemic highlighted the context-sensitivity and intersectionality of the vulnerabilities of women and children in LMICs and the aged in HICs. d) Conflicts surrounding healthcare professionals: The COVID-19 outbreak underscored the tough working conditions for nurses and other health professionals, raising awareness of the need for reform. CONCLUSION The pandemic exposed pre-existing structural problems in LMICs and HICs. Without neglecting individual contextual factors in the observed countries, we created a mosaic of different voices of experts in bioethics across the globe, drawing attention to the need for international solidarity in the context of a global crisis.
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Affiliation(s)
- Jane Vonderschmitt
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36 / 37073, Goettingen, Germany.
| | - Sabine Wöhlke
- Department of Health Sciences, Hamburg University of Applied Sciences, Ulmenliet 20 / 21033, Hamburg, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36 / 37073, Goettingen, Germany
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14
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Afoko V, Hewison A, Newham R, Neilson S. Moral distress in nurses in developing economies: an integrative literature review. J Res Nurs 2023; 28:609-627. [PMID: 38162718 PMCID: PMC10756174 DOI: 10.1177/17449871231216606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Moral distress has been extensively studied in developed economies; however, not much in terms of studies has been carried out in developing economies. Objective To review the literature reporting the experience of moral distress in nurses in health care settings in developing economies. Design An integrative literataure review was used. Method Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online Cochrane and Psych INFO were searched to retrieve titles and abstracts of papers on the experience of moral distress in nurses in developing economies. Results Sixteen articles reporting the experience of moral distress in nurses in developing economies published between 1984 and March 2019 were used for the review. Analysis of the findings revealed seven themes, nurses' experience of moral distress, inadequate material and human resources, end-of-life challenges, cultural and religious beliefs as a source of moral distress, perceived inactions of medical and nursing staff, impact of moral distress on nurses in developing economies and coping strategies. Conclusion There is paucity of empirical studies on moral distress in nurses in developing economies. More qualitative studies are needed in various cultural settings to enhance its understanding in nurses working in developing economies.
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Affiliation(s)
- Vivian Afoko
- Lecturer, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Alistair Hewison
- Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Roger Newham
- Associate Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Susan Neilson
- Senior Lecturer, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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15
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Erler KS, Robinson EM, Bandini JI, Regel EV, Zwirner M, Cremens C, McCoy TH, Romain F, Courtwright A. Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis. HEC Forum 2023; 35:371-388. [PMID: 35290566 PMCID: PMC8922390 DOI: 10.1007/s10730-022-09474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters.
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Affiliation(s)
- Kimberly S Erler
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- School of Health and Rehabilitation Science, MGH Institute of Health Professions, Boston, MA, USA.
| | - Ellen M Robinson
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Patient Care Services Office of Quality, Safety and Practice, Boston, MA, USA
| | - Julia I Bandini
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- RAND Corporation, Boston, MA, USA
| | - Eva V Regel
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Mary Zwirner
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Cornelia Cremens
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas H McCoy
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Fred Romain
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Respiratory Care, Mass General Hospital, Boston, MA, USA
| | - Andrew Courtwright
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Pulmonary and Critical Care Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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16
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St Marie BJ, Bai J, Knisely MR, Booker SQ, Saravanan A, Sowicz TJ. Experiences of Pain Management Nurses during the COVID-19 Pandemic: A Qualitative Study. Pain Manag Nurs 2023; 24:603-609. [PMID: 37806899 DOI: 10.1016/j.pmn.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The knowledge and skills of pain management nurses positions them well to manage people's pain and provide critical services to patients with COVID-19. AIM To understand the personal and professional experiences and the support pain management nurses received during the COVID-19 pandemic. METHODS Between July 2020 and 2021, data were collected through semi-structured telephone interviews from members of the American Society for Pain Management Nursing. Content analysis was used. RESULTS Eighteen pain management nurses who worked during the early stages of the pandemic were interviewed. Three main categories were identified: experiencing stress and burden, pain management strategies changed, learning to cope with support. Pain management nurses reported fear of exposure, difficulties with staff shortages, the complex social milieu, and how pain management took a backseat to other symptoms of COVID-19. They coped through support from their colleagues, organizational leaders, and community members. Pain management nurses provided recommendations for future care of patients' pain during a pandemic. CONCLUSIONS Pain management nurses shared their professional and personal experiences and the support they received while managing patients' pain during the COVID-19 pandemic. Their experiences provided findings on the importance of pain management and to support nurses during personal and professional vulnerabilities during crises. Key recommendations on the care of patients' pain in future pandemics included developing expertise in pain management and health-related emergencies; engaging nurses in supportive mental health services, infectious disease testing, and vaccine efforts; and planning for surge capacity to reach out to underserved people living with pain.
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Affiliation(s)
| | - Jinbing Bai
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | | | - Staja Q Booker
- University of Florida, College of Nursing, Gainesville, FL
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17
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Shan Y, Zhou X, Zhang Z, Chen W, Chen R. Enhancing the work engagement of frontline nurses during the COVID-19 pandemic: the mediating role of affective commitment and perceived organizational support. BMC Nurs 2023; 22:451. [PMID: 38037090 PMCID: PMC10691007 DOI: 10.1186/s12912-023-01623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Overload and anxiety were common phenomena among frontline nurses during the pandemic. Understanding the potential pathway for fostering engagement in high-stress working conditions can provide evidence of targeted intervention to facilitate nurses' well-being and safety practices. This study aims to investigate the level of nurses' work engagement during nucleic acid collection tasks in the COVID-19 pandemic and identify its potential antecedents. METHODS A cross-sectional design was adopted. A sample of 824 nurses who engaged in nucleic acid collection tasks completed an online self-report questionnaire between 1 March and 31 May 2022. Descriptive and path analyses were utilized to analyse the interrelationships among anxiety, perceived workload, affective commitment, perceived organizational support and work engagement. This study was conducted and reported under the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS The results showed that frontline nurses engaged in such tasks reported high levels of anxiety and task load and low levels of work engagement. Path analysis identified anxiety symptoms, perceived workload, perceived organizational support, and affective commitment as associated with work engagement, and among these factors, perceived organizational support and affective commitment played key roles in mediating the relationship of anxiety, workload and work engagement in high-stress working conditions. CONCLUSIONS Affective commitment and perceived organizational support were associated with frontline nurses' level of work engagement during the COVID-19 pandemic; these two variables might explain how engagement is generated in high-anxiety and high-workload situations. When healthcare organizations give more attention to frontline nurses' physical and psychological conditions and are able to innovatively motivate affective commitment and facilitate organizational support, nurses' work engagement in high-level tasks may increase, thus enhancing work safety and personal well-being.
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Affiliation(s)
- Yawei Shan
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Shanghai, 201203, China.
| | - Xuemei Zhou
- Department of Nursing, Shanghai Hongkou Mental Health Centre, Shanghai, China
| | - Zhiyi Zhang
- Department of Nursing, Changshu No. 2, People's Hospital, Jiangsu, China
| | - Weijia Chen
- Department of Nursing, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ru Chen
- Department of Nursing, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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18
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Oh Y, Gastmans C. Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review. Nurs Ethics 2023:9697330231200564. [PMID: 37793022 DOI: 10.1177/09697330231200564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Frontline nurses who care for patients with COVID-19 work in stressful environments, and many inevitably struggle with unanticipated ethical issues. Little is known about the unique, ethically sensitive issues that nurses faced when caring for patients with COVID-19. AIM To better understand how frontline nurses who care for patients with COVID-19 experience ethical issues towards others and themselves. METHODS Systematic review of qualitative evidence carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses on ethical literature (PRISMA-Ethics). The electronic databases PubMed, Embase, Cinahl, Web of Science, Philosopher's Index, and Scopus were queried to identify candidate articles. Articles appearing from March 1, 2020 to December 31, 2022 were considered if they met the following inclusion criteria: (1) Published qualitative and mixed method studies and (2) ethical issues experienced by nurses caring for patients with COVID-19. We appraised the quality of included studies, and data analysis was guided by QUAGOL principles. FINDINGS Twenty-six studies meeting our inclusion criteria for how nurses experience ethical issues were characterised by two key themes: (1) the moral character of nurses as a willingness to respond to the vulnerability of human beings and (2) ethical issues nurses acted as barriers sometimes, impeding them from responding to requests of vulnerable human beings for dignified care. CONCLUSION Our review provides a deeper understanding of nurses' experiences of ethically sensitive issues, while also highlighting the critical need for adjustments to be made at organisational and societal levels. Ethical issues that emerged in situations where organisational and situational constraints impeded nurses' ethical responses to patients' appeals suggests that early practical support should be made available to resolve ethical issues recognised by nurses. Such support contributes to protecting and promoting not only the dignity of patients with COVID-19 but also of fellow humans in need during crisis.
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19
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Gurdap Z, Cengiz Z. Compassion Fatigue and Ethical Attitudes in Nursing Care in Intensive Care Nurses During the COVID-19 Pandemic: A Cross-sectional Study. J Nurs Care Qual 2023; 38:312-318. [PMID: 36917830 DOI: 10.1097/ncq.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Intensive care unit (ICU) nurses faced an increased risk of compassion fatigue and ethical concerns during the COVID-19 pandemic. PURPOSE To evaluate compassion fatigue of ICU nurses and their ethical attitudes in care during the COVID-19 pandemic and analyze contributing factors. METHODS An exploratory cross-sectional research design was used. RESULTS A total of 103 ICU nurses participated. The nurses' compassion fatigue and ethical attitude scores were high. Compassion fatigue was explained by the following variables: considering resigning, receiving support for ethical decisions, willingness to work in the ICU, duration of providing activities of daily living in a shift, and number of patients per nurse. CONCLUSIONS Compassion fatigue was high in nurses working in the ICU during COVID-19. The high level of ethical attitudes shows commitment to professional ethics and reflects the development of the nurses' professional identity. Implementation of interventions that help improve compassion fatigue among nurses is needed.
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Affiliation(s)
- Zuleyha Gurdap
- Department of Fundamentals of Nursing, Nursing Faculty, Inonu University, Malatya, Turkey
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20
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Aydin Dogan R. Compassion fatigue and moral sensitivity in midwives in COVID-19. Nurs Ethics 2023; 30:776-788. [PMID: 36927231 PMCID: PMC10028444 DOI: 10.1177/09697330221146224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The Covid-19 pandemic has impacted compassion fatigue and the mental health of health care providers, particularly midwives and nurses. Although there are studies involving health workers such as nurses and physicians affected by the pandemic's compassion fatigue, few studies include midwives. RESEARCH OBJECTIVE The present study seeks to investigate the effects of compassion fatigue experienced by midwives working under intense stress during the third wave of the COVID-19 pandemic on the level of moral sensitivity. RESEARCH DESIGN This is a descriptive-correlation study. PARTICIPANTS The statistical population consisted of all the midwives in Türkiye hospitals in 2021. This cross-sectional study was collected through a questionnaire using convenience sampling. Three hundred and ten midwives working in different units of the country participated in the study. ETHICAL CONSIDERATIONS Approval from the researcher's university Institutional Review Board for ethical review was obtained with the code of IRB 20/510. FINDINGS The average age of the midwives is 34.29 ± 8.39. It has been noticed that 43.5% of the midwives work in public hospitals and 38.1% in family health and community health centers. Midwives' mean MR-CS score is 67.11 ± 25.13, secondary trauma sub-dimension average 15.77 ± 6.23, and occupational burnout sub-dimension 40.69 ± 16.35. The mean moral sensitivity questionnaire score is determined as 93.86 ± 19.51. It has been observed that the working style and working time are effective on compassion fatigue. In the linear regression model, 98% of compassion fatigue was explained. Age, secondary trauma, and occupational burnout sub-dimensions affect the model. DISCUSSION Working year, working style, second trauma, age, and occupational burnout parameters may help explain some of the links between midwives' symptoms of compassion fatigue. CONCLUSION The pandemic affects the compassion fatigue of midwives. It is crucial to provide social support to midwives and health workers to prevent compassion fatigue and examine and control groups at risk in mental health.
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Affiliation(s)
- Reyhan Aydin Dogan
- Department of Midwifery, Faculty of Health
Sciences, Karabuk University, Turkey
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21
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Ren H, Liu C, Chen F, He L, Zhang M, Gu B, Zhu H, Jiang Y. Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China. Nurs Open 2023; 10:6091-6100. [PMID: 37247342 PMCID: PMC10415983 DOI: 10.1002/nop2.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/17/2022] [Accepted: 05/07/2023] [Indexed: 05/31/2023] Open
Abstract
AIM To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China. DESIGN A nationwide cross-sectional online survey. METHODS A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation. RESULTS The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.
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Affiliation(s)
- Hong‐fei Ren
- Department of Gastroenterology and Hepatology, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Chang‐qing Liu
- Department of Operating Room, West China HospitalSichuan University/West China School of Nursing, Sichuan University/Nursing Key Laboratory of Sichuan ProvinceChengduChina
| | - Feng‐jiao Chen
- Department of Hematology, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Ling‐xiao He
- Trauma Center of West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Ming‐guang Zhang
- Department of Gastroenterology and Hepatology, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Bo Gu
- Nursing Department of West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Hong Zhu
- Nursing Department of West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Yan Jiang
- Nursing Department of West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
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22
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Luo Y, Feng X, Wang D, Zheng M, Reinhardt JD. Understanding early experiences of Chinese frontline nurses during the COVID-19 pandemic: A text mining and thematic analysis of social media information. Nurs Health Sci 2023; 25:389-401. [PMID: 37503817 DOI: 10.1111/nhs.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/29/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023]
Abstract
This study aims to explore the early experiences of frontline nurses at the beginning of the COVID-19 pandemic in China as expressed through social media posts. This study used an explanatory sequential mixed-method design. Text mining was used for sentiment analysis. The chi-square test was used to compare the differences in the composition ratio of sentiment classification of posts in different months. Word frequency was statistically analyzed. Further thematic analysis was also performed. The primary sentiments of the posts were discovered to be positive and neutral. The number of posts containing positive emotions was the lowest in January, peaked in March, and gradually declined in April 2020. The following nurse-oriented narrative themes were developed: "To see and be seen," "Moving forward amid adversity and support," and "Returning to everyday life and constructing meaning." The sentiments of Chinese nurses in response to the pandemic fluctuated, with positive emotions in the early stage, but it could not be sustained. This study recommends nurses could be encouraged to engage in expressive writing while adhering to ethical guidelines.
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Affiliation(s)
- Yunting Luo
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
- Center of Infectious Diseases, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Xianqiong Feng
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Dandan Wang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Mingyue Zheng
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Rehabilitation Medicine Center, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, China
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23
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Fleischmann KR. The Sociotechnical Construction of Distrust during the Covid-19 Pandemic. Hastings Cent Rep 2023; 53 Suppl 2:S16-S21. [PMID: 37963040 DOI: 10.1002/hast.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
What were the impacts of the Covid-19 pandemic on trust in public health information, and what can be done to rebuild trust in public health authorities? This essay synthesizes insights from science and technology studies, information studies, and bioethics to explore sociotechnical factors that may have contributed to the breakdown of trust in public health information during the Covid-19 pandemic. The field of science and technology studies lays out the dynamic nature of facts, helping to explain rapid shifts in public health messaging during Covid-19 and reasons they produced a lack of trust in public health authorities. The information field looks at how facts are sociotechnically constructed through systems of classification, illustrating how extrascientific factors influence public health authorities. Putting these perspectives alongside bioethics principles raises additional factors to consider. The goal of this essay is to learn from past failures to point toward a brighter future where trust in public health authorities can be rebuilt, not on faith, but rather through striving for calibrated trust within which, through a virtuous circle, trust is validated.
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Jaarsma P, Gelhaus P, Eklund Saksberg M. Two cases of nursing older nursing home residents during COVID-19. Nurs Ethics 2023:9697330231185944. [PMID: 37597000 DOI: 10.1177/09697330231185944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Two ethical challenges of nursing home nurses during the COVID-19 pandemic in Sweden are discussed in this paper. BACKGROUND Historically, the nurse's primary concern is for the person who is ill, which is the core of nurses' moral responsibility and identity. In Sweden, person-centered care is generally deemed important in nursing older nursing home residents. OBJECTIVE To chart moral responsibilities of nursing home nurses in two cases involving older residents during the COVID-19 pandemic in Sweden. METHODS We used Margaret Urban Walker's framework for moral responsibilities and the International Council of Nurses (ICN) code of ethics for nurses (2021) for our normative analysis. ETHICAL CONSIDERATIONS Written and verbal consent was obtained before the interviews, and information was given that participation was entirely voluntary and possible to cancel at any time before the work was published. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to this research project (Dnr. 2020-05649). FINDINGS Case #1: a palliative older nursing home resident who was coercively tested for COVID-19, and case #2: a COVID-19-infected resident with dementia who was isolated using sedation. The decision that was finally made in the respective case was analyzed in the light of either consequentialist/utilitarian or non-consequentialist/deontological reasons. DISCUSSION Empowerment of nurses as moral agents is required for the application of practical wisdom in the balancing of different care relationships (responsibilities), moral identities (professional virtues), and competing moral values. This requires resources and opens possibilities for profound ethical reflection in nursing education and at work. CONCLUSION During the COVID-19 pandemic, the moral and professional responsibility of nursing home nurses to deliver person-centered care was sometimes problematically abandoned in favor of a more utilitarian manner of ethical decision-making.
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Affiliation(s)
- Pier Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Petra Gelhaus
- Department of Psychiatry, Region Östergötland, Linköping, Sweden
| | - My Eklund Saksberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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25
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Pagnotta A, Antonacci R, Curiale L, Sanzone L, Kapoustina O, Cervantes A, Monaco E, Tsimicalis A. Exploring Novice Nurses' Experiences During the First Wave of the COVID-19 Pandemic. J Nurs Educ 2023; 62:461-466. [PMID: 37561900 DOI: 10.3928/01484834-20230612-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic affected how nurses learn and prepare for their future careers. This study explored the experiences of college-prepared, novice nurses pursuing a baccalaureate degree during the first wave of the pandemic. METHOD This qualitative descriptive study analyzed students' individual reflective assignments describing the effects of the COVID-19 pandemic on novice nurses' personal, professional, and educational lives. RESULTS Three themes emerged: (1) emotions generated in the clinical workplace due to the lack of control and the unknown of working as novice nurses during a pandemic; (2) cognitive dissonance of the nursing role regarding novice nurses' moral distress and their growing empowerment within the scope of practice; and (3) a disconcerted image of nursing with contrasting views of nursing from the public's perspective and a disconnect between frontline workers and decision makers. CONCLUSION Novel pedagogical strategies are needed to help novice nurses cope with stress, uncertainty, and role challenges to foster healthy learning in academic and working environments. [J Nurs Educ. 2023;62(8):461-466.].
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Grace PJ, Milliken A. A semantic exploration: Nurse ethicist, medical ethicist, or clinical ethicist: Do distinctions matter? Nurs Ethics 2023; 30:659-670. [PMID: 37946385 DOI: 10.1177/09697330221146251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Since the 1960s, it has been recognized that "medical ethics," the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one's prior profession's nomenclature as a prefix to "ethicist," under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good.
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Affiliation(s)
- Pamela J Grace
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Aimee Milliken
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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Sillero Sillero A, Ayuso Margañon R, Gil Poisa M, Buil N, Padrosa E, Insa Calderón E, Marques-Sule E, Alcover Van de Walle C. Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study. Healthcare (Basel) 2023; 11:1937. [PMID: 37444771 DOI: 10.3390/healthcare11131937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The COVID-19 pandemic has led to an increase in the complexity of caregiving, resulting in challenging situations for perioperative nurses. These situations have prompted nurses to assess their personal and professional lives. The aim of this study was to explore the experiences of perioperative nurses during the first wave of the COVID-19 pandemic, with a specific focus on analyzing moral breakdowns and ethical dilemmas triggered by this situation. (2) Methods: A qualitative design guided by a hermeneutical approach was employed. Semi-structured interviews were conducted with 24 perioperative nurses. The interviews were transcribed and thematically analysed following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. (3) Results: The findings revealed three main categories and ten subcategories. These categories included the context in which moral breakdowns emerged, the ethical dilemmas triggered by these breakdowns, and the consequences of facing these dilemmas. (4) Conclusions: During the first wave of COVID-19, perioperative nurses encountered moral and ethical challenges, referred to as moral breakdowns, in critical settings. These challenges presented significant obstacles and negatively impacted professional responsibility and well-being. Future studies should focus on identifying ethical dilemmas during critical periods and developing strategies to enhance collaboration among colleagues and provide comprehensive support.
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Affiliation(s)
- Amalia Sillero Sillero
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Raquel Ayuso Margañon
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Maria Gil Poisa
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Neus Buil
- Nursing Care Research, IIBSANT PAU, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Eva Padrosa
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Esther Insa Calderón
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Faculty of Physiotherapy, Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Carlota Alcover Van de Walle
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
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Ahmadi F, Shaker H, Eterafi M, Kamran A. Exploring nursing students' perceptions from nursing role function (SP-NRF) during the COVID-19 pandemic in Ardabil Province: a cross sectional study from Iran. BMC Nurs 2023; 22:219. [PMID: 37365591 DOI: 10.1186/s12912-023-01389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Perception of nursing roles among nursing students significantly influences their active engagement in nursing processes and care delivery. However, there is evidence to suggest that students' interest in and perceptions from the nursing profession at the undergraduate level are often insufficient. OBJECTIVE This study aimed to assess nursing students' perceptions of nursing role function and identify areas that require improvement. METHODS A cross-sectional study was conducted in 2021 among nursing students in the third- and fourth-years from three faculties in the Ardabil Province. The participants were selected through census sampling. The data were collected through interviews with the Standardized Professional Nursing Role Function (SP-NRF) questionnaire. Statistical analysis was performed using the SPSS-18 software at a significance level of less than 0.05. RESULTS A total of 320 nursing students participated in this study. The mean score for nursing role perception was 223.1 ± 20.3 out of 255. The results indicated significant gender differences in the mean scores of perception of the nursing role function, particularly in the supportive, professional-moral care, and professional-educational dimensions. Women scored significantly higher than men did (P < .05). Additionally, students who obtained a mean score of 19 to 20 (A) had significantly higher total scores in perception of the nursing role function than other students. Furthermore, a positive correlation was observed between students' interest in nursing and their perceived ability with nursing role perception (r = .282, P < .01) and all its dimensions. CONCLUSION Overall, nursing students demonstrated a favorable perception of nursing role function. However, their perception of mental and spiritual care was relatively weak. These findings highlight the need to review nursing education programs and incorporate the spiritual care dimension to enhance students' understanding of and preparation for their role as nurses.
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Affiliation(s)
- Fatemeh Ahmadi
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Islamic Republic of Iran
| | - Hamidreza Shaker
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Islamic Republic of Iran
| | - Majid Eterafi
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Islamic Republic of Iran
| | - Aziz Kamran
- School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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Buchbinder M, Browne A, Berlinger N, Jenkins T, Buchbinder L. Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-15. [PMID: 37347222 PMCID: PMC10758677 DOI: 10.1080/15265161.2023.2224270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic factors. We conclude by reflecting on how and why this conceptual clarity matters for improving clinicians' professional wellbeing, and offer preliminary pathways for intervention.
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Affiliation(s)
| | | | | | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA
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van Zuylen ML, de Snoo-Trimp JC, Metselaar S, Dongelmans DA, Molewijk B. Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned. BMC Med Ethics 2023; 24:40. [PMID: 37291555 PMCID: PMC10249541 DOI: 10.1186/s12910-023-00919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. METHODS A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. RESULTS All 178 respondents (response rate: 25-32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to 'team cooperation', 'team solidarity' and 'work ethic'. Lessons learned were mostly related to 'quality of care' and 'professional qualities'. CONCLUSIONS Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals' dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. TRIAL REGISTRATION The trial was registered on The Netherlands Trial Register, number NL9177.
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Affiliation(s)
- Mark L. van Zuylen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Janine C. de Snoo-Trimp
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care, Amsterdam, UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Bert Molewijk
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
- Center of Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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De Luca E. Supporting ethical end-of-life care during pandemic: Palliative care team perspectives. Nurs Ethics 2023; 30:570-584. [PMID: 36730007 PMCID: PMC9899681 DOI: 10.1177/09697330231153684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. AIMS To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. RESEARCH DESIGN A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. PARTICIPANTS AND RESEARCH CONTEXT Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. ETHICAL CONSIDERATIONS The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. FINDINGS The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. CONCLUSIONS Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.
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Affiliation(s)
- Enrico De Luca
- Faculty of Health and Life Science, Academy of
Nursing, Exeter, Exeter University, Exeter, UK
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32
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Rushton CH, Swoboda SM, Reimer T, Boyce D, Hanson GC. The Mindful Ethical Practice and Resilience Academy: Sustainability of Impact. Am J Crit Care 2023; 32:184-194. [PMID: 37121900 DOI: 10.4037/ajcc2023236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Nurses face many ethical challenges, placing them at risk for moral distress and burnout and challenging their ability to provide safe, high-quality patient care. Little is known about the sustainability of interventions to address this problem. OBJECTIVE To determine the long-term impact on acute care nurses of a 6-session experiential educational program called the Mindful Ethical Practice and Resilience Academy (MEPRA). METHODS MEPRA includes facilitated discussion, role play, guided mindfulness and reflective practices, case studies, and high-fidelity simulation training to improve nurses' skills in mindfulness, resilience, and competence in confronting ethical challenges. A prospective, longitudinal study was conducted on the impact of the MEPRA curriculum at 2 hospitals in a large academic medical system. The study involved surveys of 245 nurses at baseline, immediately after the intervention, and 3 and 6 months after the intervention. RESULTS The results of the intervention were generally sustained for months afterward. The most robust improvements were in ethical confidence, moral competence, resilience, work engagement, mindfulness, emotional exhaustion, depression, and anger. Some outcomes were not improved immediately after the intervention but were significantly improved at 3 months, including anxiety and empathy. Depersonalization and turnover intentions were initially reduced, but these improvements were not sustained at 6 months. CONCLUSIONS Many MEPRA results were sustained at 3 and 6 months after conclusion of the initial foundational program. Some outcomes such as depersonalization and turnover intentions may benefit from boosters of the intervention or efforts to supplement the training by making organizational changes to the work environment.
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Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics at the Berman Institute of Bioethics and a professor of nursing and pediatrics, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Sandra M Swoboda
- Sandra M. Swoboda is the Department of Surgery research program coordinator and prelicensure master's entry program simulation coordinator/educator, Johns Hopkins University School of Medicine and School of Nursing, Baltimore, Maryland
| | - Teresa Reimer
- Teresa Reimer is a PhD student, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Danielle Boyce
- Danielle Boyce is an instructor, Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ginger C Hanson
- Ginger C. Hanson is an assistant professor at Johns Hopkins University School of Nursing, Baltimore, Maryland
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Afzal M, Hassan Rashid MAU, Fischer F. Beyond heroism: a qualitative study on the lived experiences of nurses caring for patients with COVID-19 in Pakistan. BMC Nurs 2023; 22:101. [PMID: 37024924 PMCID: PMC10077319 DOI: 10.1186/s12912-023-01279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Healthcare professionals around the globe suffered severely during the COVID-19 pandemic. The present study aims to explore the lived experiences of nurses caring for COVID-19 patients in Pakistan. METHODS The study is a qualitative exploration of the lived experiences caring for patients with COVID-19 in Pakistan. This research was conducted in two government hospitals there. Face-to-face in-depth interviews were conducted amongst 30 nurses who had been selected using purposive sampling technique. Thematic analysis was applied to extract the themes from respondents' answers. RESULTS By using thematic analysis, social response, impacts on physical and mental health, and experience of handling COVID-19 patients were extracted as major themes. CONCLUSIONS The findings of this research are of immense importance in showing the impact of COVID-19 on mental and physical health, along with the social and personal consequences for nurses providing care to COVID-19 patients.
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Affiliation(s)
- Mahreen Afzal
- Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Islamabad, Pakistan
| | | | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany.
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Özdemir RC, Işik MT. Intensive Care Nurses’ Fears about Returning to Work After Recovering from COVID-19: A Qualitative Study. Indian J Crit Care Med 2023. [DOI: 10.5005/jp-journals-10071-24430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Structural Equation Modelling of Professional Values and Competency of Nurses During the COVID-19 Pandemic. Collegian 2023. [PMCID: PMC10027944 DOI: 10.1016/j.colegn.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Background The COVID-19 pandemic is a global health crisis that affected nurses’ professional values and competence. Aim Our study examined the relationship between nurses’ professional values and competence in Saudi Arabia during the COVID-19 pandemic. Methods This study used a descriptive cross-sectional design with 748 nurses from Saudi Arabia. Two self-report instruments were used to collect data. Structural equation modelling was conducted to analyse the data. Findings The emerging model showed acceptable model fit indices. Two dimensions of nurse professional values significantly affected professional competence: professionalism and activism. Professionalism significantly affected the other four facets (e.g., caring, activism, trust, and justice) of nurse professional values. The dimension of caring had a strong, direct effect on activism. Justice had a moderate, direct impact on trust, while activism had a weak, direct impact on trust. Professionalism and caring had strong, indirect effects on professional competence by mediating the dimension of activism. Discussion The study’s findings highlight the need for strategies to evaluate and strengthen the various areas of professional values to foster professional competence among nurses. Moreover, nurse administrators should encourage nurses to participate in continuing nursing education programs or provide in-service educational training to promote professional values and competence. Conclusion This study provides a structural model of the interaction between nurses’ professional values and competence during the pandemic. Nurse administrators can leverage the presented model to develop policies and strategies to evaluate and strengthen nurses’ professional values and competence.
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McMillan K, Akoo C, Catigbe-Cates A. New Graduate Nurses Navigating Entry to Practice in the Covid-19 Pandemic. Can J Nurs Res 2023; 55:78-90. [PMID: 36635915 PMCID: PMC9843155 DOI: 10.1177/08445621221150946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic. PURPOSE To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession. METHODS Thorne's interpretive description method was utilized. FINDINGS All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession. CONCLUSIONS Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.
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Affiliation(s)
- Kim McMillan
- School of Nursing, University of Ottawa, Ottawa, ON, Canada,Kim McMillan, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada.
| | - Chaman Akoo
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Brysiewicz P, Chipps J. Out of Chaos Leaders Emerged. Nurs Clin North Am 2023; 58:87-96. [PMID: 36731962 PMCID: PMC9729585 DOI: 10.1016/j.cnur.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
COVID-19 had a major influence on nursing with the pandemic resulting in changes in the work environment while experiencing physical and emotional challenges such as moral distress, fear for self and family and dealing with the unknown. However, during this period, nurses demonstrated extraordinary resilience, crafted innovations in clinical practice, communication and support, providing leadership in the health service and in the nursing profession.
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Affiliation(s)
- Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, King George Mazisi Kunene Road, Glenwood, Durban 4041, South Africa.
| | - Jennifer Chipps
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, 14 Blanckenberg Road, Belville, Cape Town 7041, South Africa
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Alshawish E, Benbenishty J. Global Nurse Involvement in ethical decision-making during pandemics: a concept analysis. J Res Nurs 2023; 28:92-101. [PMID: 37152192 PMCID: PMC10140761 DOI: 10.1177/17449871231159612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background During pandemics, there are considerable ethical dilemmas. It is imperative that nurses are involved in ethical decision-making bringing nursing theory, practice and perspectives to better advocate for patients. In order to prepare nurses to be partners in ethical dilemma decision-making during pandemics, it is vital to understand the extent that nurses are involved in such decision-making during the COVID-19 pandemic. Aim The purpose of this concept analysis is to identify nurse involvement in ethical decision-making during pandemics. Method Concept analysis methodology based on literature searches used bibliographic databases: PubMed - 20 papers; Google Scholar - 8120 papers; EMBASE - 25 papers; Science Direct - 246 papers and hand searches. Results Nurse involvement in ethical decision-making during pandemics focused on nurses' physical and emotional stress, communication challenges, saturation and collapse of limited resources and allocation of scarce resources. Additional dilemmas included, changing nature of nurses' relationships with patients and families, questionable ethical equipoise preforming COVID-19 research, triage patient decisions receiving scarce resources, partner participation during labour and delivery and end-of-life decisions. Conclusion In order to protect and sustain nurses' well-being and competency, nurses should establish a framework for nurses' involvement in ethical policy development in emergencies, pandemics, education and preparedness and decision-making to be able to deal with public health emergencies.
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Affiliation(s)
- Eman Alshawish
- Assistant Professor, Faculty of Medicine and Health Sciences, An-Najah National University Palestine, Nabulus, Palestine
| | - Julie Benbenishty
- Julie Benbenishty, Nursing Administration, Hadassah Hebrew University Medical Center, Hadassah Hospital PO Box 12000 Ein Kerem Jerusalem 91120, Israel.
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Brewer KC, Horning MA, Walker MS, Ness MM. Analyzing the Effects of Family Presence and Visitation Restrictions During the COVID-19 Pandemic Among Nurse Leaders and Non-Nurse Leaders. J Nurs Adm 2023; 53:132-137. [PMID: 36753455 DOI: 10.1097/nna.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
AIM This analysis seeks to identify the effect of family presence and visitation during COVID-19 pandemic among nurses and nurse leaders. BACKGROUND Visitation restrictions were widespread during the initial months of the COVID-19 pandemic and were a potential source of distress for nurses. Few studies have examined sources of distress, such as visitation restrictions, among nurse leaders and non-nurse leaders. METHODS Secondary analysis was performed using a national survey of nurses conducted by the American Nurses Foundation. RESULTS More nurse leaders than nonleaders reported that nurses were involved in policy decisions/discussions and that visitation restrictions created additional burdens. There was similar level of agreement among nurse leaders and nonleaders that restrictions were not in the best interest of the patients. Many nurses reported the restrictions impacted their own well-being. CONCLUSION Visitation restrictions were a likely source of distress. Improvements to communication, planning, and transparency should be considered in preparation for future emergencies that may require visitation restrictions.
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Affiliation(s)
- Katherine C Brewer
- Author Affiliations: Assistant Professors, Department of Nursing, Towson University, Maryland
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Goktas S, Aktug C, Gezginci E. Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic. Nurs Crit Care 2023; 28:261-271. [PMID: 35821613 PMCID: PMC9350110 DOI: 10.1111/nicc.12820] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems. AIM The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID-19 pandemic. DESIGN Descriptive cross-sectional survey. METHODS A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines. RESULTS In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = -.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001). CONCLUSION The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage. RELEVANCE TO CLINICAL PRACTICE The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.
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Affiliation(s)
- Sonay Goktas
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cemile Aktug
- Faculty of Health Sciences, Department of Nursing, Gümüşhane University, Gumushane, Turkey
| | - Elif Gezginci
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
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Gustavsson ME, Juth N, Von Schreeb J, Arnberg FK. Moral Stress among Swedish Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study. SCANDINAVIAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2023. [DOI: 10.16993/sjwop.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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AH H. Nurses' ethical challenges when providing care in nursing homes during the COVID-19 pandemic. Nurs Ethics 2023; 30:32-45. [PMID: 36250534 PMCID: PMC9577762 DOI: 10.1177/09697330221105631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses' ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses' own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner.
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Affiliation(s)
- Hillestad AH
- Lovisenberg Diaconal University College, Oslo, Norway
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43
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Song MS, Park SS, Park S. Factors Influencing Frontline Screening Nurses' Depression as a Long-Term Impact of COVID-19. West J Nurs Res 2023; 45:554-561. [PMID: 36715305 PMCID: PMC9892809 DOI: 10.1177/01939459231152121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Frontline screening nurses experienced exhaustion and depressive symptoms as a long-term impact of COVID-19. This study aimed to explore fatigue, depression, and empowerment among frontline screening nurses and examine the factors influencing depression. This was a descriptive cross-sectional study. The study included 140 frontline screening nurses in South Korea recruited from February to March 2021. The measures included a fatigue scale, the Text of Items Measuring Empowerment (TIME), and the Center for Epidemiological Studies Depression Scale (CES-D). The STROBE checklist was used for reporting aspects of the cross-sectional design. Frontline screening nurses showed high fatigue scores (M = 3.47, SD = 0.55), and 55.7% (n = 78) of them were depressed and had low empowerment scores (M = 3.53, SD = 0.69). Empowerment and fatigue were predictors of depression. Increased empowerment and decreased fatigue were important in decreasing depression. Therefore, efforts to provide sufficient staffing, screening for depression, and listening to nurses' voices are necessary.
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Affiliation(s)
- Min-Sun Song
- College of Nursing, Konyang University, Daejeon, Republic of Korea
| | - Sung Suk Park
- Konyang University Hospital, Daejeon, Republic of Korea
| | - Soohyun Park
- Department of Nursing, Eulji University (Seongnam), Seongnam-si, Gyeonggi-do, Republic of Korea,Soohyun Park, Department of Nursing, Eulji University (Seongnam), 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do 13135, Republic of Korea.
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Ulrich CM, Deatrick JA, Wool J, Huang L, Berlinger N, Grady C. Ethical Challenges Experienced by Clinical Ethicists during COVID-19. AJOB Empir Bioeth 2023; 14:1-14. [PMID: 35994631 DOI: 10.1080/23294515.2022.2110965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Health care providers are exhausted, becoming ill themselves, and in some instances have died. Indeed, hospitals are struggling to find staff to care for critically ill patients most in need. Previous work has reported on the unending work-related conditions that hospital staff are laboring under and their subsequent mental and physical health strains. Health care providers need support, but it is not clear where that support is to come from. While much research has reported on the COVID-19-related fears of nurses and physicians, fewer studies have focused on supportive features of the hospital work environment and how it may provide relief to front-line health care providers. PURPOSE This purpose of this study was to explore an often-overlooked resource within hospital systems across the United States-clinical ethicists-and examine their many roles during COVID-19 and the types of ethical issues they addressed with nurses, physicians, administrators, and others. METHODS This was a primary analysis of semi-structured, qualitative interviews with 23 clinical ethicists across the United States. The interviews were conducted from November 2020-April 2021 and were audiotaped, transcribed verbatim, and de-identified; both inductive and deductive analyses were used to identify qualitative themes. RESULTS Five major themes were identified: ethical issues that were increasingly more complex, moral distress that was "endemic," shifting ethical paradigms from the focus on the individual to the population, fostering a supportive environment, and organizational ethics: variation in the value, roles, and policy input of clinical ethicists. CONCLUSIONS Our findings report on the integral and expanded role of clinical ethicists at an unprecedented time in our nation, and how they stepped forward to support front-line clinicians in hospitals across the country.
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Affiliation(s)
- Connie M Ulrich
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janet A Deatrick
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Jesse Wool
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,LaSalle University, Philadelphia, Pennsylvania, USA
| | - Liming Huang
- Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Christine Grady
- Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, US
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45
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Caring in the Context of Risk: Moving Beyond Duty. ANS Adv Nurs Sci 2023; 46:2-13. [PMID: 36165678 DOI: 10.1097/ans.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hospital-based nurses face many occupational risks. In the early days of the coronavirus disease-2019 (COVID-19) pandemic, questions were raised regarding nurses' responsibilities to provide care in the context of risk of exposure to this infectious disease. In the United States, these questions were answered relatively swiftly using a deontological framework. If nurses did not have access to appropriate personal protective equipment, they were not duty bound to provide nursing care to patients with a known infection. Another occupational risk hospital-based nurses face is exposure to patient violence. Questions about nurses' responsibilities to provide care in the context of this occupational risk have not been addressed. The purpose of this article is to examine these 2 occupational risks and ethical decision-making frameworks that can be used to answer questions about the provision of nursing care in the face of personal risk. While useful in the context of COVID-19, a duty-based framework seems insufficient to capture the contextual nuances and moral complexity of providing nursing care to hospitalized patients who exhibit violent behavior. Professional duties are explored as are other ethical frameworks. Ethics of the everyday, virtue ethics, and care ethics are introduced as additional perspectives that can help inform nurses' decision-making and actions when they are exposed to occupational risks such as patient violence and COVID-19.
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Rosa D, Bonetti L, Villa G, Allieri S, Baldrighi R, Elisei RF, Ripa P, Giannetta N, Amigoni C, Manara DF. Moral Distress of Intensive Care Nurses: A Phenomenological Qualitative Study Two Years after the First Wave of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192215057. [PMID: 36429775 PMCID: PMC9690457 DOI: 10.3390/ijerph192215057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has imposed great pressure on healthcare facilities, exposing healthcare professionals to various challenges that may result in the onset of moral distress, a condition of psychological distress caused by the inability to act as it would be most morally appropriate. The purpose of this research was to investigate the experience lived by nurses who worked in an intensive care unit during the COVID-19 pandemic. METHODS This is a phenomenological study using interpretative phenomenological analysis. Sixteen nurses who worked in the COVID-19 Intensive Care Unit of Northern Italian Hospitals from January to April 2022 were selected through purposive sampling. Data on experiences, thoughts, and symptoms were collected through semi-structured interviews with in-person and remote modalities. RESULTS Five themes and fourteen subthemes emerged from the study. The themes are: (1) pride, isolation, and fear; (2) teamwork and organisation; (3) moral/ethical aspect; (4) true heroes; and (5) dignity. CONCLUSIONS This study highlights the impact of the COVID-19 pandemic on intensive care unit nurses. It has emerged that the risk of moral distress is high among healthcare workers in the front line of the fight against the virus. This condition should be avoided and managed through early psychological interventions, sharing of experiences, and a good organization that supports decision-making and professional well-being.
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Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano-IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Centre, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Sara Allieri
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Riccardo Baldrighi
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Rolando Francesco Elisei
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy
| | - Paola Ripa
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy
| | - Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano-IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Tang X, Lu J, Chen Z, Liu C, Jiang X, Ning M. Influencing Factors of Patients' Trust in Nurses During the COVID-19 Pandemic: A Mixed-Methods Study. Disaster Med Public Health Prep 2022; 17:e302. [PMID: 36325834 PMCID: PMC9947035 DOI: 10.1017/dmp.2022.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to investigate the nurse-patient trust among in-patients in the context of the coronavirus disease (COVID-19) epidemic; it further analyzed the related influencing factors, which will provide a theoretical basis for developing corresponding measures. METHODS This study employed a mixed-method design and analyzed 149 patients at the Hongqi Hospital, affiliated with Mudanjiang Medical University, from December 2020 to February 2021. Quantitative analysis was carried out using the "Nurse Patient Trust Scale," and qualitative analysis was performed using a semi-structured interview with in-patients. RESULTS The average score on the scale was 46.65 ± 2.83, and the scores of the 2 dimensions were: 23.24 ± 1.51 for ability and peace of mind, and 23.32 ± 1.53 for attitude and care. According to the interview data, the factors included 3 aspects: a comfortable hospital environment and humane management measures; the nurse's own competence; and effective communication with patients. CONCLUSION During the COVID-19 epidemic, there are still many factors affecting patients' trust in nurses that can be addressed by taking different measures. All these factors must be considered by the relevant managers and clinical nursing staff to maintain a better nurse-patient trust relationship.
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Affiliation(s)
- Xiaolan Tang
- College of Nursing, Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, China
| | - Junhua Lu
- College of Nursing, Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, China
| | - Zhihui Chen
- Department of Emergency, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, China
| | - Chao Liu
- Department of General Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, China
| | - Xue Jiang
- Department of General Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, China
| | - Mei Ning
- Department of General Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, China
- Corresponding author: Mei Ning,
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Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes. Healthcare (Basel) 2022; 10:healthcare10102074. [PMID: 36292521 PMCID: PMC9602732 DOI: 10.3390/healthcare10102074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022] Open
Abstract
Moral distress is commonly experienced by nurses in all settings. This bears the risk of a reduced quality of care, burnout and withdrawal from the profession. One approach to the prevention and management of moral distress is ethical competence development in undergraduate nursing education. Profession-specific legal regulations function as a foundation for the decision on the educational content within these programmes. This theoretical article presents the extent to which legal regulations may open framework conditions that allow for the comprehensive preparation of prospective nurses to manage moral distress. The legal frameworks and the immediate responsibilities regarding their realisation in the context of undergraduate nursing education vary slightly for the three chosen examples of Switzerland, Austria and Germany. While an increased awareness of ethics’ education is represented within the nursing laws, no definite presumption can be made regarding whether undergraduate nursing students will be taught the ethical competencies required to manage moral distress. It remains up to the curriculum design, the schools of nursing and instructors to create an environment that allows for the realisation of corresponding learning content. For the future, the establishment of professional nursing associations may help to emphasise acutely relevant topics, including moral distress, in undergraduate nursing education.
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Miner SA, Berkman BE, Altiery de Jesus V, Jamal L, Grady C. Navigating Pandemic Moral Distress at Home and at Work: Frontline Workers' Experiences. AJOB Empir Bioeth 2022; 13:215-225. [PMID: 35472000 DOI: 10.1080/23294515.2022.2064000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: During the COVID-19 pandemic, frontline workers faced a series of challenges balancing family and work responsibilities. These challenges included making decisions about how to reduce COVID-19 exposure to their families while still carrying out their employment duties and caring for their children. We sought to understand how frontline workers made these decisions and how these decisions impacted their experiences.Methods: Between October 2020 and May 2021, we conducted 61 semi-structured interviews in English or Spanish, with individuals who continued to work outside of the home during the pandemic and had children living at home. Interviews were recorded, transcribed verbatim, and analyzed using abductive methods.Results: Frontline workers experienced moral distress, the inability to act in accordance with their values and obligations because of internal or external constraints. Their moral distress was a result of the tensions they felt as workers and parents, which sometimes led them to feel like they had to compromise on either or both responsibilities. Individuals felt morally conflicted because 1) their COVID-19 work exposures presented risk that often jeopardized their family's health; 2) their work hours often conflicted with their increased childcare responsibilities; and 3) they felt a duty to their colleagues, patients/customers, and communities to continue to show-up to work.Conclusions: Our findings point to a need to expand the concept of moral distress to include the perspectives of frontline workers outside of the healthcare professions and the fraught decisions that workers make outside of work that may impact their moral distress. Expanding the concept of moral distress also allows for a justice-based framing that can focus attention on the disparities inherent in much frontline work and can justify programmatic recommendations, like increasing paid childcare opportunities, to alleviate moral distress.
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Affiliation(s)
- S A Miner
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA.,Department of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - B E Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - V Altiery de Jesus
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA.,John Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - L Jamal
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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Yildirim D, Kocatepe V. Professional values and ethical sensitivities of nurses in COVID-19 pandemic. Nurs Forum 2022; 57:1111-1119. [PMID: 36075863 PMCID: PMC9538836 DOI: 10.1111/nuf.12797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nurses are facing several ethical problems like the safety of the nurses, patients, co-workers, and families, allocation of scarce resources, and the changing nature of the relationships of nurses with patients and families during the COVID-19 pandemic. These have caused nurses to have feelings such as stigmatization, fear, anger, anxiety, uncertainty, work-related strain, and burnout. Identifying nurses' ethical sensitivities and professional values are highly important to ensure that nurses are placed in the right decision-making position. This descriptive correlational study was carried out to evaluate the professional values and ethical sensitivities of nurses during the COVID-19 pandemic. METHODS A quantitative descriptive and correlational study was performed with 245 nurses in Turkey. The "personal information form," the "nurses professional values scale-revised (NPVS-R)," and the "moral sensitivity questionnaire (MSQ)" were employed for data collection. RESULTS The nurses' 52.7% reported facing an ethical dilemma. Also, 40.3% of the nurses who had an ethical dilemma during the pandemic failed to solve it. The mean NPVS-R scores of the nurses had statistically significant negative correlations with mean scores of the overall MSQ and its autonomy, benefit, integrative approach, and orientation subscales (p < .05). The nursing staff had high levels of professional values and moral sensitivities. CONCLUSION Professional value perceptions were enhanced, and moral sensitivities were improved. Age and professional experience were identified as factors that affected the professional value perceptions and moral sensitivities of the nurses. The results will form the basis for future studies and contribute to the resolution of ethical dilemmas experienced by nurses.
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Affiliation(s)
- Dilek Yildirim
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Vildan Kocatepe
- Department of Nursing, Faculty of Health Sciences, Izmir Demokrasi University, Izmir, Turkey
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