Global emotional and spiritual well-being and resilience of Advanced Practice Nurses during the COVID-19 pandemic: A cross-sectional study

Hardship, coping, and joy: ACPs' experiences of working through the COVID-19 pandemic

PURPOSE

This paper reports Advanced Clinical Practitioners' (ACPs) experiences of working in the United Kingdom during the COVID-19 pandemic, specifically the factors that impacted their mental, emotional, and physical wellbeing.

METHODS

The study presents qualitative data collected via two surveys in 2020 and 2021. Several survey questions elicited free-text responses, including a specific request for narratives. Narrative responses were thematically analysed and cross-referenced with non-narrative qualitative responses.

RESULTS

Three factors contributed to poor wellbeing: a changing work environment and expectations; bearing witness to the impact of Covid on patients; and the risk of catching and spreading Covid. Three factors improved wellbeing, whether through mitigating these challenges or directly, in the absence of specific hardship. These factors were new working practices; support structures; and individual resilience and self-managed coping strategies.

CONCLUSION

This study expands research on professionals' experiences of working through Covid to the under-researched experience of ACPs and demonstrates the intersecting and overlapping nature of factors contributing to poor and positive wellbeing. There are significant implications for stakeholders who need to consider the impact of future pandemics and opportunities for supporting and promoting wellbeing post-pandemic. The analysis also highlights the rich narrative data that can be collected using surveys.

The relationships among nurses' spiritual health, sleep quality, and stress and the factors influencing stress during the late global COVID-19 pandemic: A cross- sectional study

BACKGROUND

COVID-19 has had a significant impact on healthcare workers. Although several studies have looked at the pandemic's physical and mental effects on nurses, little has been done to investigate their spiritual health and its relationship to stress and sleep quality during the late pandemic.

PURPOSE

This study sought to fill a knowledge gap in the literature about the relationships between nurses' reported stress, sleep quality, and spiritual health during the late COVID-19 epidemic.

METHODS

A cross-sectional study using purposive sampling was performed out in a medical center in Taiwan. A total of 376 nurses participated. The Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Spiritual Health Scale-Short Form were used for assessing nurses' stress levels, sleep quality, and spiritual health.

RESULTS

The results showed that the mean perceived stress score was 1.80 ± 0.50 (out of 4), the sleep quality score was 8.17 ± 3.29 (out of 21), and the mean spiritual health score was 3.66 ± 0.59 points (out of 5). Although 77.1% of the nurses in this study experienced sleep disorders (PSQI > 5), they had better sleep quality during the COVID-19 pandemic than those in other countries. Perceived stress, sleep quality, and spiritual health were significantly correlated. Nurses with support from their friends and family and hospital during the COVID-19 pandemic had lower perceived stress and higher sleep quality and spiritual health scores than their peers (p < .05). Age, work experience, sleep quality, and spiritual health were predictors of perceived stress in nurses during the late COVID-19 pandemic (F = 20.19, p < .001) and could explain 30.6% of the variation.

CONCLUSIONS

Spiritual health is correlated with the nurses' stress levels. Despite providing extrinsic support, we encourage nursing management to pay attention to nurses' spiritual needs and implement psychological education programs to help frontline nurses navigate ever-changing and discerning healthcare environments.

Factors associated with resilience, spiritual and mental well-being of advanced practice nurses: Implications for role integration

AIM(S)

To examine the overall level of resilience and spiritual and mental well-being of advanced practice nurses (APN) in Singapore and to describe the associated factors of mental well-being.

BACKGROUND

Research shows that healthcare workers' resilience and mental well-being are positively associated with spiritual well-being, which encompasses a sense of peace and meaning. Understanding APNs' spiritual and mental health, alongside resilience, may help maintain the sustainability and effectiveness of the APN workforce within the healthcare system, especially in the post-pandemic environment.

METHODS

This nationwide cross-sectional online survey (May-June 2023) assessed APNs' resilience and spiritual and mental well-being. The Connor-Davidson Resilience 10 Scale, the Warwick-Edinburgh Mental Well-Being Scale, and the Functional Assessment of Chronic Illness Therapy-2-Factor Non-Illness Spiritual Well-Being Scale Version 4 were used. Sociodemographic and work-related information were collected to explore associations between participants' characteristics and their level of resilience and spiritual and mental well-being.

RESULTS

Eighty-two APNs and APN interns participated in the study, representing 21.4% nationwide. Participants' level of resilience, peace and meaning components of spirituality, and whether they worked in an acute care setting, were statistically significant predictors of APNs' mental well-being. APNs working in acute care hospitals had higher levels of mental well-being than other healthcare settings.

CONCLUSION

The significant roles of the Peace and Meaning subscales of spiritual well-being underscore the importance of fostering supportive work environments. Supportive work environments can foster peace and meaning by facilitating the integration of APN roles and nurturing a sense of purpose and connection within their professional practice.

IMPLICATIONS FOR NURSING

Effective APN integration into the healthcare system, crucial for their mental well-being, requires addressing macro-, meso- and micro-level issues. At the macro level, clear scopes of practice and legislative support can provide stability and purpose, fostering peace of mind. Meso-level strategies, such as collaborative practice models, can cultivate a sense of connection and shared meaning within teams. Micro-level strategies, including professional development, mentorship and supportive work environment, can nurture reflective practice and personal growth, further enhancing APNs' spiritual well-being through a sense of peace and meaning. These strategies collectively strengthen APNs' professional identity, job satisfaction and mental well-being, leading to better patient outcomes and a more resilient healthcare workforce.

Advanced Clinical Practitioners' Resilience and Emotional and Spiritual Well-Being During COVID-19

Aim: This study investigated the impact of the COVID-19 pandemic on the emotional and spiritual well-being and the resilience of advanced clinical practitioners in the United Kingdom. Background: Advanced clinical practitioners are experienced healthcare professionals educated to a master's level who demonstrate expertise, professional judgment, and autonomy across four pillars of advanced practice. Normally, in nursing and the allied health professions, advanced clinical practitioners provide clinical leadership and improve clinical continuity by providing high-quality care to patients through complex decision-making and managing risk. The role contributes to workforce transformation enabling organizations to meet changing population, patient, and service delivery needs. Advanced clinical practitioners' well-being and resilience were particularly at risk during the pandemic due to the increased workload, moral distress, redeployment into other clinical areas, and isolation. Phase 1 of this study identified that advanced clinical practitioners had worryingly low levels of well-being and resilience during the first 6 months of the pandemic. This paper reports Phase 2' findings 1 year into the pandemic. Method: Three hundred and seventy-one respondents completed an online survey comprising three validated scales assessing resilience and emotional and spiritual well-being. Results: One year into the pandemic, advanced clinical practitioners reported a continued decline in their well-being, with average scores on this measure being 12 percent lower compared to prepandemic levels Differences also emerged in the scores of advanced clinical practitioners practicing in primary and secondary care services. Conclusion: Our findings showed the ongoing deleterious impact of the pandemic on the well-being and resilience of advanced clinical practitioners. As the attention of healthcare leaders shifts to the delivery of services post-COVID-19, the longer-term impact of the pandemic on the mental health and well-being of the workforce, alongside the ongoing workforce crisis in the UK and globally, means the well-being and resilience of advanced clinical practitioners need urgent addressing if these role holders are to continue to lead patient care, workforce transformation, and service innovation. Tailored interventions to support advanced clinical practitioners appear necessary to prevent significant workforce impact including absenteeism, long-term stress, sickness absence, and loss to the healthcare workforce.

Advanced nurse practitioner well-being: A 4-year cohort mixed methods study

AIMS

To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period.

DESIGN

Longitudinal Cohort study.

METHODS

Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic.

RESULTS

Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.

CONCLUSION

The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.

IMPACT

This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.

PATIENT OR PUBLIC CONTRIBUTION

None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.

Text messaging support to enhance nurses' well-being and connectedness

ABSTRACT

Nurses face numerous stressors due to increasing patient acuity, challenging staffing ratios, and trauma from the COVID-19 pandemic, among many other factors. To help improve nurses' daily self-care, nurses need diverse tools and interventions, such as peer support through text messaging (TM). This article evaluates the benefits of TM and strategies to use TM in providing effective peer support among nurses.

Nurses' perspectives on professional self-concept and its influencing factors: A qualitative study

BACKGROUND

Nurses with a strong professional self-concept tend to exhibit a positive mindset and strong work engagement, delivering high-quality patient care. Although numerous quantitative studies have examined the factors impacting professional self-concept, there remains a limited exploration of these factors from the perspective of nurses themselves.

METHODS

This qualitative descriptive study uses the PERMA theory and Social Cognitive Theory as the theoretical framework. Semi-structured interviews were conducted with 15 nurses from six public hospitals in China. The data were analyzed thematically using a combination of inductive and deductive approaches.

RESULTS

Nurses' understanding of professional self-concept could be divided into four categories: professional identity, competence, care, and knowledge. Factors influencing nurses' professional self-concept were categorized into eight subthemes in three domains: (1) personal factors, including psychological qualities and attitude towards the nursing profession; (2) occupational-related behavioral factors, including role-oriented behavior and knowledge-oriented behavior; and (3) work environment and external factors, including external evaluation and perceptions of nurses, time allocation, nursing work tasks, work atmosphere, school education, and perceived supports.

CONCLUSIONS

This study found that, although nurses had different personal experiences, their perceptions of professional self-concept were similar. Nurses' professional self-concept is a multidimensional concept and involves various factors, such as personality, work-related characteristics, environment, and family. To thrive in a nursing career, nurses must discern the factors that can enhance or hinder their professional self-concept. By identifying and adjusting these factors, personalized support and positive interventions can be tailored to meet nurses' specific needs, which ultimately nurtures their professional development.

TRIAL REGISTRATION

This study was registered on December 14, 2022, in the Chinese Clinical Trial Registry (ChiCTR2200066699) as part of our ongoing study.

The well-being of nurses working in general practice during the COVID-19 pandemic: A qualitative study (The GenCo Study)

AIM

Exploration of experiences of nurses working in general practice during the COVID-19 pandemic to evaluate the impact on nurses' professional well-being.

DESIGN

An exploratory qualitative study comprised of case studies of three general practice sites in England and a nationwide interview study of nurses working in general practice and nurse leaders. The study was funded by The General Nursing Council for England and Wales Trust. University of York ethics approval (HSRGC/2021/458/I) and Health Research Authority approval was obtained (IRAS: 30353, Protocol number: R23982, Ref 21/HRA/5132, CPMS: 51834).

METHODS

Forty participants took part. Case site data consisted of interviews/focus groups and national data consisted of semi-structured interviews. Data collection took place between April and August 2022. Analysis was underpinned by West et al.'s The courage of compassion. Supporting nurses and midwives to deliver high-quality care, The King's fund, 2020 ABC framework of nurses' core work well-being needs.

FINDINGS

The majority of participants experienced challenges to their professional well-being contributed to by lack of recognition, feeling undervalued and lack of involvement in higher-level decision-making. Some participants displayed burnout and stress. Structural and cultural issues contributed to this and many experiences pre-dated, but were exacerbated by, the COVID-19 pandemic.

CONCLUSIONS

By mapping findings to the ABC framework, we highlight the impact of the COVID-19 pandemic on the well-being of nurses working in general practice and contributing workplace factors. The issues identified have implications for retention and for the future of nursing in general practice. The study highlights how this professional group can be supported in the future.

IMPACT

The study contributes to our understanding of the experiences of nurses working in general practice during the COVID-19 pandemic and beyond. Findings have implications for this skilled and experienced workforce, for retention of nurses in general practice, the sustainability of the profession more broadly and care quality and patient safety.

REPORTING METHOD

Standards for Reporting Qualitative Research (O'Brien et al. in Journal of the Association of American Medical Colleges, 89(9), 1245-1251, 2014).

PATIENT OR PUBLIC CONTRIBUTION

As this was a workforce study there was no patient or public contribution.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (β = -.29) and indirect negative effects (β = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Supporting Advanced Practice Fellowship During COVID-19

With the aging population and increasing number of cancer survivors contributing to a projected provider shortage, one solution is the specialization of nurse practitioners and physician assistants (part of the advanced practice provider [APP] workforce) in oncology. However, a lack of preparation in caring for the patient with cancer has led to burnout and stress in these groups. The authors studied an APP fellowship program to describe resilience, stress, and compassion in a transition-to-practice program and explore the experience of intentional, facilitated conversations. During 2019 and 2020, 18 APP fellows at a large, academic comprehensive cancer center participated in this descriptive study. The fellowship started in-person but changed to a virtual setting due to the COVID-19 pandemic. Resilience was measured through the Connor Davidson Resilience Scale 10, the Perceived Stress Scale, and the Professional Quality of Life Scale at four points in time: baseline, 6 months, 12 months, and 18 months. The experience of intentional, facilitated conversations was captured through simple theme collection as part of a standard program evaluation. Resilience, perceived stress, and compassion showed no statistical significance over the course of the fellowship. Evaluations of an intentional, facilitated conversation program found focal areas that included challenges, fatigue, empathy, relationships, role, self-awareness, and self-care. Despite the challenges of the pandemic on the health-care provider, the retention rate of APPs remained steady during the fellowship. The findings from this study suggested there was a benefit in an oncology fellowship for advanced practice and that intentional, facilitated conversations provide reflection and support during this experience.

Spiritual Well-Being, Depression, Anxiety, and Stress in Indonesian Muslim Communities During COVID-19

Purpose

This study investigated how spirituality as a defensive factor of psychological well-being reduces anxiety among Indonesian Muslims during the pandemic COVID-19.

Patients and Methods

Data were collected from 538 Indonesian Muslims through a survey using the spiritual well-being and depression, anxiety and stress (DAS-21) and examined using structural equation model (SEM) analysis.

Results

The empirical results indicate that spirituality is a factor that increases happiness, psychological well-being and mental health among Indonesian Muslims.

Conclusion

The study also concluded that spirituality positively and significantly reduces anxiety, depression, and stress. This finding confirms that the spiritual beliefs of Indonesian Muslims can play a significant role in improving mental health during pandemic. This study can control mental illness based on spirituality theory and practice.