Impact of nurses' roles and burden on burnout during the COVID-19 pandemic: multicenter cross-sectional survey

The relationship between the COVID-19 burnout levels of nurses and their holistic nursing competence: a cross-sectional study

This cross-sectional study was carried out to determine the relationship between the COVID-19 burnout levels of nurses and their holistic nursing competence. The data were collected from 468 nurses working in a hospital between 1 August 2021-9 September 2021 by using a Sociodemographic Information Form, the COVID-19 Burnout Scale(BCV-19S), the Holistic Nursing Competence Scale(HNCS). The mean scores on the total BCV-19S and HNCS were 36.36(9.51) and 194.27(35.71),respectively. It was found that the mean score on the total BCV-19S was significantly higher in nurses worked ≥ 51 hours a week on average, worked in the COVID-19 pandemic unit (p < 0.05). The mean score of nurses who worked ≤ 40 hours a week on average on the total HNCS was significantly higher (p < 0.05). In this study, it was determined that nurses' COVID-19 burnout levels and holistic nursing competence were high. Nurses' COVID-19 burnout levels positively affected their holistic nursing competence.

Comparison of Fixed Dosing vs Train of Four Titration of Cisatracurium in COVID-19 ARDS Patients

Background: Early neuromuscular blockade with cisatracurium has been associated with improved outcomes in moderate-severe acute respiratory distress syndrome (ARDS). Previous studies have demonstrated increased drug utilization without benefits in oxygenation using fixed dose cisatracurium compared to train-of-four (TOF) titration. Objective: We sought to compare a novel, lower fixed dose cisatracurium protocol to TOF titration evaluating the impact on PaO2:FiO2 ratio (P/F). Methods: We conducted a single-center retrospective cohort study comparing fixed dose cisatracurium to TOF titration. We included patients aged 18-89 treated for COVID-19 ARDS with a baseline P/F≤200 who received a cisatracurium infusion for ≥12 h. The primary outcome was change in P/F at 48 h from baseline. Secondary outcomes included change in P/F at 24 h and 7 days, need for mechanical ventilation at day 28, and cisatracurium utilization. Results: Analyses included 125 patients (fixed dose = 65, TOF = 60). Severe ARDS was common with a baseline median P/F of 73.7 vs 79.5, P = .133. The change in P/F at 48 h was larger in the TOF cohort in the adjusted analysis (24.9 vs 70.8, P < .005). The rate and total cumulative dose of cisatracurium were higher in the fixed dose cohort (5 vs 3 mcg/kg/min, P < .001; 1034 vs 612 mg, P < .001) despite similar infusion durations (44.1 h vs 48.5 h, P = .642). Conclusions: Patients in the TOF cisatracurium cohort had improved P/F at 48 h compared to the fixed dose cohort, while also using only 60% of the cumulative dose. Future directions should include analysis of the implications of increased cisatracurium exposure on patient outcomes.

Nurses' Experiences of the Caring Role during the COVID-19 Pandemic: A Scoping Review of Qualitative Research

Aims

To synthesize the evidence on nurses' experiences of their caring role during the COVID-19 pandemic and identify emerging concepts that have affected nurses within the caring role in relation to (a) their professional lives and (b) their personal lives.

Background

The concept of caring is central to the science and art of nursing practice, and fulfilment of the caring role is fundamental to the profession. The COVID-19 pandemic imposed unprecedented change globally transforming the caring role of the nurse. The WHO highlights that a well-supported workforce is paramount to emergency preparedness; therefore, understanding the experiences of the nurse's caring role during the COVID-19 crisis is paramount to practice in future healthcare crises.

Methods

A scoping review. Data Sources. Studies published between January 2020 and November 2023 were identified from the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Coronavirus Database, PUBMED, PsycINFO, PsycArticles, Scopus, Web of Science, and SocINDEX. Reporting Method. The scoping review adhered to the Joanna Briggs Institute (JBI) Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) checklist.

Results

The search identified 1,347 studies, subsequent review of title and abstract, resulted in 117 full-text papers for further eligibility screening, with a total of 52 studies being included in the scoping review. Findings were grouped thematically using the Braun and Clarke (2006) approach. The five distinctive themes that emerged were (a) emotional turmoil, (b) erosion of care, (c) relationships and solidarity, (d) expansion of role, and (e) professional growth.

Conclusion

During the COVID-19 pandemic, there was an evolutionary shift in the caring role of the nurse, on a trajectory from emotional turmoil to professional growth. The process followed a theoretical framework of transformative learning that could support nurses' capability and preparedness in their caring role for future inevitable extreme events and crisis in healthcare. Implications for Nursing Management. Mapping current knowledge of the unprecedented COVID-19 crisis from a nurse's professional and personal perspective purposefully aims to highlight gaps for future research, education, and policy and is paramount to emergency preparedness and a well-supported workforce in future healthcare crisis.

Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic

This is a qualitative phenomenological study that was designed to navigate through nurses' lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses' lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses' eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

The association between workload and quality of work life of nurses taking care of patients with COVID-19

BACKGROUND

The COVID-19 epidemic has brought significant changes and complexities to nurses' working conditions. Given the crucial role of health workers, particularly nurses, in providing healthcare services, it is essential to determine the nurses' workload, and its association with the quality of work life (QWL) during COVID-19 epidemic, and to explain the factors predicting their QWL.

METHODS

A total of 250 nurses, who provided care for patients with COVID-19 in Imam Hossein Hospital of Shahrud, and met the inclusion criteria, were considered the samples in the present cross-sectional study in 2021-2022. Data were collected using the demographic questionnaire, NASA Task Load Index (TLX), and Walton's QWL questionnaire, which were analyzed using SPSS26 and based on descriptive and inferential statistical tests. A p-value less than 0.05 was considered significant for all cases.

RESULTS

The nurses' mean scores of workload and QWL were 71.43 ± 14.15 and 88.26 ± 19.5, respectively. Pearson's correlation test indicated a significant inverse relationship between workload and QWL (r=-0.308, p < 0.001). The subscales with the highest perceived workload scores were physical demand and mental demand (14.82 ± 8.27; 14.36 ± 7.43), respectively, and the subscale with the lowest workload was overall performance (6.63 ± 6.31). The subscales with the highest scores for QWL were safety and health in working conditions and opportunity to use and develop human capabilities (15.46 ± 4.11; 14.52 ± 3.84), respectively. The subscales with the lowest scores were adequate and fair compensation, work and total living space (7.46 ± 2.38; 6.52 ± 2.47), respectively. The number of children (β = 4.61, p = 0.004), work experience (β= -0.54, p = 0.019), effort (β = 0.37, p = 0.033) and total workload (β= -0.44, p = 0.000) explained 13% of the variance of nurses' QWL.

CONCLUSIONS

The study's findings showed that a higher workload score is associated with nurses' lower perception of QWL. In order to improve the QWL of nurses, reducing the physical and mental demands of their workload and strengthening overall performance is necessary. Additionally, when promoting QWL, adequate and fair compensation and the work and living space should be considered. The researchers suggest that hospital managers should make more significant efforts to develop and promote the QWL of nurses. To achieve this goal, organizations can pay attention to other influential factors, primarily by increasing organizational support.

Managing health care under heavy stress: Effects of the COVID-19 pandemic on care unit managers' ability to support the nurses-A mixed-methods approach

AIM(S)

This study aims to investigate care unit managers' perceptions of how the COVID-19 pandemic influenced their ability to support the nurses.

BACKGROUND

The COVID-19 pandemic placed extreme pressure on health care organizations. More knowledge regarding how the pandemic influenced care unit managers' ability to support nurses is central to ensuring high-quality health care in future crises.

METHOD(S)

A mixed-methods study in Swedish hospitals with a survey (n = 128) and interviews (n = 20) with care unit managers.

RESULTS

Approximately half of the managers reported having spent more time available to and supporting the nurses. Availability was positively predicted by their perceived organizational support while negatively by their job demands. These job demands concerned meeting staff anxiety and managing organizational restructuring. Full focus on direct patient care and strong professional and social support were important job resources.

CONCLUSION(S)

For care unit managers to effectively support the nurses during a crisis, they need proficient job resources and moderate job demands. Managers' perceived organizational support positively affects the quality of their crisis leadership. Creating arenas in which staff collegiality can form and develop is beneficial for the ability to meet future crises.

IMPLICATIONS FOR NURSING MANAGEMENT

This study specifies important job resources that should be acknowledged and reinforced to strengthen the ability of care unit managers to actively support the nurses during a crisis.

The moderating effect of burnout on professionalism, values, and competence of nurses in Saudi Arabia amidst the COVID-19 pandemic: A structural equation modeling approach

Aim

To examine the moderating effect of burnout on the relationship between nurses' competence, professional competence and professional values.

Background

There is a preponderance of burnout studies of nurses before and during the COVID‐19 pandemic. However, little is known about burnout's moderating influence on nurses' professionalism, competence and values during the ongoing pandemic.

Methods

This study used a correlational, cross‐sectional design and convenience sampling to recruit 809 Saudi nurses employed in four government hospitals. Four self‐report instruments were used to collect data from August 2021 to March 2022. Spearman Rho, structural equation modelling and multi‐group moderation analysis were used to analyse the data.

Results

Most of the participants had high burnout. There was a moderate to high correlation between the dimensions of professional competence, nurse professional values, burnout and nurse competence. Both professional competence and nurse professional values significantly affected nurse competence. Nurse professional values also had a direct effect on professional competence. Professional competence and nurse professional values on nurse competence may vary among those with low, moderate and high levels of burnout, suggesting the moderating effect of burnout.

Conclusions

The positive impacts of nurse professional values and professional competence on nursing competence were validated in this study, as was the evidence of burnout's moderating effect on the studied connections. To avoid burnout, it is necessary to increase organizational knowledge and support for nurses, their working conditions and the environment through strategies that promote well‐being and empowerment.

Implications for nursing management

Nurse managers can implement policies to help nurses minimize burnout and improve their professional values and competence. Management policies may be considered include increased staffing, opportunities to improve technical abilities through education and vocational training programs, and increased diversity of job assignments.

Burnout and Nursing Care: A Concept Paper

Burnout comprises a series of undetermined physical and psychosocial symptoms caused by an excessive energy requirement at work-it is a crisis in relationships with work itself and not necessarily a concern with underlying clinical disorders related to workers. Professions involving human interactions commonly involve emotional engagement, especially when the cared-for person needs assistance and support, as is the primary concern in the nursing profession. To some extent, the acknowledgment of the phenomena of burnout and how it affects people is sometimes addressed from a biomedical perspective. This concept paper aims to describe the burnout concept and reflect on the impact on nurses. Our intention with this reflection, considering the burnout impact on nurses, is to support a paradigm change in the prevention and management of burnout in healthcare contexts, promoting and fostering the well-being of nurses.