An integrative review of factors and interventions affecting the well-being and safety of nurses during a global pandemic

Exploring Registered Nurses' Experiences of Workplace Adversity: A Descriptive Qualitative Study

AIM

To explore registered nurses' firsthand experiences of workplace adversity.

DESIGN

A qualitative exploratory, descriptive study.

METHODS

Data were collected from July to September 2022 using semi-structured interviews. A purposive sample of seven registered nurses from New Zealand was used. Data were analysed using Braun and Clarke's six-step thematic analysis.

RESULTS

Four themes emerged: (1) manifestations of workplace adversity, (2) professional identity and resilience, (3) coping and resilience in workplace adversity and (4) nature and characteristics of support. This study highlights the multifaceted nature of workplace adversity for nurses, impacting their physical, psychological and emotional well-being and performance, and beyond the workplace, spilling over to their personal lives. However, nurses demonstrated resilience, drawing on past experiences and professional identity to cope. While professional development opportunities fostered growth, a supportive work environment emerged as crucial. This work environment should value diverse experiences, promote positive role models and prioritise ethical practices alongside career advancement.

CONCLUSION

Nurses are greatly affected by various aspects of workplace adversity. Cultivating professional identity and resilience may help counter the negative effects of workplace adversity. Further research is necessary to identify organisational-level strategies to decrease workplace adversity.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare organisations must prioritise safe and supportive work environments for nurses.

IMPACT

The purpose of this research was to explore the problem of workplace adversity nurses face. Despite valuing professional identity, psychological resilience and coping mechanisms, participating registered nurses find it difficult to overcome the adverse effects of workplace adversity due to mounting demands. The results of this study are relevant when formulating policies, strategies, and programmes that can benefit nurses, healthcare institutions and patients globally.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research was used.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. Participants were not involved in the design or conduct of the study.

The impact of COVID-19 during the first two years: Giving voice to pediatric nurses

PURPOSE

The purpose of this study was to describe the experiences of pediatric nurses providing direct care in a variety of settings during the first two years of the COVID-19 pandemic.

DESIGN AND METHODS

This was a qualitative descriptive study. Donabedian's Quality Framework for the Evaluation of Healthcare was used to guide the design. Purposive sampling was used to recruit 24 direct care nurses from inpatient and outpatient settings within one healthcare system. Semi-structured, audio-recorded interviews were conducted in-person or via a virtual platform from November 2021 through March 2022.

RESULTS

Four major themes were determined across all settings and included: 1) adapting to continuous change, 2) needing effective communication, 3) triggering moral distress, and 4) searching for relief. Fifteen subthemes emerged from the major themes.

CONCLUSIONS

The impact of the COVID-19 pandemic on pediatric nurses has been profound. Given the opportunity, pediatric nurses clearly articulated the personal and professional challenges they faced throughout the pandemic, how they navigated them, and how they hope healthcare systems will handle crises in the future.

PRACTICE IMPLICATIONS

The future of pediatric nursing depends on the engagement and support for direct care nurses to practice their profession and meet the needs of both patients and families. Leaders and nurses working together are integral to this future. Nurses want leaders to be present and listen, to value their opinions and to engage them in decision-making that impacts their practice. They need leaders at all levels to understand their work environment and to advocate and support their mental health through readily available resources.

The Effects of the Physical and Professional Workplace Environments on the Well-Being of Nursing Staff

BACKGROUND

Nursing services are often compromised by excessive stress, burnout, and low job satisfaction. These experiences can cause nurses to leave jobs or the profession entirely, exacerbating staffing deficiencies that can have deleterious consequences for patient care.

PURPOSE

The aim of this study was to determine which aspects of the physical and social hospital environments might be related to nurses' well-being. Identifying factors and intervening in areas that could reduce staff stress and burnout or improve job satisfaction could help combat nursing staff turnover and improve patient outcomes.

METHODS

A total of 2,115 nurses at one tertiary health care campus were anonymously surveyed using Qualtrics. Of these, 393 returned their surveys and provided informed consent. Outcome measures included overall psychological stress, burnout, job satisfaction, and job stress. Data were analyzed using SPSS Statistics software.

RESULTS

Nurses' appreciation of the physical workplace environment was strongly associated with a positive perception of outcome measures, notably job satisfaction. There was a strong correlation between all outcome measures and nurses' perception of control over their practice, independent of their perception of their physical environment.

CONCLUSION

This study supports the idea that improvements in nurses' physical working environment can improve nursing staff well-being and job satisfaction. Notably, interventions that are designed to make it easier for nurses to perform their duties may have a positive impact on their well-being. In workplace environments, these include improving orientation, reducing excessive noise, and facilitating increased control over nursing practice by and for nursing staff.

Answering the call: Experiences of nurses of color during COVID-19

In the years following the COVID-19 pandemic, issues such as high job demands, burnout, and turnover continue to influence the nursing workforce, with heavier impacts to marginalized groups. Understanding the work and life contexts of nurses of color can help guide strategies for workplace equity and meaningful support. This qualitative study explored the experiences of nurses of color in the United States during the pandemic, focusing on feelings about the profession and job decisions. The overarching theme was "answering the call," with subthemes of "COVID shone a light," "being consumed by COVID," and "is it worth it?" Participants shared how their racial identities shaped their perceptions and job decisions in positive and negative ways, noting how racism impacted many facets of their work and added to the stressors felt in the workplace and the community. Findings provide insight into the underrepresented perspectives of nurses of color and suggest strategies to eliminate racism in nursing.

Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study

AIM

To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care.

DESIGN

A qualitative descriptive study design was used.

METHODS

A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis.

FINDINGS

Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care.

CONCLUSIONS

The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk.

IMPACT

Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Covid-19 pandemic? Mental health implications among nurses and Proposed interventions

Background

With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times.

Objectives

Review the current literature on mental health problems among nurses caring for COVID-19 patients.

Methods

This is a narrative review and critical evaluation of relevant publications.

Results

Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support.

Conclusions

Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.

Toxic Leadership in Emergency Nurses: Assessing Abusive Supervision and Its Team-Level Impacts on Conflict Management and Organizational Commitment

Background

Emergency departments suffer from authoritarian and manipulative leadership styles that affect team dynamics, emotional exhaustion, and quality patient care. However, little research specifically explores these toxic leadership effects on conflict management and nurses' organizational commitment.

Objectives

This cross-sectional study aimed to assess the correlations between perceived toxic leadership, conflict resolution strategies, and commitment dimensions among emergency nurses while evaluating conflict tendencies as a mediating mechanism.

Methods

A cross-sectional design that included multiple regression and mediation analyses was utilized. The sample consisted of 387 emergency nurses from five major Saudi hospitals surveyed using validated scales that measure perceived toxic leadership, conflict styles, and organizational commitment.

Results

High prevalence rates for perceived authoritarian (77%), narcissistic (75%), and unpredictable (63%) leadership were reported. Increased toxicity was positively related to dominating and avoiding conflict styles but negatively related to integrating and compromising strategies. Toxic leadership is also associated with lower affective/normative commitment but higher continuance commitment. Conflict management partially mediated the leadership-commitment relationship, which explained 29% of the total effect. Finally, higher experience and education predicted greater perceived toxicity.

Conclusions

The significant correlations between destructive leadership, adverse conflict, and reduced commitment in emergency nurses underscore the need for context-specific leadership training. Fostering supportive environments through multifaceted interventions can counteract toxicity impacts, impart constructive communication techniques, improve nurse well-being, and ensure high-quality patient care. As conflict tendencies and nurse characteristics influence susceptibility to detrimental leadership, tailored programs addressing experience levels are vital.

Listen to the voices of nurses: the role of community chief nurses and registered nurses in the provision of care for older people in Sweden during the COVID-19 pandemic - a cross-sectional study

BACKGROUND

During the pandemic in Sweden, the aim was to protect older people, especially those among them who were sick, frail and vulnerable in residential care facilities. A ban was put on visits at all residential care facilities in March 2020 to prevent the spread of infection among the older people. This study aims to describe the experiences of Community Chief Nurses and Registered Nurses who provided medical and nursing care for older people in residential care facilities and home care during the first wave of the COVID-19 pandemic, and to examine factors associated with the quality of care.

METHODS

The study has a mixed method cross-sectional design (STROBE). Data were collected using a web-based survey that comprised two questionnaires, for Community Chief Nurses and Registered Nurses developed for the study. Data were analysed using descriptive statistics and logistic regression models, as well as qualitative content analyses.

RESULTS

The majority of Community Chief Nurses reported adequate opportunities to work with management to handle the COVID-19 pandemic. The Registered Nurses reported that the quality of care, as well as the person's safety, was negatively affected during the pandemic. Factors associated with good care were as follows: information-sharing; ability to comply with hygiene practices; competence in how to care for older persons with COVID-19; a physician at bedside assessing their health; and support from frontline managers.

CONCLUSION

The study highlights crucial facets that care organizations must address to enhance their readiness for future pandemics or disasters, ensuring the security and well-being of the older people.