Exploring the challenges of Iranian government hospitals related to Covid-19 pandemic management: a qualitative content analysis research from the nurses perspective

Post-COVID-19 pandemic lived experiences of nurses about evidence-based care: A phenomenological study

BACKGROUND

During the COVID-19 pandemic, nursing care was very complicated and confusing due to the special conditions of this time period and due to the lack of objective evidence to provide evidence-based nursing care. The purpose of this study was to post-COVID-19 investigate nurses' lived experiences of evidence-based care in Iran.

MATERIALS AND METHODS

This research was conducted through a qualitative approach using Husserli's descriptive phenomenological method. The participants included nurses working in the wards of COVID-19. Sampling in this study was conducted using a targeted method. People were selected based on inclusion and exclusion criteria. A code of ethics and necessary permits were received. Data collection was performed using unstructured interviews. The time of the interviews varied between 30 and 60 minutes. All interviews were recorded and then transcribed. The method proposed by Colaizzi was used for data analysis. Lincoln and Guba's criteria were used for the accuracy and robustness of the data. Also, MAXQDA software was used for data management.

RESULTS

The main themes and sub-themes in this study include barriers (lack of mastery in searching for evidence, lack of prioritization of evidence-based care, lack of availability of sufficient evidence, and the complexity of the condition of the COVID-19 disease) and facilitators (need for new evidence, a different care context, the need for extensive training, and the need to improve the nursing care).

CONCLUSION

The findings of this research showed that based on the experiences of nurses, there are still barriers to patient care after the COVID-19 pandemic, and in addition, there are facilitators that are effective in the development of evidence-based care. We recommend that based on examining barriers and facilitators in this study, necessary planning should be performed to conduct applied research, develop clinical regulations, and better manage patients in the future.

Impact of the COVID-19 pandemic on long-term sickness absences due to mental disorders in public servants: a retrospective observational study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted lives worldwide, influencing the incidence and severity of health problems. This may have affected the occurrence of workers' sickness absences. This study aims to examine the incidence of long-term sickness absences due to mental disorders from 2009 to 2022 and the impact of the COVID-19 pandemic from the beginning of the COVID-19 pandemic (2020) to the end of the COVID-19 pandemic (2022).

METHODS

A retrospective observational design was employed. An anonymized record of public servants in City A with long-term sickness absences (≥ 90 days) from 2009 to 2022 was obtained. We defined 2009-2019 as the pre-COVID-19 pandemic period and 2020-2022 as the COVID-19 pandemic period. The influence of the COVID-19 pandemic on each disease category, classified using the ICD-10, was analyzed through interrupted time series analysis (ITSA) to evaluate changes in long-term sickness absences incidence before and during the COVID-19 pandemic period and the Cochran‒Armitage test to estimate trends in incidence rates over time.

RESULTS

Mental and behavioural disorders consistently demonstrated the highest incidence rates among all disease categories, with mood disorders being the most prevalent. Trends for all diseases analyzed did not change due to the COVID-19 pandemic. However, both ITSA and the Cochran‒Armitage test revealed increasing trends for depressive states and adjustment disorders throughout the study period.

CONCLUSIONS

The COVID-19 pandemic did not influence the incidence of long-term sickness absences. However, depressive states and adjustment disorders exhibited an upward trend. This study underscores the need for tailored workplace mental health interventions to tackle the increasing stress-related illnesses, necessitating future research exploring the root causes.

Novice nurses' professional competence: A qualitative content analysis

BACKGROUND

Novice nurses comprise a significant number of health personnel who are working in health systems. The significance of acquiring professional competence by nurses entering the hospital will ensure results such as professionalizing and giving quality services. This study aimed to explain the needs, facilitating and inhibiting factors of novice nurses' professional competence.

MATERIALS AND METHODS

This qualitative study was done using a conventional content analysis method at Shiraz University of Medical Sciences, Iran, in 2021-2022. The study participants included 15 novice nurses, supervisors, head nurses, and nurses in the departments where novice nurses operate. Participants were selected purposefully. Data were collected through 17 sessions of deep and semistructured interviews and 16 sessions of semistructured field observations until data saturation was reached.

RESULTS

Following data analysis, 2570 initial codes were extracted forming four subcategories, two categories, and one theme. The theme of the present study entitled "on the path to becoming a professional" included two categories "strengthening professional skills" and "committed adherence to the profession."

CONCLUSION

The concept of professional competence in novice nurses occurred through on the path to becoming a professional. This concept included strengthening professional skills and committed adherence to the profession. Policymakers and educational planners of nursing education can use the results of this study to get acquainted with this concept and develop policies and guidelines to develop professional competence. By getting familiar with the concept of novice nurses' professional competence, facilitating and inhibiting factors can educate competent nurses.

Identifying competency development needs of hospital managers in Iran: a national survey

BACKGROUND

A competent management workforce is crucial to achieve the effectiveness and efficiency of health service provision and to lead and manage the health system reform agenda. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentives for competency development and improvement among hospital managers in Iran. There is limited evidence on the competency development needs of hospital managers in Iran that can guide setting training and development direction. This study aims to identify the competency development needs of three management levels (senior, mid-level, and frontline) in public hospitals and explore the difficulties that managers experienced.

METHODS

The study adopted a cross-sectional survey using the validated management competency assessment partnership (MCAP) tool. The MCAP tool, consisting of 82 behavioral items that measure six core management competencies, was distributed to 162 public hospitals in 19 provinces in Iran between September 2021 and March 2022. The data were analyzed using descriptive and inferential statistics including the mean and standard deviation, chi-square test, independent-samples t-test, and one-way analysis of variance.

RESULTS

In total, 1051 managers completed the survey either online or on paper. Peer and team conflict, employee performance, loss of skilled staff, and supervisor confrontation were the five difficulties most often encountered by all three levels of managers. The survey confirmed that only a small proportion of managers had the opportunities to participate in formal and informal management-related education/training, such opportunities were much lower for middle and frontline managers (P < 0.001). Middle managers were less confident in their demonstration of the core management competencies than that of senior and frontline managers (P < 0.001). Managers who completed management training organised internally by the hospitals consistently received higher mean competency scores for all competencies (P < 0.001).

CONCLUSION

The study provides compelling evidence highlighting the importance of developing strategies to systematically enhance the capabilities of hospital managers, particularly mid-level managers. Incentives to encourage hospital managers to participate in both formal and informal management training, along with the commitment from hospitals to establish mechanisms that build management capacity, support managers, and guide the preparation and recruitment of management positions, are essential.

Policy brief: addressing the shortage of human resources in the Iranian health system

This policy brief highlights the critical shortage of healthcare workers in Iran, which hinders access, quality, and patient outcomes. The growing demand from population increases and chronic diseases, coupled with issues like geographic maldistribution, workforce migration, inadequate training, and limited support systems, exacerbates the crisis. Urban areas benefit disproportionately, leaving rural communities underserved and healthcare quality compromised. Evidence-based recommendations include incentivizing rural placements, improving workforce management systems, enhancing salaries and working conditions, expanding education and training, and leveraging digital health tools and task-shifting models. A phased implementation strategy is proposed, combining short-term pilot projects with long-term reforms to build a resilient healthcare workforce.

Under pressure - Nursing staff's perspectives on working hours and recovery during the COVID-19 pandemic: A qualitative study

Background

The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions.

Objectives

The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being.

Design

A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences.

Methods

Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study.

Results

The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes.

Conclusion

The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

What are the antecedents of nosiness among nurses? A qualitative study

PURPOSE

Nosiness is an annoying behavior at the workplace that can lead to negative consequences. It is characterized by being overly curious about other people's affairs. Specifically, this study aims to identify the factors contributing to nosiness among nurses.

DESIGN/METHODOLOGY/APPROACH

We conducted an exploratory qualitative interview study involving 38 nurses in Iran. The participants were selected by purposive sampling.

FINDINGS

We identified nine themes as the antecedents of nosiness among nurses: defamation motive, the need for certainty, the need for power, recreational motive, empathy, social comparison, the allure of the subject for the individual, having an employee-friendly workplace, and work environment and workload.

ORIGINALITY/VALUE

Understanding the antecedents of nosiness can help healthcare organizations curtail this phenomenon and foster a positive work environment, particularly in nursing where empathy, compassion, and attention to detail make them susceptible to nosiness.

Nurses' perception of emergency department overcrowding: A qualitative study

INTRODUCTION

One of the most important wards of the hospital is the emergency department (ED). Due to the increasing number of referrals, overcrowding has become a significant problem. It means an increase in patients' referrals and swarms at the ED, limiting their medical staff access. This study investigates the nurses' experiences and perceptions about the reasons for ED overcrowding.

MATERIALS AND METHODS

Twelve emergency nurses were purposefully selected to take part in this study. Data collection was through face-to-face semi-structured interviews until data saturation was finalized. Data analysis was conducted using Graneheim and Lundman's conventional content analysis.

RESULTS

Nurses' experiences with the reasons for ED overcrowding came into two main categories. The first was "increased referral to the emergency department," which had three subcategories: "increased referral due to health system reform plan," "increased referral due to corona pandemic," and "improper triage." The second was "increased patients' length of stay at the ED" with seven subcategories including "shortage of bed," "shortage of nursing staff," "lack of physical space," "turtle para-clinic," "on-call specialists' delay," "timely medical record documentation requirements," and "delaying in patients' transfer from the ED to the ward."

CONCLUSION

The results showed ED overcrowding is inevitable. Intentional or unintentional changes in the health system, such as implementing the health system reform plan or the corona pandemic, can also increase overcrowding. Findings showed ED overcrowding increased referrals and patients' length of stay. This study suggests the health system authorities pay more attention to this phenomenon and look for solutions.

Exploring Lived Experiences of Vulnerability in Nursing Management during the Coronavirus Disease 2019 Pandemic: A Phenomenological Study of Nurse Managers and Nurses

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic placed enormous pressure on healthcare systems around the world, but it also provided valuable insights for healthcare organizations during this challenging period.

Objective

This study aimed to explore nurses' lived experiences of vulnerability in hospital nursing management during the COVID-19 pandemic, and reflect on the lessons learned.

Methods

In this phenomenological study, 14 participants, including nurse managers at different levels and staff nurses, were selected by purposive sampling from one center university hospital. Data collection was done through in-depth individual semistructured interviews with participants and a review of weekly reports of crisis management meetings at the university hospital. Interviews were analyzed using Colaizzi's method in seven phases by MAXQDA software Version 10.

Results

One overarching theme, four themes, and 15 subthemes were obtained from analyses of interviews. Four themes of "nurses' attrition," "distrust of society to the organization," "fragility in the organization's performance," and "intensified inequalities" were extracted as threats to nursing management at the hospital. Subsequently, the weekly reports of crisis management meetings at the university hospital were analyzed to extract the solutions and lessons.

Conclusion

The unpreparedness of the healthcare system against a crisis can led to the loss of organizational assets, including medical staff and the credibility of the healthcare system. Limitations of the infrastructure at hospital became more obvious during the pandemic and caused serious threats to the healthcare system. Despite severe challenges along with the pandemic, it offered four valuable lessons in nursing management.

Resilience of first-line nurses during adaptation to the COVID-19 pandemic: A grounded theory study

AIM

Nurses are a vital resource in providing care to COVID-19 patients. During adaptation to the pandemic, the mental health of nurses was disturbed. The present study aimed to explain the resilience development process and adaptive strategies of first-line nurses during the COVID-19 pandemic.

METHODS

This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian first-line nurses, who were employed in one teaching hospital in Qazvin city, were included via purposive and theoretical sampling. The data were collected through semi-structured interviews and were analyzed based on the Corbin and Strauss approach 2015.

RESULTS

The resilience development process of nurses had three stages including initial confrontation with changes, managing conditions and reorganizing, developing resilience. Professional commitment was identified as a core category that affected all stages of resilience development. Negative emotions, nurses' characteristics, and caring challenges were identified as contextual factors which affected the adaptation of nurses to the COVID-19 pandemic and the development of resilience.

CONCLUSION

Regarding the importance of professional commitment in the nurses' resilience development and not leaving the profession in the COVID-19 pandemic, it is important to emphasize the ethical values and principles of the nursing profession in practice and especially in the education of nursing students. It is necessary to monitor mental health and provide professional psychological counseling by the healthcare systems; also, nursing managers should follow a supportive leadership style and consider first-line nurses' worries.

Picture of the employment status of nurses in the world: Scoping review on pros and cons

Nurses play a vital role in the delivery, quality improvement of healthcare services, and promoting patient health. Therefore, methods of providing nurses are an important issue. This study was conducted to collect evidence on the methods of providing nurses and their advantages and disadvantages by a scoping review method. The Arksey and O'Malley Framework and PRISMA were used in directing the present scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct the review and report on results. The ISI Web of science, PubMed, Scopus, and ProQuest electronic databases were searched for relevant articles published between January 2010 and December 2020 using the keywords and their synonyms. Finally, 19 articles out of 1813 ones to answer the research questions were selected. The results showed that although two general methods are for the employment status of nurses (full-time and part-time nurses), different classification countries are dissimilar from each other. A total of 13 advantages and 20 disadvantages of the part-time pattern and 6 advantages and 4 disadvantages were extracted from the full-time pattern of studies. None of the patterns has precedence over the other. Despite the strengths and weaknesses, each of the full-time or part-time patterns in its position is beneficial. With proper management and planning, it is possible to minimize their weaknesses and benefited from their advantages. Training part-time nurses to maintain and improve their level is a key point in reducing the disadvantages of this pattern.