It's What We Do: Experiences of UK Nurses Working during the COVID-19 Pandemic: Impact on Practice, Identity and Resilience

Redeployment and changes in working patterns of healthcare workers during COVID-19 in the UK: a qualitative study

BACKGROUND

Redeployment was critical in addressing the increased demands of COVID-19 on the healthcare system. Previous research indicates that ethnic minority healthcare workers (HCWs), those on visas, and in junior roles, were more likely to be redeployed to COVID-19 duties compared to White UK-born HCWs. There is limited evidence on how redeployment was practically organized, preparedness of HCWs and the NHS for rapid changes, and the decision-making processes involved. This paper discusses HCWs' redeployment experiences, their alignment with NHS policy for deploying staff safely, and potential links to staff attrition.

METHODS

As part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes among Healthcare workers, we conducted a qualitative sub-study, between December 2020 and July 2021, consisting of interviews and focus groups with 164 HCWs from different ethnicities, genders, job roles, migration statuses, and UK regions. Sessions were conducted online or by telephone, recorded, transcribed and analysed with participants' consent. We utilised the breadth-and-depth approach, initially identifying transcripts mentioning redeployment or changes in work patterns, followed by an in-depth thematic analysis.

RESULTS

Of the 164 HCWs, 22 (13.4%) reported redeployment to a new role, while 42 (26.8%) reported changes in their working patterns. Redeployment experiences varied based on HCWs' workplaces, skillsets, input into decisions, and perceived risks. Four themes were identified: 1. redeployment and the changing nature of work, 2. pandemic (un)preparedness, 3. redeployment decision-making, and 4. risk assessments in the context of redeployment. Our data revealed the practical realities of redeployment, including discrepancies between the NHS policy and actual practices, particularly early deployment without adequate training and supervision. The lack of planning and preparedness had an operational and emotional impact on HCWs, affecting their morale. Lastly, some HCWs felt disempowered and undervalued due to a lack of agency in redeployment decisions.

CONCLUSION

This study highlights HCWs' redeployment experiences during COVID-19, the conditions under which it occurred, and its impacts. The findings, although rooted in the pandemic, remain relevant for addressing staffing challenges in the healthcare workforce. We recommend future redeployment strategies prioritise HCWs' training and supervision, ensure strategic planning with clear communication and support for all staff, foster a sense of value among HCWs, and integrate an intersectional equity lens into workforce planning to improve staff retention and morale.

Using journalling to support nurses' mental well-being and self-care in challenging times

Nurses frequently experience multiple challenges and face numerous demands in their professional role, which may lead to adverse effects such as stress, depression, anxiety and burnout. Therefore, it is important to identify effective and accessible strategies that can support them. This article explores how nurses can use journalling as a tool for navigating the challenges they experience in their practice. It offers a step-by-step guide that provides nurses with an accessible and effective approach to journalling, which they can use to support their mental well-being and self-care.

Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics

OBJECTIVES

The potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation of a DHI consisting of a patient-facing app and a digital dashboard for clinicians providing supported self-management for long COVID to support both clinicians and patients.

DESIGN

Qualitative reflexive thematic analysis, mapped against Normalisation Process Theory.

SETTING

Fifty-five and a half hours of zoom recordings of meetings between clinicians in community and secondary care long COVID clinics and members of the research team.

PARTICIPANTS

Allied health professionals, service delivery managers and members of the core team, including representatives from industry partners.

RESULTS

The DHI fitted with contextual circumstances and the design supported flexibility to suit circumstances in different trusts. The DHI also aligned with existing ways of working.Healthcare professionals worked together to support the implementation of the DHI, requiring flexibility to take account of local circumstances. The DHI was appraised in both positive and negative terms by healthcare professionals. Using DHIs was said to have the potential to complement care but not be a replacement for face-to-face clinical input. The DHI was judged to have demonstrated the potential to affect long-established patterns and organisational structures of engagement between healthcare professionals and patients in terms of access to care.

CONCLUSIONS

NPT provided a framework for considering both individual agency and the organisation context, enabling reflections to be made at the level of the structure of services as well as people's experiences. The discipline of considering first the context, then the work and finally the practical effects helped place order on the 'mess' involved in the rapid cycle of developing, refining and implementing a DHI in an atypical environment (a pandemic).

RePAIRing the student nurse journey: empowering interrupted students through innovative support strategies

This article reports on a study that evaluated an innovative 6-week summer returners' programme, part of the Health Education England RePAIR project, designed to support nursing students who have interrupted their studies. Held from May to July 2022, the programme addressed diverse needs through academic guidance, mental health and resilience workshops, creative arts, professional identity development, and practical nursing skills training. The programme ran alongside support from the programme team, student engagement services, and ongoing communication via phone and email. Despite non-mandatory sessions leading to varying attendance, the combined efforts facilitated the return of 67 out of 135 interrupted students. Thematic analysis identified four key themes: anticipation and fear, making contact and reaching out, preparing for return, and psychological wellbeing. The programme's effectiveness underscores the necessity of tailored support strategies to enhance retention and wellbeing. This innovative approach highlights the importance of personalised support in aiding nursing students' return to education and addressing nursing workforce shortages.

Knowledge graph analysis of research on nurses' psychological resilience

In recent years, a surge in literature on psychological nurse resilience, largely driven by the COVID-19 pandemic, has prompted the need for a comprehensive understanding of the current state and emerging trends through reliable methodologies. The purpose of this study was to analyzes the research on nurses' psychological resilience through bibliometrics to understand the current situation, foundation, and hotspot of this research field. The Web of Science core collection database was used as the search source, and CiteSpace analysis software was employed to conduct bibliometric analysis on authors, countries, institutions, keywords, and references of nurse psychological resilience-related literature published from the establishment of the database to July 11, 2023. A total of 1060 articles were included in the final analysis. The study of nurses' psychological resilience had been highly popular and had formed a new and important research basis in recent years. China and the United States led in the number of publications and centrality respectively, with Monash Univ and Curtin Univ as top institutions in the number of publications and centrality respectively. The authors with the highest number of publications and the most frequently cited were Rees and Connor Km respectively. The most frequently cited article was Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 published by Lai, JB, etc. Important key keywords included mental health, resilience, stress, health, outbreak, acute respiratory syndrome, etc. The research topics in this field mainly focused on 4 aspects, including nurses' mental health, post-traumatic stress disorder, job burnout and job satisfaction, and intervention research on psychological resilience. The results of bibliometric analysis provide direct support for future scholars to explore and determine the research direction, hot spots, and find authoritative authors and institutions. At the moment, nurses' psychological resilience research has established a new foundation, primarily focusing on COVID-19-related topics. Given the potential prolonged coexistence of COVID-19 and other diseases, the main research focus remains innovating and validating effective psychological resilience intervention strategies for nurses' overall well-being.

How did student district nurses feel during the COVID-19 pandemic? A qualitative study

BACKGROUND

The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot.

AIMS

This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken.

METHOD

A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes.

RESULTS

The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork.

CONCLUSION

This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible.

The mediating role of coping styles in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study among nurses

Fear of being infected by coronavirus disease 2019 (COVID-19) could trigger mental health problems among nurses at the frontline. In such a situation, coping strategies are needed to deal with the imminent threat. The purpose of this study was to test the mediating effects of coping on relationships of fear of COVID-19 with anxiety, depression and post-traumatic syndrome among nurses who were in contact with COVID-19 patients. A cross-sectional and correlational research design was used to recruit a sample of 278 nurses who treated COVID-19 patients in four government referral hospitals in Indonesia. A bootstrap resampling procedure was used to test the significance of the total and specific indirect effects of coping on relationships of Fear of COVID-19 with anxiety, depression and post-traumatic syndrome. The nurses reported moderate levels of fear of COVID-19, considerable anxiety and depression, and a moderate level of coping. We found coping to be significantly negatively correlated with the reported levels of anxiety, depression and post-traumatic syndrome (p < 0.001). Coping mediated relationships of fear of COVID-19 on depression, anxiety and post-traumatic syndrome after controlling for relevant confounders for each dependent variable. This shows that enacting coping mechanisms is important to achieve an adaptive effect on nurses' mental health. Proper assessments and interventions should be tailored and implemented for nurses who have contact with COVID-19 patients to facilitate their use of coping strategies when needed in stressful situations.

Exploring nurses' well-being and strategies to support self-care

Nurses experience a range of challenges in their practice that can adversely affect their well-being, for example work-related stress and workforce issues. These challenges may have been intensified by various factors, such as the coronavirus disease 2019 (COVID-19) pandemic and shift working. This article considers the concept of well-being and explores nurses' well-being in the context of ongoing stressors and workforce issues. It also examines some of the effects of shift work on nurses' well-being and how these could be mitigated. The authors outline a range of self-care practices that nurses could engage in and consider how they may be supported in this by their line managers and healthcare organisations.

Implementation of a Web-Based Resilience Enhancement Training for Nurses: Pilot Randomized Controlled Trial

BACKGROUND

Global workforce challenges faced by health care providers are linked to low levels of job satisfaction, recruitment, retention, and well-being, with detrimental impacts on patient care outcomes. Resilience-building programs can provide support for staff who endure highly stressful environments, enhance resilience, and support recruitment and retention, with web-based formats being key to increasing accessibility.

OBJECTIVE

We aimed to examine participants' engagement with a newly developed Resilience Enhancement Online Training for Nurses (REsOluTioN), explore its acceptability, and compare levels of resilience and psychological well-being in nurses who completed REsOluTioN with those who did not.

METHODS

We carried out a pilot randomized trial (1:1), conducted at a single site (mental health and community trust in South England) between August 2021 and May 2022. Local research ethics approvals were obtained. Nurses were invited to participate and were randomly assigned to a waitlist group or REsOluTioN group. Training lasted for 4 weeks, consisting of prereading, web-based facilitated sessions, and mentorship support. We evaluated trial engagement, acceptability of training, and pre-post changes in resilience, measured by the Brief Resilience Scale, and psychological well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale. Qualitative participant feedback was collected. Consolidated Standards of Reporting Trials 2010 extension guidelines for reporting pilot and feasibility trials were used.

RESULTS

Of 108 participants recruited, 93 completed the study. Participants' mean age was 44 (SD 10.85) years. Most participants were female (n=95, 88.8%), White (n=95, 88.8%), and worked in community settings (n=91, 85.0%). Sixteen facilitated and 150 mentoring sessions took place. Most REsOluTioN program participants reported the sessions helped improve their resilience (n=24, 72.8%), self-confidence (n=24, 72.7%), ability to provide good patient care (n=25, 75.8%), relationships with colleagues (n=24, 72.7%), and communication skills (n=25, 75.8%). No statistically significant differences between training and control groups and time on well-being (F_1,91=1.44, P=.23, partial η²=0.02) and resilience scores (F_1,91=0.33, P=.57, partial η²=0.004) were revealed; however, there were positive trends toward improvement in both. Nurse participants engaged with the REsOluTioN program and found it acceptable. Most found web-based training and mentoring useful and enjoyed learning, reflection, networking, and participatory sessions.

CONCLUSIONS

The REsOluTioN program was acceptable, engaging, perceived as useful, and nurses were keen for it to be implemented to optimize resilience, psychological health, communication, and workplace environments. The study has evidenced that it is acceptable to implement web-based resilience programs with similar design features within busy health care settings, indicating a need for similar programs to be carefully evaluated. Mentorship support may also be a key in optimizing resilience. Trial limitations include small sample size and reduced statistical power; a multicenter randomized controlled trial could test effectiveness of the training on a larger scale.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/37015.