Experiences and perspectives of nurses infected with COVID-19: A qualitative systematic review and meta-synthesis

This qualitative systematic review aims to comprehensively understand the experiences and perspectives of nurses infected with COVID-19, addressing a significant gap in the current literature. Following the JBI meta-synthesis approach, a rigorous search was conducted across nine electronic databases and references until January 16, 2023. Seventeen eligible studies underwent quality assessment using the JBI critical checklist. Data were synthesized using standardized tools, and the ConQual tool evaluated confidence in the findings. Seven key findings emerged, providing valuable insights into emotional experiences, adaptation to COVID-19 challenges, influence of support systems, coping strategies, posttraumatic growth perceptions, and effects on professional identity and career advancement. The findings highlight emotional toll, adaptive strategies, and professional implications for nurses. Moreover, they emphasize the importance of support systems, coping mechanisms, and posttraumatic growth in promoting nurses' well-being and resilience. These insights have practical implications for targeted interventions and support mechanisms to enhance infected nurses' well-being and improve healthcare outcomes.

Nurse-led care for people with early rheumatoid arthritis: Interview study with thematic analysis

AIMS

To develop an understanding of what comprises nurse-led care in early rheumatoid arthritis from the perspective of rheumatology nurse specialists in England.

DESIGN

Qualitative study.

METHODS

Semi-structured telephone interviews with rheumatology nurse specialists in England were conducted in Summer 2020. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Reporting follows the appropriate elements of consolidated criteria for reporting qualitative research.

RESULTS

Sixteen nurses were recruited and interviews lasted 30-60 min. Four themes with 14 subthemes were identified. A SPECIALIST SERVICE DELIVERED BY EXPERIENCED RHEUMATOLOGY NURSES: Specialist care is provided by experienced nurse specialists with a high degree of autonomy in the rheumatology multidisciplinary team context.

ADDRESSING PATIENTS' COMPLEX CARE NEEDS

Care is evidence-based and aims to start treatment, keep in treatment, educate and support. Access to psychology expertise is needed. CARE WITH COMPASSION USING PERSON-CENTRED, HOLISTIC AND EMPATHETIC APPROACHES: Nurses create patient relationships and a positive therapeutic environment. Nurse-led telephone advice lines are essential for treatment adjustment, patient support and empowerment.

CONTINUED EVALUATION AND DEVELOPMENT OF THE SERVICE

Consultations are reviewed, and patients are asked for feedback. The COVID-19 pandemic caused disruption, but changes streamlined procedures and improved documentation and communication.

CONCLUSION

Nurse-led care in early rheumatoid arthritis is a specialist service delivered with compassion, addressing complex care needs and using person-centred approaches. This study identifies key aspects of care in early disease from the nurse perspective.

Helping Patients Access Mental Health Services

Tips for nurses on addressing this widespread challenge.

Nurse's experience in giving nursing care to Covid-19 patients

Objective

The objective was to describe Nurse's experience in giving nursing care to covid-19 patients.

Method

Phenomenology design was used in this study. Participants in this study were nurses who provided nursing care for COVID-19 patients. Participant data were obtained from the nursing office and contacted via cell phone to become participants. After data saturation the researcher found six nurses as participants. In-depth interviews were conducted from July to August 2020 to explore the experiences of nurses giving nursing care to Covid-19 patients. Data was analyzed using the Colaizzi method.

Result

We found five themes of nurses giving nursing care to Covid-19 patients. The themes include the Motivation of nurses to provide nursing care during the COVID-19 pandemic, the nurse emotional response, the patient emotional response, the problems faced by COVID-19 nurses, and the expectations of the nurses.

Conclusion

Nurses need support while giving nursing care to Covid-19 patients to break Covid-19 transmission.

Nurse preceptors' perceptions of benefits, rewards, support, and commitment to the preceptor role in a new preceptorship program

BACKGROUND

Nurse preceptorship is a new concept emerging in the Iranian health care system. The purpose of this research was to assess preceptor nurses' perceived benefits, rewards, support, and commitment to the role in a new nurse preceptorship program in Iran and to examine the relationships between these concepts.

METHODS

A descriptive correlational study was employed, and using total population sampling method, 45 preceptor nurses were recruited from a tertiary referral teaching hospital in Iran. Data were collected using the Preceptor's Perception of Benefits and Rewards Scale, the Preceptor's Perception of Support Scale, and the Commitment to the Preceptor Role Scale. Descriptive statistics and correlational analysis were used to analyse data.

RESULTS

Preceptors' commitment to their role was positively and moderately associated with their perceived benefits and rewards (r = 0.503, p = 0.001) and perceived support (r = 0.430, p = 0.003). None of the examined demographic and practice variables showed statistically significant association with commitment to the preceptor role.

CONCLUSIONS

Commitment to the preceptor role was associated with benefits, rewards and support that preceptor nurses perceive in relation to their role. To optimise the effectiveness of nurse preceptorship programs, benefits, rewards, recognition, and support should be integral to planning of these programs.

Nurses' Perspectives of Their Impact While Serving on Boards

OBJECTIVE

The study objective was to identify nurses' perceptions of their impact while serving on boards.

BACKGROUND

Nurse leaders serving as voting board members are key experts for board effectiveness and may be associated with stronger performing organizations. Extant research indicates that nurse leaders are qualified for board service; however, no research explores the impact of nurses on boards.

METHODS

We conducted an exploratory qualitative study by interviewing 20 nurses serving on boards. Hermeneutic analysis of the data resulted in 1 overarching pattern and 7 traversing themes.

RESULTS

Nurses who serve on boards reported leveraging expert knowledge of healthcare and caring wisdom to influence strategic thinking to meet stakeholder needs.

CONCLUSION

Nurses promote effective board governance by ensuring that the perspectives and needs of all stakeholders are represented in board processes. We recommend health-related organization executives and board leaders appoint nurses as voting members of their governing boards.

Forever Changed: RNs Speak of their COVID-19 Experiences through a System-Wide Nursing Web Site

A COVID19RNStories website allowed RNs in this integrated health system to "tell their stories" during the recent pandemic. From April to August 2020, approximately 100 items were posted with 4 themes emerging. COVID19RNStories had no preconceived hypotheses or specific questions to answer: RNs shared whatever they felt was relevant to their experiences. This approach provided real-time information on issues and concerns of RNs during the 1st wave of COVID-19. This article discusses the identified themes with recommendations for nursing leaders to support staff during the pandemic and future unexpected emergency situations.

Effects of nurse-led transitional care interventions for patients with heart failure on healthcare utilization: A meta-analysis of randomized controlled trials

BACKGROUND

Heart failure (HF) imposes a substantial burden on patients and healthcare systems. Hospital-to-home transitional care, involving time-limited interventions delivered predominantly by nurses, was introduced to lighten this burden. This study aimed to examine the effectiveness and dose-response of nurse-led transitional care interventions (TCIs) on healthcare utilization among patients with HF.

METHODS

Health-related databases were systematically searched for articles published from January 2000 to June 2020. We included randomized controlled trials (RCTs) that compared nurse-led TCIs with usual care for adults hospitalized with HF and reported the following healthcare utilization outcomes: all-cause readmissions, HF-specific readmissions, emergency department visits, or length of hospital stay. Random-effects meta-analysis, meta-regression analysis, and dose-response analysis were performed to estimate the treatment effects and explain the heterogeneity.

RESULTS

Twenty-five RCTs including 8422 patients with HF were included. Nurse-led TCIs for patients with HF resulted in a mean 9% (RR = 0.91; 95% CI = 0.82 to 0.99; p = 0.04; I2 = 46%) and 29% (RR = 0.71; 95% CI = 0.60 to 0.84; p < 0.0001; I2 = 0%) reduction in all-cause and HF-specific readmission risks respectively compared to usual care. The interventions were also effective in shortening the length of hospital stay (MD = -2.37; 95% CI = -3.16 to -1.58; p < 0.0001; I2 = 14%). However, no significant reduction was found for emergency department visits (RR = 0.96; 95% CI = 0.84 to 1.10; p = 0.58; I2 = 0%). The effect of meta-regression coefficients on all-cause and HF-specific readmissions was not statistically significant for any prespecified trial-level characteristic. Dose-response analysis revealed that the HF-specific readmission risk decreased in a dose-dependent manner with the complexity and intensity of nurse-led TCIs.

CONCLUSIONS

Nurse-led TCIs were effective in decreasing all-cause and HF-specific readmission risks, as well as in reducing the length of hospital stay; however, the interventions were not effective in reducing the frequency of emergency department visits.

Factors Influencing Role Ambiguity and Role Conflict Among Intensive Care Unit Nurses Providing End of Life Care

AIM

The aim of this study was to determine the relationship of compassion satisfaction, compassion fatigue, and death anxiety with role ambiguity and role conflict in intensive care unit (ICU) nurses providing care at end of life.

BACKGROUND

Understanding the factors that impact care for patients and families at the end of life is important for nursing practice and nursing leaders.

METHODS

A quantitative nonexperimental correlation design was used, with 216 critical care nurses recruited using an Internet-based website. Data were analyzed using, Pearson product-moment correlation, χ2 test of independence, and the independent-samples t test or analysis of variance as appropriate.

RESULTS

Role ambiguity and role conflict were negatively related to compassion satisfaction and were positively related to compassion fatigue and death anxiety. There was no relationship between increased years of ICU experience and role ambiguity and role conflict.

CONCLUSION

Compassion satisfaction is a significant predictor for role ambiguity, whereas burnout is best predicted by role conflict for ICU nurses providing end of life care.

Qualifications of Executive Nurses for Service on Hospital Boards

OBJECTIVE

The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment.

BACKGROUND

Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight.

METHODS

Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale.

RESULTS

Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance.

CONCLUSION

This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments.

Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics

OBJECTIVE

This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics.

BACKGROUND

Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience.

METHODS

University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program.

RESULTS

The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction.

CONCLUSIONS

Interventions targeting frontline leaders positively impact CN performance.

Following the Lead

You can support a family member's treatment plan without taking charge.

Expressing Gratitude for Transitions, for Relationships, and for the Hope They Bring

The past 18 months has been filled with transitions for healthcare organizations, for nurses, and for the patients and families they care for. As we transition from the real and virtual confines inflicted by the pandemic, the light shines on gratitude for relationships cultivated and the hope they bring.

Developing an Elective on Spirituality for the BSN Curriculum

When a curriculum evaluation of a BSN program at a public university revealed a content gap on spirituality and spiritual assessment, faculty developed an elective covering a nurse's role in spiritual care and assessment of patients. The resulting 300-level course was of hybrid design and received positive evaluation from students after implementation.

When Healthcare Isn't Enough: A Christian Response to Social Determinants of Health

Education, employment, housing, neighborhood safety, and traumatic life experiences influence people's health, and poor health as a result of inequities in these areas cannot be remedied by medical care alone. Although social determinants of health threaten the attainment of a healthy life for people across North America, nurses are positioned to be leaders in a movement toward health equity. Nurses can follow the example of Jesus in loving their neighbors as themselves by addressing the social needs of patients, championing health system change, educating their communities, and advocating for Health in All Policies.

The Future of Nursing: Creating A Culture of Equity

As development of the Future of Nursing 2020-30 Report by the National Academy of Medicine is underway, the nursing profession is positioned to continue positively impacting health and health equity in the United States. Progress to date engenders hope that nurses will continue to take a significant role in reducing health disparities. The work to create a culture of health aligns with the Christian imperative to "love your neighbor as yourself."

Neuman Systems Model With Nurse-Led Interprofessional Collaborative Practice

The Neuman Systems Model was developed to create a structure to depict nursing clients as complex systems, in constant energy exchange with their environments, comprised of multiple interrelated parts. It has been widely used in practice, education, research, and administration. An analysis of the theory, based upon Meleis' methods, was conducted. The theory has high utility and a large circle of contagiousness despite its complexity, lack of teleology, and level of abstractness. Based upon this analysis, a new model entitled the Neuman Systems Model Perspective of Nurse-Led Interprofessional Collaborative Practice has been created to provide a framework for the care of community-dwelling older adults. As a first step in its development, this new model will be used to guide a mixed-methods study evaluating an interprofessional collaborative practice intervention for community-dwelling older adults.

Using Activism to Get Nurses on Boards

Over the past 15 years, there has been a growing call for nurses to be placed on boards of hospitals and health systems. Rationale for this action includes the changing nature of health care; a greater emphasis on person and family-centered care; nurses' background and experience in health care delivery; and that boards with a more diverse composition are associated with better organizational performance. Several national organizations have come forward to support this, among them the Robert Wood Johnson Foundation, American Hospital Association, the Institute of Medicine, and several industry leaders in health care. While progress has been made, however, nurses still occupy only 4% of board seats. This article reviews some of the myths and barriers that have prevented nurses from serving on boards, as well as offering 3 major recommendations for action that reflect not only long-term efforts but also short-term activism.

Reflecting on two distinct leadership roles during the pandemic

ABSTRACT

For more than a year, the COVID-19 pandemic has caused unprecedented stress, anxiety, sadness, and fear, but it has also allowed people to reflect, learn, self-improve, and change. In this article, the author demonstrates how reflective practice enabled her to improve in two distinctly different leadership roles.

The Value of Including the Nursing Perspective in the Boardroom

In response to the Future of Nursing Report, the Nurses on Boards Coalition promotes the health of communities and the nation by engaging nurses in board service. Nurses possess knowledge and skills that when leveraged in boardroom discussions and decisions may impact the health of the populations served by the board. This article highlights the insights of organizational board leaders, as they describe the impact and influence of nurse board members within their organizations.

Fully Protected: A Look at PPE and the Armor of God

ABSTRACT

The use of personal protective equipment (PPE) by nurses during the COVID-19 pandemic can be compared with a Christian's spritiual protective action of putting on the armor of God as described in the New Testament. The use and significance of each item of PPE is compared with the equivalent article of the spiritual armor of God.

Nurses on Boards: Still a Challenge for Health Care Organizations

Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table.

Coming of Age During Coronavirus: New Nurses' Perceptions of Transitioning to Practice During a Pandemic

BACKGROUND

The global COVID-19 pandemic has created unprecedented challenges to the health care workforce. Little is known about the effect of the pandemic on new RNs and their preparedness for such a crisis. This study explored the lived experiences of RNs transitioning from students to professionals during the pandemic.

METHOD

Semistructured interviews were conducted with 15 new RNs working in acute care facilities during the Maryland COVID-19 State of Emergency.

RESULTS

Three themes were identified to describe the experiences of new nurses transitioning to practice in the midst of the COVID-19 pandemic: uncertainty, vulnerability, and resilience.

CONCLUSION

New nurses need greater support during transition to practice. Initiatives to improve trusting relationships between new nurses and their organizations and support of the development of essential relationships (e.g., peers, frontline management, and educators) could enhance new nurses' resilience and commitment to stay with the organization. [J Contin Educ Nurs. 2021;52(6):294-300.].

Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses

OBJECTIVES

To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC).

DESIGN

Qualitative study conducted through semi-structured in-depth interviews.

SETTING

Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care.

PARTICIPANTS

In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC.

DATA COLLECTION AND ANALYSIS

All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads.

RESULTS

340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC.

CONCLUSIONS

European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.

CE: Providing Care for Caregivers During COVID-19

ABSTRACT

Care for the Caregiver is a peer-to-peer program that provides support and guidance to clinicians who have experienced an unexpected and emotionally distressing event. Its development was preceded by communication and resolution programs that were endorsed by the Joint Commission in 2001, subsequently introduced at several U.S. medical centers, and in 2009 were incorporated within demonstration projects funded by the Agency for Healthcare Research and Quality. In August 2014, the authors introduced the Care for the Caregiver program across the MedStar Health System, which includes seven hospitals in Maryland and three in the District of Columbia. Here, they describe how the program was initially conceived and structured-and how it evolved in response to the current pandemic.

Perceptions of Authentic Nurse Leadership and Work Environment and the Pandemic Impact for Nurse Leaders and Clinical Nurses

OBJECTIVE

The aim of this study was to determine the pandemic impact on the relationship between nurses' perception of the authentic nurse leadership (ANL) of their manager and their perception of the work environment.

BACKGROUND

Both ANL and healthy work environment (HWE) contribute to staff and patient outcomes. Our 1st study of these 2 variables revealed a positive relationship. Will this be upheld in a pandemic year?

METHODS

More than 5000 nurses from a national sample participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire, the Critical Elements of a Healthy Work Environment Scale, and a pandemic impact on practice question.

RESULTS

Overall, nurses perceived ANL and HWE were present despite a high level of pandemic impact; however, when clinical nurses were separated from managers/directors, HWE was not present for frontline nurses. The moderate correlation of ANL and HWE was replicated in this larger study.

CONCLUSIONS

This is the 2nd study of the positive relationship between ANL and HWE using these models, supporting ANL as an essential standard of a HWE. ANL was present for clinical nurses in a pandemic year signaling that nurse leaders rose to meet frontline leadership needs. HWE was present overall, but not for clinical nurses. Leadership is essential to work environments and outcomes especially in times of crisis and significant change.

Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes: An International Comparison

OBJECTIVE

Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals.

BACKGROUND

Nursing governance and effects on nurse-related outcomes are not well studied.

METHODS

Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries).

RESULTS

International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3).

CONCLUSIONS

Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.

From the Operating Room to the Front Lines: Shared Experiences of Nurse Anesthetists During the Coronavirus Pandemic

Coronavirus disease 2019 (COVID-19) has resulted in severe health, economic, social, political, and cultural consequences while thrusting Certified Registered Nurse Anesthetists (CRNAs) at the forefront of battling an often invisible enemy. A mixed-methods study was conducted to assess the impact of the COVID-19 pandemic on CRNA practice. The purpose of the qualitative component of the study, a focused ethnography, was to use personal and group interviews to determine the shared experiences of CRNAs who worked during the COVID-19 pandemic. Six themes were identified: (1) CRNAs are part of the solution, (2) doing whatever it takes, (3) CRNAs are valued contributors, (4) removal of barriers promotes positive change, (5) trying times, and (6) expertise revealed. The quantitative component of the study will be discussed in a separate article.

What Lies Ahead for Nursing

This is the last of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study. For this third article, interviews were conducted with nurse leaders from diverse practice areas to see how their thinking about the future had shifted as 2020 drew to a close.

Redeployment of Certified Registered Nurse Anesthetists During the Coronavirus Disease 2019 Pandemic

Certified Registered Nurse Anesthetists (CRNAs) are uniquely skilled anesthesia providers with substantial experience managing critically ill patients. During the coronavirus disease 2019 (COVID) pandemic, CRNAs at a large academic medical center in the Mid-Atlantic United States experienced a shift in their daily responsibilities. As the hospital transitioned to the management of patients who tested positive for the virus that causes COVID, the severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2), CRNAs were redeployed into the roles of respiratory therapists and intensive care unit registered nurses. Although facing the stress of the global pandemic, this facility's CRNAs proved to be flexible, capable, and necessary members of the care team for patients with COVID-19.

Risky Business: A Mediated Model of Antecedents and Consequences of Presenteeism in Nursing

BACKGROUND

Nurses are a high-risk group for presenteeism: When one is present at work but not fully engaged. Presenteeism can occur because of multiple work, personal, and event factors and is linked to negative nurse, patient, and organizational outcomes. A model that accounts for the multiple antecedents that lead to presenteeism, as well as its consequences, is needed.

OBJECTIVE

The aim of this study was to evaluate our proposed presenteeism in nursing model among registered nurses in the United States by examining the fit of the data with the model.

METHODS

Four hundred forty-seven registered nurses who provide direct patient care completed a cross-sectional survey on presenteeism, its antecedents and consequences, and demographics. Structural equation modeling was used to test relationships in the proposed model and overall model fit.

RESULTS

The presenteeism in nursing model holistically accounted for significant presenteeism antecedents and consequences. There were significant relationships between work environment, perceived stress and work-life balance, and presenteeism. There were also significant relationships between presenteeism and missed care, and burnout.

DISCUSSION

These relationships align with prior research and identify antecedents and consequences of presenteeism. This model can be used by practitioners and researchers to develop interventions addressing presenteeism to improve health system, nurse, and patient outcomes.

Nurse Sensemaking for Responding to Patient and Family Safety Concerns

BACKGROUND

Hospitals need to prevent, respond to, and learn from safety risks and events perceived by patients and families, who in turn rely on nurses to respond to and report their safety concerns.

OBJECTIVES

The aim of the study was to describe the process by which bedside nurses evaluate and determine the appropriate response to safety concerns expressed by patients or their families.

METHODS

A qualitative design was employed. We recruited inpatient bedside nurses in an 811-bed Midwest academic medical center. Nurses provided demographic information and participated in semistructured interviews designed to elicit narratives related to evaluation and response to patient- or family-expressed safety concerns. Data analysis and interpretation were guided by grounded theory.

RESULTS

We enrolled 25 nurses representing 22 units. Based on these nurses' experiences, we developed a grounded theory explaining how nurses evaluate a patient or family safety concern. Nurses make sense of the patient's or family's safety concern in order to take action. Achieving this goal requires evaluation of the meaningfulness and reasonableness of the concern, as well as the potential effect of the concern on the patient. Based on this nursing evaluation, nurses respond in ways designed to (a) manage emotions, (b) immediately resolve concerns, (c) involve other team members, and (d) address fear or uncertain grounding in reality. Nurses reported routinely handling safety concerns at the bedside without use of incident reporting.

DISCUSSION

Safety requires an interpersonal and evaluative nursing process with actions responsive to patient and family concerns. Safety interventions designed to be used by nurses should be developed with the dynamic, cognitive, sensemaking nature of nurses' routine safety work in mind. Being sensitive to the vulnerability of patients, respecting patient and family input, and understanding the consequences of dismissing patient and family safety concerns are critical to making sense of the situation and taking appropriate action to maintain safety. Measuring patient safety or planning improvement based on patient or family expression of safety concerns would be a difficult undertaking using only standard approaches. A more complex approach incorporating direct patient engagement in data collection is necessary to gain a complete safety picture.

Varying perceptions of the role of "nurse as teacher" for medical trainees: A qualitative study

INTRODUCTION

The informal curriculum-an essential complement to the formal curriculum-is delivered to medical trainees through learning outside the classroom. We sought to explore nurse-mediated aspects of trainee education in the informal curriculum in obstetrics and gynecology (OBGYN), as well as nursing perceptions of their role in medical trainee education.

METHODS

Naturalistic, non-participant observations (40 h) were performed on a tertiary care birthing unit (BU) to document teaching and learning interactions. Insights gleaned from observations informed subsequent semi-structured interviews with BU nurses (n = 10) and focus group discussions with third-year medical students who had completed an OBGYN rotation (n = 10). Thematic analysis was conducted across data sets.

RESULTS

Conceptions of nurse-mediated education differed considerably between nurses and trainees. Nurses were widely acknowledged as gatekeepers and patient advocates by both groups, although this role was sometimes perceived by trainees as impacting on learning. Interest and engagement were noted as mediators of teaching, with enhanced access to educational opportunities reported by trainees who modelled openness and enthusiasm for learning. Nurse-driven education was frequently tailored to the learner's level, with nurses feeling well positioned to share procedural knowledge or hard skills, soft skills (i.e. bedside manners), and clinical insights gained from bedside practice.

DISCUSSION

Nurses are instrumental in the education of medical trainees; however, divergence was noted in how this role is enacted in practice. Given the valuable teaching resource BU nurses present, more emphasis should be placed on interprofessional co-learning and the actualization of this role within the informal curriculum.

Advice for aspiring nurse leaders

ABSTRACT

Advice from current nurse leaders can offer valuable insight for aspiring leaders. This article discusses how the collective wisdom of practicing nurse leaders can assist new leaders as they transition into the role.

[Thoughts on the role of the advanced practice nurse in emergency care and the patient pathway]

Abroad, advanced practice in emergency medicine has had positive effects on populations. In France, following the reform of emergency departments, advanced practice nurses in emergency medicine will become a reality. This new profession raises certain fears. Their contribution must be alongside the patients and in the organisations. For this, patient pathways need to be identified and cooperation between the advanced practice nurses and emergency room doctors must be established.

[Perception of hospital-based nurses on the discharge from hospital.]

Numerous studies show the risk of a breakdown in the continuity of care when a patient leaves hospital. A study was carried out of hospital-based nurses, to find out their representations with regard to their role in the hospital-home transition. The results enable areas of improvement to be identified.

An Exploration of Factors Associated With Nurses' Perceptions of Decisional Involvement

OBJECTIVE

The purpose of this study was to evaluate nurses' perceptions of decisional involvement (DI).

BACKGROUND

Decisional involvement is a measure or gauge of nurses' perceived shared leadership. There has been limited research examining factors associated with actual and preferred DI.

METHODS

A descriptive, observational study design was used. A total of 189 RNs completed the Decisional Involvement Scale and Evidence-Based Practice Implementation Scale. Nurses' preferred DI (DI-P) and actual DI (DI-A) were analyzed, and DI total and subscale scores were compared based on nurses' demographic and clinical practice characteristics.

RESULTS

The DI-A and DI-P total scores were significantly different, including subscales for DI-A compared with DI-P score. Dissonance scores by subscale were highest for recruitment, governance, and support. Unit-based council (UBC) participants had significantly higher actual DI, compared with non-UBC participants. Nurses' perceptions of implementing evidence-based practice (EBP) was not significantly different by low versus high EBP implementation; nor were the scores significantly correlated with their DI-A or DI-P scores.

CONCLUSIONS

Findings indicate nurses' perceptions of DI-A and DI-P. This study provided further examination of the differences and interrelationships between DI and nurses' demographic and clinical practice characteristics. Dissonance DI scores provide opportunities for targeting interventions to engage nurses in shared leadership.

DAISY: Affirmation of Gratitude in Times of Pandemic

The recent pandemic has caused many changes in the professional and personal lives of patients, their families, and the nurses who care for them. Something the pandemic could not change is the profound gratitude that patients, families, and others have for the extraordinary compassionate care that nurses have provided.

An Examination of Work Characteristics, Fatigue, and Recovery Among Acute Care Nurses

OBJECTIVE

To examine self-perceived fatigue among nurses and to quantify levels of fatigue and the ability to recover from fatigue between worked shifts across various work characteristics.

BACKGROUND

Fatigue is associated with working long hours, disruption of sleep, and inadequate time to recover between shifts. Fatigue degrades the nurses' performance leading to poorer patient outcomes and increased occupational injuries.

METHODS

This quantitative study surveyed 573 nurses across 5 hospitals in the southeastern United States.

RESULTS

Significant levels of acute fatigue were associated with working labor and delivery and medical-surgical units and working a 12-hour shift. Nurses working night shift and on the behavioral health unit showed a significantly lower ability to recover between worked shifts.

CONCLUSIONS

Fatigue threatens safety and the quality of patient care. Leaders should ensure that nurses take duty-free breaks and schedule adequate time off to recover between worked shifts.

Nurse Leaders' Experiences and Learnings Navigating Through the Chaos of a Pandemic

This article explores the experiences and learnings of 2 ambulatory care nurse leaders on the front lines of the Covid-19 pandemic using the theory "navigating through chaos" as a framework.

The Car Ride Home

As stories of dying alone from COVID-19 pervade the news, a reminder of the intimacy and love that can surround a hospice patient's last moments.

Examining Associations With Mental, Well-Being and Faith in Nurses (LIFT)

OBJECTIVE

The aim of this study was to explore the association between religion/spirituality (r/s) and mental health outcomes in hospital-based nursing staff.

BACKGROUND

The relationship between r/s and health has been studied extensively. Most frequently, r/s has been studied in association with mental health outcomes, including depression, anxiety, and distress among patients. However, hospital-based nurses suffer from the mental health effects of working in high-stress work environments. To date, little research has focused on the relationship between r/s and mental health outcomes in nurses.

METHODS

A cross-sectional online survey was completed by 207 nurses from 6 community hospitals.

RESULTS

Approximately half of the nurses sampled identified as religious, whereas nearly 75% identified as spiritual. There were significant associations between measures of r/s and mental health outcomes such as depression, anxiety, and mental well-being.

CONCLUSIONS

This whole-person assessment of nurses may inform future retention and engagement strategies focused on faith-based interventions.

Implementing an Unfolding Case Study Throughout the Nursing Curriculum to Increase Opioid Addiction Education

BACKGROUND

Opioid use disorder (OUD) will touch the careers of future generations of nurses no matter their chosen setting of work. It is critical to incorporate OUD education into the nursing school curriculum to prepare these future nurses.

METHOD

Research has shown that the unfolding case study is a beneficial pedagogical modality. It allows for the building of new information and the expansion of critical thinking by encouraging the student to assess and ask questions to receive further information.

RESULTS

An unfolding case study was created that centered on a person who develops OUD and their family. It includes simulations, activities, and discussion topics.

CONCLUSION

The unfolding case study can be integrated throughout the undergraduate curriculum from assessment to critical care. The unfolding case study can continue into the graduate program, which allows for interdisciplinary use. [J Nurs Educ. 2020;59(4):235-238.].

Original Research: Nurses' Perspectives on Caring for Patients with Do-Not-Resuscitate Orders

BACKGROUND

Confusion about what a do-not-resuscitate (DNR) order means, including its misinterpretation as "do not treat," has been extensively documented in the literature. Yet there is a paucity of research concerning nurses' perspectives on DNR orders.

PURPOSE AND DESIGN

This mixed-methods study was designed to explore nurses' perspectives on the meaning and interpretation of DNR orders in relation to caring for hospitalized adults with such orders.

METHODS

Direct care nurses on three units in a large urban hospital were asked to respond online to a case study by indicating how they would prioritize care based on the patient's DNR designation. These nurses were then invited to participate in open-ended interviews with a nurse researcher. Interviews were audiotaped, transcribed, and analyzed.

FINDINGS

A total of 35 nurses responded to the case study survey. The majority chose to prioritize palliative care, despite no indication that any plan of care was in place. Thirteen nurses also completed a one-on-one interview. Analysis of interview data revealed this overarching theme: varying interpretations of DNR orders among nurses were common, resulting in unintended consequences. Participants also reported perceived variances among health care team members, patients, and family members. Such misinterpretations resulted in shifts in care, varying responses to deteriorating status, tension, and differences in role expectations for health care team members.

CONCLUSIONS

Nurses have opportunities to address misconceptions about care for patients with DNR orders through practice, education, advocacy and policy, and research.

COVID-19: Korean nurses' experiences and ongoing tasks for the pandemic's second wave

Nurses are the largest group of healthcare workers in the world, and during the COVID-19 pandemic, nurses have been recognized worldwide as frontline warriors working hard to stem suffering, infection rates and deaths. Korean nurses experienced the effects of the pandemic earlier than in most other countries, and the work of our nurses has been recognized as a successful model in responding COVID-19. In this paper, we share the experiences of Korean nurses, including their experiences of workload, acute shortages of staff and equipment and work overload, and suggest ongoing tasks that need to be addressed to combat the pandemic's second wave and other possible waves. Specifically, the nursing issues relating to COVID-19 are critically reviewed and recommendations for each issue are suggested in terms of nursing staffing, practice and policy, as well as health policy.

Nurses' knowledge about palliative care and attitude towards end- of-life care in public hospitals in Wollega zones: A multicenter cross-sectional study

BACKGROUND

Palliative care is nowadays essential in nursing care, due to the increasing number of patients who require attention in the final stages of their life. Lack of knowledge of and negative attitude palliative care among nurses is one of the most common barriers to quality palliative care. This study, therefore, aimed to assess nurses' knowledge about palliative care and attitude toward end-of-life care in public hospitals in Wollega zones, Ethiopia.

METHODS

A multicenter institutional-based cross-sectional study design was employed to collect data from 372 nurses working in public hospitals in Wollega zones from October 02-22, 2019. A self-administered questionnaire with three different parts: Demographic characteristics of nurses, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Towards Care of the Dying (FATCOD). SPSS version 21 was used for analysis used for data analysis. The binary logistic regression test was used for analysis at p < 0.05.

FINDINGS

Our final sample size was 422 nurses (response rate = 88%). With the mean total PCQN scores (9.34), the majority of them showed an inadequate level of knowledge about palliative care. The mean total FATCOD scores (79.58) displayed a positive attitude toward end-of-life care, with 52% of respondents eager to care for a dying person and their family. Nurses who had PC service experience [AOR = 1.94 CI (1.10-3.42), p = 0.02] and had ever attended training/lecture on PC [AOR = 1.87 CI (1.01-3.46), p = 0.04] were independently associated with nurses' knowledge about PC. Similarly, nurses who had no PC service experience [AOR = 0.41, CI (0.21-0.79), p = 0.008], who read articles/brochures about PC [AOR = 1.94, CI (1.11-3.39), p = 0.01] and had provided care for a smaller number of terminally ill patients [AOR = 1.74, CI (1.01-2.97), p = 0.04] were significantly associated with nurses' attitude towards end-of-life care.

CONCLUSION

The study highlighted that nurses' knowledge about palliative care is inadequate, and showed a less favorable attitude toward end-of-life care. The findings also provide evidence for greater attentions and resources should be directed towards educating and supporting nurses caring for patients with palliative care needs in Wollega Zones.