The Challenges of Nursing Presence at the Patient's Bedside from the Perspective of Nurses: A Qualitative Study

Background

Presence is one of the vital aspects of nursing care that improves the outcome of treatment, self-care, satisfaction, loneliness, and anxiety of patients. The literature review shows that most of the studies have been conducted on the conceptual analysis of the presence of nurses, while there are many challenges for the presence of nurses at the bedside. Therefore, this study aimed to determine the perceived challenges of nurses from being at the bedside of patients.

Methods

This is a qualitative descriptive study. Conventional inductive content analysis was used. Field notes and in-depth semi-structured interviews were conducted with nineteen clinical nurses. Participants were selected from general and intensive care units. Data analysis was performed using Zhang and Wildemuth approach.

Results

Three categories emerged: (1) professional challenges with subcategories: Supervision of novice nurses, insufficient skills and cultural unfamiliarity, (2) Management challenges with subcategories: managers' negligence toward nurse's needs, Strategies of nursing managers, lack of medical staff, inadequate medical facilities, inappropriate planned visits and appointments, (3) work environment challenges with sub-categories: ward overcrowding and non-standard hospital environment.

Conclusions

This study identified the challenges and obstacles of nurses' presence at the bedside in different dimensions from the perspective of clinical nurses. To increase the presence of nurses at the bedside, nursing managers should create a standardized work environment.

The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses’ statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients’ values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients’ voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients’ values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.

Teamwork competence and readiness of emergency nurses in the care of trauma patients: A multicenter cross-sectional study

INTRODUCTION

Emergency nurse's teamwork competency and readiness are crucial to improve the quality of care and patient outcome in trauma patients. This study aimed to determine teamwork competence and readiness of emergency nurses in the care of trauma patients.

METHODS

A cross-sectional study was conducted among 230 emergency nurses and nursing assistants in emergency departments of three university hospitals in Iran in 2020. Data were collected using a researcher-made questionnaire on nurses' readiness and the nontechnical skills scale.

RESULTS

The mean score for nurses' readiness was 3.55 ± 0.60 (maximum 5) and for nurses' teamwork competence was 3.49 ± 0.77 (maximum 5). The significant variables related to teamwork competency were gender and type of hospital. Emergency nurses with master's degrees, who had completed training courses of advanced trauma life support and triage, their source of information were from seminars' participations and clinical experiences, and worked at trauma hospital reported a higher level of readiness. Older age and higher work experiences were positively associated with readiness in emergency nurses.

CONCLUSION

The significant variables associated with the teamwork competence and readiness identified in this study may be used to improve the teamwork competence and readiness of emergency nurses in emergency settings.

Nurses' experiences of providing ethical care to the patients with COVID-19: A phenomenological study

INTRODUCTION

Coronavirus disease (COVID-19) is a newly emerging infectious disease that bringing a heavy workload on nursing staff.

OBJECTIVE

This study explores the nurses' experiences of providing ethical care for patients with COVID-19.

METHODS

This qualitative study was carried out based on hermeneutic phenomenology. Unstructured interviews were conducted with 18 Iranian nurses. Data were analyzed based on the hermeneutic approach using the Diekelmann approach.

RESULTS

Three themes emerged: strong clinical dilemma, flourishing of professional values, and strengthening human and organizational communication.

CONCLUSION

The findings highlight ethical care and its dimensions for COVID-19 patients. Nurses need support from health managers to provide ethical care in such health crises.

A Whirlpool of Stress in Families of Intensive Care Unit Patients: A Qualitative Multicenter Study

BACKGROUND

Family members of patients admitted to the intensive care unit must tolerate high levels of stress, making them emotionally and physically vulnerable. However, little is known about the kinds of stress family members may experience.

OBJECTIVE

To explore perceived stress in the families of patients admitted to the intensive care unit.

METHODS

This qualitative content analysis study involved 23 family members of patients admitted to intensive care units. Participants were drawn from family members of patients hospitalized in intensive care units of 3 public and 2 private hospitals. Data were collected through semistructured interviews.

RESULTS

Three themes emerged from the data: "distrust," "repeated stress exposure," and "a whirlpool of persistent negative emotional-physical state." The first theme had 2 categories: "fearful mindset" and "negative beliefs about professional caregivers." The second theme also had 2 categories: "fear of the future" and "sustained accumulation of tensions." The third theme had 3 categories: "impaired mental health," "impaired physical health," and "impaired family function."

CONCLUSIONS

The findings of this study may help critical care nurses better understand the nature and sources of family stresses during a patient's intensive care unit stay. Supervisory nurses should alert their staff to these issues so that family care programs can address them, thereby reducing family members' risk of posttraumatic stress disorder and post-intensive care syndrome-family.

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.