Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability

Experiences of clinical nurses with medication interruption: A systematic review and qualitative meta-synthesis

BACKGROUND

Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions.

AIMS

A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals.

METHODS

Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies.

RESULTS

Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption.

LINKING EVIDENCE TO ACTION

Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

Job crafting strategies of nurse mentors as mentors and nurses and their impact on missed nursing care: A cross-sectional study

BACKGROUND

Nurse mentors face challenging circumstances because of their dual role as nurses and mentors. As nurses, they are expected to provide high-quality care for patients and as mentors, they are concomitantly engaged with developing the next generation of nurses.

OBJECTIVES

To examine the relationship between job crafting strategies and missed nursing care among nurse mentors, in their roles as nurses and mentors.

DESIGN

A cross-sectional design.

SETTING

Various wards and hospitals during 2021.

PARTICIPANTS

Eighty nurse mentors responsible for supervising nursing students.

METHODS

Participants completed on-line survey, including the MISSCARE questionnaire, the Job Crafting Scale, and control variables. SPSS was used to conduct two multivariable linear regressions.

RESULTS

As a nurse, higher enhancing structural job resources was significantly associated with lower missed nursing care, while higher enhancing social job resources was significantly associated with higher missed nursing care. As a mentor, higher enhancing structural job resources was significantly associated with lower missed care, while higher enhancing challenging job demands was significantly associated with higher missed care.

CONCLUSION

The results indicate that not all job crafting strategies are effective in maintaining high-quality care among nurse mentors. In their dual role as nurses and mentors, nurse mentors often face a Catch-22 situation, namely, meeting expectations of both students and patients. Thus, they increase their job resources and challenging demands; however, not all strategies improve the quality of care. Nursing policymakers and managers should provide tailored interventions that enhance the structural job resources of nurse mentors and avoid the use of challenging job demands and social job resource strategies when mentoring nursing students.

High demand, high commitment work: What residential aged care staff actually do minute by minute: A participatory action study

This article explores staff work patterns in an Australian residential aged care facility and the implications for high-quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector.

Institutional Constraints as an Obstacle for Prioritizing Nursing Interventions During the COVID-19 Pandemic—Critical Care Nurses’ Experiences

Introduction

The demands of the pandemic such as staff shortages and limited resources combined with new guidelines regarding infection control may have required the prioritizing of nursing interventions.

Objectives

The aim of this study was to describe critical care nurses’ experiences of prioritizing nursing interventions for patients with COVID-19 in intensive care units (ICUs) during the pandemic.

Method

A qualitative descriptive study was gathered from open-ended questions included in a cross-sectional online questionnaire. Characteristics were presented using descriptive statistics, and open-ended questions were analyzed using qualitative content analysis with an inductive approach. The study was conducted in Sweden and focused on critical care nurses working in ICUs during spring 2021 and the second year of the COVID-19 pandemic.

Results

During the COVID-19 pandemic, 87% of the critical care nurses had provided orientations for new co-workers, and 52% had supervised intensive care nursing students. In all, 70 answered the question of whether they had prioritized nursing care differently during the pandemic; 86% reported that they had and 14% had not. The qualitative analysis resulted in one theme, Institutional constraints as an obstacle for nursing interventions, with three categories: Prioritizing lifesaving interventions, Performing nursing interventions less frequently, and Not able to provide the nursing care I wish to provide.

Conclusion

Institutional constraints as an obstacle for nursing interventions is the overall theme. It illustrates how critical care nurses have been forced to prioritize, thereby not being able to provide the nursing interventions they wanted to do provide, and it describes their feelings in this situation. The nurses need recovery and possibilities for reflection. The organization must also recover and not only return to how it was before the pandemic but also to learn from recent events and take actions to reduce the long-term effects on staffing.

Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability

AIM

To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC).

DESIGN

A qualitative descriptive design.

METHODS

Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis.

RESULTS

A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.