Heroism and nursing: A thematic review of the literature

The paradox of workplace violence in the intensive care unit: a focus group study

BACKGROUND

Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence.

METHODS

A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals.

RESULTS

A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills.

CONCLUSIONS

This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.

A metasynthesis of nurses and midwives' experiences of clinical supervision

PROBLEM

Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce.

BACKGROUND

Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision.

AIM

To synthesise the experiences of nurses and midwives who have accessed clinical supervision.

METHODS

A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision.

FINDINGS

Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group.

DISCUSSION

For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace.

CONCLUSION

Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance.

Nurses' experiences of the role of organizational and environmental factors in the development of love of the profession: a qualitative study

BACKGROUND

Love of the profession has significant relationship with nurses' job motivation and care quality. However, there is limited information about organizational and environmental factors affecting love of the profession among nurses.

AIM

This study aimed at exploring nurses' experiences of the role of organizational and environmental factors in the development of love of the profession.

METHODS

This qualitative study was conducted in 2020-2021 using the conventional content analysis approach. Participants were Fifteen Iranian nurses with deep love of the profession, nursing instructors, and nursing managers purposefully selected from different healthcare and academic settings in seven large cities of Iran. Data were gathered via semi-structured interviews and were analyzed via the conventional content analysis method proposed by Graneheim and Lundman.

RESULTS

Organizational and environmental factors affecting the development of love of the profession were grouped into three main categories: The social context of the profession (with two subcategories), family support (with two subcategories), and organizational health (with four subcategories). Subcategories were respectively historical context of the profession, the evolving context, emotional family support, instrumental family support, quality of interpersonal relationships in the organization, level of organizational justice, level of authority delegation to nurses, and level of organizational support.

CONCLUSION

Different organizational and environmental factors can affect nurses' love of the profession development. Improving public image of nursing, providing nurses with stronger support, improving organizational climate, and strengthening interpersonal relationships in healthcare settings are recommended to develop nurses' Love of the profession.

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

OBJECTIVES

We aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice.

HYPOTHESIS/RESEARCH QUESTION

What does published literature tell us about heroism and paramedic practice?

SETTING

Paramedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes.

PARTICIPANTS

We conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied.

RESULTS

151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice.

CONCLUSION

Paramedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice.

STUDY REGISTRATION

PROSPERO: CRD42021234851.

Distress and pleasure indicators in health care workers on the COVID-19 front line

Abstract Objective to evaluate distress and pleasure indicators in health care workers on the front line of care for suspected or confirmed COVID-19 cases. Method an exploratory, analytical and cross-sectional study with a quantitative approach. The studied sample consisted of 437 health professionals invited by electronic means, who answered the questionnaire on sociodemographic information, occupational aspects and clinical conditions. Distress and pleasure at work were considered as outcomes, which were analyzed with multinomial logistic regression regarding the associated independent variables. Results Most of the participants were female (71.0%), nurses (55.6%), with a weekly working shift of 40 hours or more (75.8%); 61.6% of the participants suffered from mental distress. The psychosocial characteristics of high-strain work and low social support were reported by 23.8% and 52.9% of the participants, respectively. In the multiple analysis, distress and lack of pleasure at work were associated with high job strain, low support from co-workers and mental distress. The profession is also associated with distress at work. Conclusion distress and lack of pleasure at work are associated with occupational characteristics and mental strain among health care workers in the COVID-19 scenario.

The psychological outcomes of COVID-19 affected the pandemic-after risk perceptions of nurse clinicians: a latent profile analysis

BACKGROUND

Risk perception among nurses after the COVID-19 pandemic is a crucial factor affecting their attitudes and willingness to work in clinics. Those with poor psychological status could perceive risks sensitively as fears or threats that are discouraging. This article aimed to determine whether psychological outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia, following the COVID-19 pandemic were differentially related to the risk perceptions of nurses working in clinics and increased perceived risk.

METHOD

The participants were 668 nurse clinicians from five local hospitals. Risk perceptions and psychological outcomes were measured by adapted questionnaires via the Internet. Latent profile analysis (LPA) identified subgroups of individuals who showed similar profiles regarding the perceived risks in nursing. Multinomial regression and probit regression were used to examine the extent to which sociodemographic and psychological outcomes predicted class membership.

RESULTS

LPA revealed four classes: groups with low-, mild-, moderate-, and high-level risk perceptions. Membership of the high-level risk perception class was predicted by the severity of psychological outcomes. Anxiety significantly accounted for a moderate increase in risk perceptions, while the symptoms of insomnia, depression, and PTSD accelerated the increase to the high level of risk perception class.

CONCLUSIONS

By classifying groups of nurse clinicians sharing similar profiles regarding risk perceptions and then exploring associated predictors, this study shows the psychological outcomes after COVID-19 significantly impacted pandemic-associated risk perceptions and suggests intervening in nurses' psychological outcomes while simultaneously focusing on work-related worries is important following the outbreak of COVID-19.

Indicadores de sufrimiento y placer en trabajadores de la salud en la primera línea del COVID-19

Resumen Objetivo evaluar indicadores de sufrimiento y placer en trabajadores de la salud en la primera línea de atención de casos sospechosos o confirmados de COVID-19. Método estudio exploratorio, analítico, transversal con enfoque cuantitativo. La muestra estudiada estuvo conformada por 437 profesionales de la salud invitados por medios electrónicos, que respondieron el cuestionario sobre información sociodemográfica, aspectos ocupacionales y condiciones clínicas. Se consideraron como resultados el sufrimiento y el placer en el trabajo, que fueron analizados con regresión logística multinomial en cuanto a las variables independientes asociadas. Resultados la mayoría de los participantes era de sexo femenino (71,0%), enfermera (55,6%), tenía una jornada laboral semanal de 40 horas o más (75,8%); el 61,6% de los participantes presentaban sufrimiento mental. En cuanto a las características psicosociales del trabajo, los participantes lo consideraron de alta exigencia y bajo apoyo social, 23,8% y 52,9% respectivamente. En el análisis múltiple, la angustia y la falta de placer en el trabajo se asociaron con una alta exigencia laboral, poco apoyo de los compañeros de trabajo y sufrimiento mental. La profesión también está asociada al sufrimiento en el trabajo. Conclusión el sufrimiento y la falta de placer en el trabajo se asocian con características ocupacionales y el agotamiento mental en los trabajadores de la salud en el escenario del COVID-19.

Indicadores de sofrimento e prazer em trabalhadores de saúde na linha de frente da COVID-19

Resumo Objetivo avaliar indicadores de sofrimento e prazer em trabalhadores de saúde na linha de frente do cuidado aos casos suspeitos ou confirmados de COVID-19. Método estudo exploratório, analítico, transversal, com abordagem quantitativa. A amostra estudada foi constituída por 437 profissionais da saúde convidados por meio eletrônico, que responderam ao questionário sobre informações sociodemográfica, aspectos ocupacionais e condições clínicas. Foram considerados como desfechos o sofrimento e o prazer no trabalho, os quais foram analisados com regressão logística multinomial quanto às variáveis independentes associadas. Resultados a maioria dos participantes era do sexo feminino (71,0%), enfermeira (55,6%), com jornada de trabalho semanal de 40 horas ou mais (75,8%); 61,6% dos participantes estavam em sofrimento mental. As características psicossociais do trabalho de alta exigência e de baixo apoio social foram informadas, respectivamente, por 23,8% e 52,9% dos participantes. Na análise múltipla, o sofrimento e a falta de prazer no trabalho estiveram associados com a alta exigência no trabalho, baixo apoio dos colegas de trabalho e sofrimento mental. A profissão também está associada ao sofrimento no trabalho. Conclusão o sofrimento e a falta de prazer no trabalho estão associados às características ocupacionais e ao desgaste mental entre trabalhadores da saúde no cenário da COVID-19.

[Topic Modeling and Keyword Network Analysis of News Articles Related to Nurses before and after "the Thanks to You Challenge" during the COVID-19 Pandemic]

PURPOSE

This study was conducted to assess public awareness and policy challenges faced by practicing nurses.

METHODS

After collecting nurse-related news articles published before and after 'the Thanks to You Challenge' campaign (between December 31, 2019, and July 15, 2020), keywords were extracted via preprocessing. A three-step method keyword analysis, latent Dirichlet allocation topic modeling, and keyword network analysis was used to examine the text and the structure of the selected news articles.

RESULTS

Top 30 keywords with similar occurrences were collected before and after the campaign. The five dominant topics before the campaign were: pandemic, infection of medical staff, local transmission, medical resources, and return of overseas Koreans. After the campaign, the topics 'infection of medical staff' and 'return of overseas Koreans' disappeared, but 'the Thanks to You Challenge' emerged as a dominant topic. A keyword network analysis revealed that the word of nurse was linked with keywords like thanks and campaign, through the word of sacrifice. These words formed interrelated domains of 'the Thanks to You Challenge' topic.

CONCLUSION

The findings of this study can provide useful information for understanding various issues and social perspectives on COVID-19 nursing. The major themes of news reports lagged behind the real problems faced by nurses in COVID-19 crisis. While the press tends to focus on heroism and whole society, issues and policies mutually beneficial to public and nursing need to be further explored and enhanced by nurses.

Nurses' Perceptions of the Factors Contributing to the Development of the Love of the Profession: A Qualitative Content Analysis

As a professional value, the love of the profession can significantly affect nurses’ professional practice, behaviors and commitment. Many different factors can affect the love of the profession. The exploration of nurses’ experiences of these factors can provide valuable data for development of the love of the profession. The aim of this study was to explore nurses’ perceptions of the factors contributing to the development of the love of the profession. This qualitative study was conducted in 2020–2021 using the conventional content analysis approach. The participants were thirteen nurses with different organizational positions purposively recruited from different settings in Iran. The data were collected via semi-structured interviews, and were analyzed via the conventional content analysis approach proposed by Graneheim and Lundman. The factors contributing to the development of the love of the profession were categorized into four main categories, namely the public perception of the profession (with three subcategories), educational variables (with two subcategories), the characteristics of the profession (with four subcategories), and nurses’ self-evaluation (with three subcategories). The love of the profession is affected by a wide range of personal, educational, professional and social factors. The manipulation of these factors would help to develop nurses’ and nursing students’ love of the profession, and encourage people to choose nursing as a career.

"Feel the fear and do it anyway" … nursing students' experiences of confronting poor practice

AIM

The two aims of this study were, first, to explore nursing students' experiences and perspectives of reporting poor care and second, examine the process by which they raised concerns.

BACKGROUND

The nursing literature is replete with studies which explore nursing students' experiences of clinical placement. However only a small number explore students experiences of challenging poor care and how this is enacted in the practice setting.

SETTING AND PARTICIPANTS

Fourteen nursing students from undergraduate pre-registration nursing programs across three universities, two in the United Kingdom (UK) and one in Australia.

DESIGN AND ANALYSIS

This paper reports findings from narrative interviews about students' clinical experiences of reporting poor care. Data were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Emerging themes were identified, discussed and verified by the researchers.

RESULTS

Four montages from the narratives highlight the overarching themes: bullying, patient advocacy, lack of empathy and poor care. They demonstrate how, driven by an ethical imperative, students speak up when they witness poor care despite the difficulties of doing so: in some cases, the students in this study were prepared to continue speaking out even when initial concerns were dismissed.

CONCLUSION

Both practice and university teams have a responsibility to support students' development as ethical and courageous practitioners, able to recognize when care falls below an acceptable standard.

We are not heroes-The flipside of the hero narrative amidst the COVID19-pandemic: A Danish hospital ethnography

Aim

To explore how the media and socially established hero narrative, affected the nursing staff who worked in the frontline during the first round of the COVID19‐pandemic.

Background

During the COVID19‐pandemic, both media, politicians and the public have supported and cheered on the frontline healthcare workers around the world. We have found the hero narrative to be potentially problematic for both nurses and other healthcare workers. This paper presents an analysis and discussion of the consequences of being proclaimed a hero.

Design

Hospital ethnography including fieldwork and focus groups.

Method

Empirical data was collected in a newly opened COVID19‐ward in a university hospital in the urban site of Copenhagen, Denmark. Fieldwork was performed from April until the ward closed in the end of May 2020. Succeeding focus group interviews with nursing staff who worked in the COVID19‐ward were conducted in June 2020. The data were abductively analysed.

Results

The nursing staff rejected the hero narrative in ways that show how the hero narrative leads to predefined characteristics, ideas of being invincible and self‐sacrificing, knowingly and willingly working in risk, transcending duties and imbodying a boundless identity. Being proclaimed as a hero inhibits important discussions of rights and boundaries.

Conclusion

The hero narrative strips the responsibility of the politicians and imposes it onto the hospitals and the individual heroic health care worker.

Impact

It is our agenda to show how the hero narrative detaches the connection between the politicians, society and healthcare system despite being a political apparatus. When reassessing contingency plans, it is important to incorporate the experiences from the health care workers and include their rights and boundaries. Finally, we urge the media to cover a long‐lasting pandemic without having the hero narrative as the reigning filter.

The "nurse as hero" discourse in the COVID-19 pandemic: A poststructural discourse analysis

BACKGROUND

Nurses have been labelled "heroes" by politicians, the mass media, and the general public to describe their commitment to providing front-line care to people with COVID-19, despite the risks of exposure and lack of clinical resources. Few studies have examined the implications of the hero discourse to nurses' professional, social, and political identities.

OBJECTIVE

To critically examine the effects of the hero discourse on nurses who are contending with the ongoing COVID-19 crisis and to consider the political, social, cultural, and professional impact of this discourse on nursing work.

METHODS

A poststructural discourse analysis, employing the theoretical ideas of truth, power, knowledge, subjectivity, and normalization, was conducted to explore the mass media's constructions of nurse as hero in the contexts of COVID-19. Media electronic databases were searched between March 1, 2020 to August 1, 2020 to locate newspaper and magazine articles, corporate advertisements, videos, social media postings, and institutional/corporate websites.

SETTING

Data sources included English language media accounts that originated from Canada, the USA, and the UK.

RESULTS

Three main elements of the hero discourse include: 1. Nurses as a "necessary sacrifice" - portraying nurses as selfless, sacrificing, and outstanding moral subjects for practicing on the front-line without adequate protective gear and other clinical resources; 2. Nurses as "model citizens" - positioning nurses as compliant, hardworking, and obedient subjects in contrast to harmful individuals and groups that ignore or resist COVID-19 public health measures. 3. Heroism itself as the reward for nurses - characterizing hero worship as a fitting reward for nurses who were unappreciated pre-pandemic, as opposed to supporting long-term policy change, and highlighting how heroism reconfigures nursing work from the mundane and ordinary to the exciting and impactful.

CONCLUSIONS

The hero discourse is not a neutral expression of appreciation and sentimentality, but rather a tool employed to accomplish multiple aims such as the normalization of nurses' exposure to risk, the enforcement of model citizenship, and the preservation of existing power relationships that limit the ability of front-line nurses to determine the conditions of their work. Our study has implications for approaching the collective political response of nursing in the ongoing COVID-19 crisis and formalizing the ongoing emotional, psychological, ethical, and practice supports of nurses as the pandemic continues.