Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping

Relationship between Resilience and Social and Organizational Support among Nurses Working with COVID-19 Patients: A Cross-Sectional Study

Background

One of the coping strategies in stressful situations effectively is resilience skills. Due to the coronavirus disease 2019 (COVID-19) pandemic and its resulting stresses, this study was conducted to determine the relationship between resilience and social and organizational support among nurses working with COVID-19 patients.

Materials and Methods

A cross-sectional study was undertaken on 224 nurses working with COVID-19 patients in Iran in 2021. A demographic questionnaire, the Connor-Davidson Resilience Scale, Multidimensional Scale of Perceived Social Support, and Survey of Perceived Organisational Support were used for data collection. Data analysis was performed using descriptive and interpretive statistics (Pearson correlation coefficient test and linear regression).

Results

The mean [Standard Deviation (SD)] resilience score was 65.86 (14.01). In addition, the mean (SD) scores of organizational support and social support were 21.57 (4.46) and 65.10 (10.93), respectively. The Pearson correlation coefficient test results showed a statistically significant direct relationship between social support and resilience (r = 0.41, p < 0.001). In addition, there was a statistically significant relationship between organizational support and resilience (r = 0.16, p = 0.01). Multivariate linear regression analysis showed that for each unit increase in social support and organizational support scores, resilience scores increased by 0.41 (p = 0.01) and 0.15 (p < 0.001) units, respectively.

Conclusions

The results of the present study showed a direct relationship between resilience and social support and organizational support in nurses. Due to the prolongation of the COVID-19 pandemic and the high prevalence of the disease in our country, nursing managers should seriously consider measures to protect their staff.

Non-technical skills needed by medical disaster responders- a scoping review

BACKGROUND

There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response.

METHOD

A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed.

RESULTS

From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles.

CONCLUSION

Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.

Predicting nurses' safety compliance behaviour in a developing economy, using the theory of planned behaviour: A configurational approach

AIM

The study's main objective was to use a fuzzy set qualitative comparative analysis to identify the configuration of recipes that predict nurses' safety compliance behaviour.

DESIGN

A cross-sectional design.

METHODS

A survey was used where questionnaires were collected from 285 nurses across four primary healthcare hospitals within the Ashanti Region, Ghana. The data collection happened between June 1 to August 2, 2022. A fuzzy set qualitative comparative analysis was used to identify the recipes of psychological factors that determine nurses' safety compliance behaviour.

RESULTS

Results from the study suggest that the necessary configurations that explained nurses' safety compliance behaviour came from the presence of subjective norm, attitude, perceived behavioural control, perceived organizational support and negation of intention. The result highlights the need for safety protocols to be conscious of the interplay between nurses' assessment of self, social clues and perception of management care and support since such psychological factors must be considered concurrently to achieve the optimal safety compliance behaviour among nurses.

CONCLUSION

A health and safety protocol that fails to recognize the importance of psychological antecedents on subordinates' safety compliance behaviour could limit the safety policy's usefulness in bringing the appropriate behavioural change in nurses.

IMPACT

To date, no study has combined the antecedents of theory planned behaviour with perceived organizational support and cue to action to assess how they collectively predict nurses' safety compliance behaviour. Findings from the study suggest that nurses in primary health facilities inform their safety compliance behaviour by assessing self-capabilities, social signals from superiors and colleagues and perception of management support. Hospital administrators and nursing managers in sub-Saharan Africa may rely on these psychological forces to persuade nurses to develop positive safety compliance behaviour at the health facility.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Effects of sleep duration, perceived organisational support and personal resilience on anxiety in non-hospitalised residents during the COVID-19 pandemic: a survey study in Ningbo, China

OBJECTIVE

This study assessed the association between sleep duration, perceived organisational support (POS), personal resilience and anxiety among non-hospitalised residents during the COVID-19 pandemic in Ningbo, China.

METHODS

In this cross-sectional study, an online survey was conducted from 27 January 2023 to 5 February 2023, involving non-hospitalised residents over 14 years old in Ningbo. We received 1938 valid responses. The study used the General Demographic Characteristics Scale, the Generalised Anxiety Disorder Scale, Brief Resilient Coping Scale and the POS questionnaire.

RESULTS

Among the 1938 valid questionnaires, 1068 (55.1%) participants reported anxiety. Multivariate logistic regression analysis revealed that high organisational support (β=-0.34, adjusted OR (aOR) 0.71, 95% CI 0.51 to 0.98, p=0.038), moderate resilience (β=-0.26, aOR 0.77, 95% CI 0.63 to 0.95, p=0.013), high resilience (β=-0.67, aOR 0.51, 95% CI 0.36 to 0.73, p<0.001) and sleep duration of ≥7 hours (β=-1.00, aOR 0.37, 95% CI 0.28 to 0.49, p<0.001) were significantly associated with anxiety. Participant characteristics were not associated with anxiety.

CONCLUSIONS

During the COVID-19 pandemic, organisational support, personal resilience and adequate sleep duration were associated with anxiety among non-hospitalised residents. These findings highlight the importance of increasing organisational support, implementing interventions that promote resilience and stress management, ensuring sufficient rest and sleep duration, and helping residents better manage anxiety.

Digitally shaped ethnographic relationships during a global pandemic and beyond

Social distancing and public safety measures enacted in response to COVID-19 created a surge in methodological "advice" for researchers facing disruption to fieldwork. Resources and publications frequently encouraged changes vis-a-vis digitally enhanced methods or employment of digital ethnography. For ethnographers, the establishment and maintenance of ethnographic relationships in pandemic contexts restricted to virtual interactions has not been thoroughly explored, leaving those trained in recruitment, rapport-building, and field engagement with fewer resources to navigate this integral topic. Here, we provide insights into how ethnographic relationships may be developed when there is limited access to the field and traditional relationship building is not possible. We argue that as ethnographic methods change and adapt, so too must perspectives on ethnographic relationship development. By closely examining ethnographic relationships confined to digital spaces in the context of the Tennessee tornado recovery amid the COVID-19 pandemic, this project sheds light on how to overcome this challenge.

Analyzing the Effects of Family Presence and Visitation Restrictions During the COVID-19 Pandemic Among Nurse Leaders and Non-Nurse Leaders

AIM

This analysis seeks to identify the effect of family presence and visitation during COVID-19 pandemic among nurses and nurse leaders.

BACKGROUND

Visitation restrictions were widespread during the initial months of the COVID-19 pandemic and were a potential source of distress for nurses. Few studies have examined sources of distress, such as visitation restrictions, among nurse leaders and non-nurse leaders.

METHODS

Secondary analysis was performed using a national survey of nurses conducted by the American Nurses Foundation.

RESULTS

More nurse leaders than nonleaders reported that nurses were involved in policy decisions/discussions and that visitation restrictions created additional burdens. There was similar level of agreement among nurse leaders and nonleaders that restrictions were not in the best interest of the patients. Many nurses reported the restrictions impacted their own well-being.

CONCLUSION

Visitation restrictions were a likely source of distress. Improvements to communication, planning, and transparency should be considered in preparation for future emergencies that may require visitation restrictions.

A practice-based nursing emergency management system model for public health emergencies: A descriptive qualitative study

AIM

This study aims to explore nursing emergency management system under public health emergencies.

DESIGN

A descriptive qualitative study.

METHOD

Semi-structured interviews were conducted during March-November 2020 with 11 nursing emergency management administrators from 11 COVID-19 designated hospitals and infectious disease hospitals under four administrative divisions in China, who were recruited through convenience and purposive sampling. Interviews were audio-recorded and transcribed. Data were analysed with Braun and Clarke's inductive thematic analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

Three main themes emerged from data analysis: (1) Five core elements of nursing emergency management system: Structure, Staff, System, Setting, and Supply (5S); (2) Four phases of nursing emergency management system: Reduction, Readiness, Response and Recovery (4R); and (3) operational process of nursing emergency management system (5S*4R). The findings generated a conceptual model of a nursing emergency management system.

PUBLIC CONTRIBUTION

This study provides a theoretical basis for nursing emergency management system for public health emergencies in the future. Nurse administrators could refer to this model to either review or develop their system and develop viable interventions to prepare for future public health emergencies.

Nurse Leader Preparation for Disasters: A Cross-sectional Survey

OBJECTIVE

The aim of this study was to evaluate nurse leader confidence in emergency management and disaster preparedness.

BACKGROUND

There is a dearth of evidence in the literature regarding the preparation of nurse leaders to manage emergencies and disasters. Research suggests significant gaps in nurse leader confidence across roles and in structured education that prepares nurse leaders across the spectrum of experience to manage in a crisis.

METHODS

An exploratory, cross-sectional survey included a sample of 432 RNs who are members of the Northwest Organization for Nurse Leaders.

RESULTS

Results indicate significant variance in nurse leader confidence across roles, experience, and previous disaster-related education. Positive associations regarding nurse leaders' confidence in managing disasters exist with more advanced positions, advanced education, and structured training.

CONCLUSIONS

Nursing leaders lack consistent education that prepares them for emergency and disaster management. Nurse leaders across all levels would benefit from formal education in these areas.

Nurses as Clinical Advisors in an Interprofessional COVID-19 Crisis Command Center

The use of nurses as clinical advisors in an interprofessional COVID-19 crisis command center proved successful. By engaging nurses as clinical advisors in the command center structure, one organization was able to facilitate optimal decisions around nursing leadership and advocacy, capacity and staffing, the development and implementation of innovative novel care models, clinical training and upskilling, and maintaining the safest possible environment for the patients and team members. Including a nurse-led clinical advisor role within future command center structures is an important strategy to reshaping how organizations effectively respond in times of crisis.

Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters

Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were often in compliance with relevant regulations around emergency planning. However, advance planning for disasters cannot anticipate every contingency, leading to the need for flexibility and quick adaptation on the part of nursing home leaders. In addition, disasters often involve larger, regional problems and situations that individual providers cannot solve. We suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management and better integrate the long-term care sector into local, state, and federal public health planning for future pandemics and other disasters.

Implications of the COVID-19 Pandemic for Youth Housing and Homelessness Services

Youth homelessness is a growing crisis in the United States that is associated with a range of adverse outcomes. A variety of social service programs exist to address youth homelessness and its consequences, such as street outreach and diversion services, emergency shelters, transitional housing programs, and rapid rehousing services, among others. The coronavirus disease 2019 (COVID-19) pandemic reached the United States in early 2020, altering nearly every facet of daily life, including the way social service organizations structure and deliver their programming. To understand the implications of the pandemic on housing and homelessness services for youth, the current study examines data from interviews conducted with staff from a large non-profit in Austin, Texas, serving vulnerable transition-age youth. Through these interviews, programmatic changes that occurred as a result of COVID-19-as well as challenges and facilitators to service delivery-were identified. This article provides an overview of these key learnings, as well as recommendations derived from these key learnings, for other organizations adapting their housing and homelessness services in response to the COVID-19 pandemic.

Health Care Worker Burnout During the COVID-19 Pandemic in HIV Clinics in Guangxi, China: A Cross-sectional Analysis of Risk and Protective Factors

ABSTRACT

Dual epidemics of coronavirus disease 2019 (COVID-19) and HIV cause burnout among HIV health care workers. Guided by a socioecological framework, we investigated risk and protective factors of their burnout in Guangxi, China based on an online survey (N = 1,029) from April to May 2020. Descriptive and bivariate analyses and hierarchical regression were conducted. COVID-19-related stressors (B = 0.648 [0.482-0.816], p < .001), challenges while delivering HIV services (B = 0.236 [0.174-0.298], p < .001), and working in province/city-level institutes (B = 2.302, [0.828-3.776], p =.002) were risk factors. Protective factors were resilience (B = -0.596 [-0.687 to -0.504], p < .001), workplace social support (B = -0.410 [-0.717 to -0.044], p =.03), and institutional responsiveness to COVID-19 (B = -0.138 [-0.205 to -0.071], p < .001), respectively. Burnout-related interventions may benefit from promoting resilience, creating a supportive work environment, and strengthening institutional response to public health emergencies.

Factors associated with anxiety and quality of life of the Wuhan populace during the COVID-19 pandemic

In December 2019, COVID-19 broke out in Wuhan, China, affecting the mental health and quality of life (QoL) of its inhabitants. This study aimed at investigating the factors associated with anxiety and QoL in the Wuhan populace during the COVID-19 pandemic. An online questionnaire survey was carried out during July 6-10, 2020. The questionnaire collected information on demography, anxiety, QoL, and social-environmental support. The main statistical methods included descriptive statistics, independent-samples t-test, one-way analysis of variance, and multivariate regression analysis. In total, 226 participants were recruited. The findings showed that females, elderly, middle-income, poor health status, shortage of medical supplies, and insufficient basic commodities were associated with anxiety significantly. Multiple regression analysis indicated that social-environmental support was significantly related to anxiety. Higher social-environmental support was significantly associated with a higher QoL. Our findings showed that the social-environmental support may reduce anxiety and improve the QoL for those living in an area heavily affected by the pandemic.

Experiences of frontline nurse managers during the COVID-19: A qualitative study

Aim

To explore experiences of frontline nurse managers during COVID‐19.

Background

The COVID‐19 pandemic has complicated care provision and healthcare management around the world. Nurse managers have had to face the challenge of managing a crisis with precarious resources. Little research has been published about the experiences of nurse managers during the COVID‐19 pandemic.

Methods

A qualitative descriptive study of 10 frontline nurse managers at a highly specialized university hospital in Spain was carried out. Semi‐structured interviews were conducted between June and September 2020. The Consolidated Criteria for Reporting Qualitative Research checklist was used for reporting.

Results

Six themes emerged: constant adaptation to change, participation in decision‐making, management of uncertainty, prioritization of the biopsychosocial well‐being of the staff, preservation of humanized care and ‘one for all’.

Conclusions

This study provides evidence for the experiences of nurse managers during the COVID‐19 pandemic. In addition, analysing these experiences has helped identify some of the key competencies that these nurses must have to respond to a crisis and in their dual role as patient and nurse mediators.

Implications for Nursing Management

Knowing about the experiences of frontline nurse managers during the pandemic can facilitate planning and preparing nurse managers for future health disasters, including subsequent waves of COVID‐19.

From Florence to fossil fuels: Nursing has always been about environmental health

BACKGROUND

Since its founding, professional nursing has applied an environmental lens to healing.

METHODS

This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice.

FINDINGS

The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice.

CONCLUSION

This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).

Nurse Leader Expertise for Pandemic Management: Highlighting the Essentials

The COVID-19 pandemic requires military nurse leaders in various patient care settings to engage in disaster response. Evidence supports essential leadership attributes for nurses that include skilled communication, organizational influence, and personnel management. Yet, nursing expertise that shapes nurse leader responsibilities during disaster management remains unclear. A description of how military nurse leaders contributed their nursing expertise during the COVID-19 pandemic response at one U.S. Military health care facility is provided to begin to delineate disaster management responsibilities.

Role of hospital leadership in combating the COVID-19 pandemic

Hospitals all around the world play an essential role in response to the COVID-19 pandemic. During an epidemic event, hospital leaders frequently face new challenges requiring them to perform unaccustomed tasks, which might be well beyond the scope of their previous practice and experience. While no absolute set of characteristics is necessary in all leadership situations, certain traits, skills and competencies tend to be more critical than others in crisis management times. We will discuss some of the most important ones in this manuscript. To strengthen those managerial competencies needed to face outbreaks, healthcare leaders should be better supported by competency-based training courses as it is more and more clear that traditional training courses are not as effective as they were supposed to be. It seems we should look at the COVID-19 pandemic as a learning opportunity to re-frame what we expect from hospital leaders and to re-think the way we train, assess and evaluate them.

Emergency department registered nurses overestimate their disaster competency: A cross-sectional study

BACKGROUND

Major incidents continue to pose a threat to health care systems by overwhelming them with a sudden surge of patients. A major factor impacting a hospital's surge capacity is the skills, abilities, and knowledge of emergency department (ED) registered nurses (RN). The level of disaster nursing competency they possess affects patient safety and outcome. ED RNs' ability to accurately assess their competency and knowledge is imperative for mitigating the effect of major incidents. ED RN's perception of overall disaster preparedness has not been thoroughly addressed. The aim of this study was to assess emergency department registered nurses' self-perceived disaster preparedness.

METHOD

The study was a cross-sectional study per the STROBE checklist. A self-assessment questionnaire based on the results of a study identifying specific disaster nursing competencies for ED RNs was distributed to all ED RNs at six participating hospitals between January 10th to February 19th of 2019. A five-point Likert-type scale was used to assess competency.

RESULTS

ED RNs' disaster preparedness according to the Total Disaster Competency mean was low. Furthermore, the results indicate that ED RNs' significantly overestimate their disaster nursing competency when compared to the Total Disaster Competency mean. Additionally, this study identified factors such as experience and education were positively associated with disaster preparedness and self-assessment ability.

CONCLUSION

ED RNs' overestimate their disaster preparedness. However, ED RNs with experience and education may be better prepared. ED RNs with formal disaster education appeared to have better insight concerning their preparedness. Clinical experience, advanced levels of education, and training were positively associated with preparedness. Overestimating disaster competencies may negatively impact patient outcomes during a major incident.

Filling the Knowledge Gap for Nurse Leaders: Next Steps Following COVID-19

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.

Experiences of nurses involved in natural disaster relief: A meta-synthesis of qualitative literature

Aim

To explore nurses’ experiences in natural disaster response.

Background

Nurses are key to disaster response. There is a growing body of qualitative research exploring this emerging nursing issue. However, there is a need to synthesise and summarise this body of knowledge to identify the overarching elements of how nurses experience working in disaster situations to reflect on their experiences so that we may help shape future clinical practice, research and education.

Design

Qualitative meta‐synthesis.

Method

Following PROSPERO guidelines (Moher et al., 2015), an exhaustive and systematic literature search and quality appraisal was undertaken in December 2019 to reveal nurses’ experiences during natural disaster response. Sandelowski and Barroso's systematic retrieval, analysis and interpretation of findings method was used to produce a meta‐summary of findings from 10 papers evaluating experiences across 9 disasters. A meta‐aggregation was used to synthesise the findings from the studies and was methodically quality assessed with PRISMA and CASP.

Results

Our findings aggregated data from 42 sub‐themes, into the following four themes to capture nurses’ experiences after responding to disasters. These included agile response; leadership and innovative problem solving; building resilience; positive communication and need for psychological/emotional support.

Discussion

This meta‐synthesis provides evidence to illustrate nurses’ resilience and leadership capabilities as means to manage and perceive their disaster relief response. Factors such as emotional intelligence, capacity to react to changing situations, to manage scant resources in extreme situations were highlighted in nurses practising in highly stressful environments. Managers can use these examples to support ways to improve disaster management policies, but also, to engage in support for their staff.

Relevance to clinical practice

The role of nursing staff in disaster rescue is receiving significant attention. Understanding nurses’ experiences during disaster rescue can help future leaders to improve capacity to respond and nursing preparedness through education, training and management, but also for continuing emotional support after the event.

COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support

Aim

This study examines the relative influence of personal resilience, social support and organisational support in reducing COVID‐19 anxiety in front‐line nurses.

Background

Anxiety related to the COVID‐19 pandemic is prevalent in the nursing workforce, potentially affecting nurses’ well‐being and work performance. Identifying factors that could help maintain mental health and reduce coronavirus‐related anxiety among front‐line nurses is imperative. Currently, no studies have been conducted examining the influence of personal resilience, social support and organisational support in reducing COVID‐19 anxiety among nurses.

Methods

This cross‐sectional study involved 325 registered nurses from the Philippines using four standardized scales.

Results

Of the 325 nurses in the study, 123 (37.8%) were found to have dysfunctional levels of anxiety. Using multiple linear regression analyses, social support (β = −0.142, p = .011), personal resilience (β = −0.151, p = .008) and organisational support (β = −0.127, p = .023) predicted COVID‐19 anxiety. Nurse characteristics were not associated with COVID‐19 anxiety.

Conclusions

Resilient nurses and those who perceived higher organisational and social support were more likely to report lower anxiety related to COVID‐19.

Implication for Nursing Management

COVID‐19 anxiety may be addressed through organisational interventions, including increasing social support, assuring adequate organisational support, providing psychological and mental support services and providing resilience‐promoting and stress management interventions.

Shared Governance During a Pandemic

When the COVID-19 pandemic struck US hospitals in early 2020, many nurse leaders went into crisis mode management. As the pandemic ensued, shared governance endured at hospitals with well-established models, even without council meetings. At other hospitals, clinical nurses began to wonder what happened to shared governance. This article offers advice and lessons learned from the interplay between the COVID-19 pandemic and shared governance at American hospitals.

Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review

OBJECTIVES

To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster.

METHODS

An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence.

RESULTS

Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks.

CONCLUSIONS

Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.