Ethical challenges of novice nurses in clinical practice: Iranian perspective

Nurse manager support of graduate nurse development of work readiness: An integrative review

AIM

To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness.

BACKGROUND

Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment.

DESIGN

A five-step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist.

METHODS

The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework.

DATA SOURCES

MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020.

RESULTS

Studies eligible for inclusion (N = 40) represented research from 15 countries; most (67.5%, n = 27) used a qualitative design, 22.5% (n = 9) were quantitative and 10% (n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning.

CONCLUSION

The review identified a lack of robust evidence about the effectiveness of specific nurse manager-led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness.

IMPLICATIONS FOR THE PROFESSION OR PATIENT CARE

Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce.

IMPACT

What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).

Influence of experience, tenure, and organisational preparedness on nurses' readiness in responding to disasters: An exploration during the COVID-19 pandemic

Background

The coronavirus 2019 (COVID-19) pandemic has placed unprecedented challenges on the nursing practice, particularly in Poland. Nurses, as crucial healthcare service providers, have faced organisational disruptions, altered working conditions, and heightened professional anxieties.

Methods

We undertook a comprehensive survey across all medical centres in Lublin, Poland in 2020 to understand nurses' attitudes towards their roles and working conditions during the pandemic. This involved 470 nurses completing a questionnaire which focused on four pivotal areas: readiness to be on call in a disaster situation (even when not formally asked); willingness to work overtime in a disaster without additional compensation, preparedness to undertake health risks by caring for individuals with infectious diseases or exposure to hazardous substances, and willingness to be transferred to other departments during a disaster.

Results

We found that excessive workload, fear of infection, and feelings of helplessness significantly influenced nurses' readiness to work overtime, particularly when unpaid. We also presented the ethical dilemmas that nurses encountered during the pandemic and how these dilemmas affected their decision-making processes. We further explored the impact of variables such as nurses' professional experience, tenure, and level of organisational preparedness on their readiness to respond to crisis situations.

Conclusions

Gaining an understanding of nurses' perspectives is key for formulating strategies to bolster their professional engagements and resilience during crises. Addressing these issues can help build a more robust and well-prepared healthcare system that can effectively navigate future crises.

An Evaluation of Uncivil Behaviors in Clinical Learning Environments from the Perspective of Nursing Students in Western Iran in 2020

Background: Uncivil behavior in clinical learning environments is a growing challenge that severely disrupts the teaching and learning process. Objectives: The aim of this study is to evaluate the incidence of uncivil behavior in clinical learning environments from the perspective of nursing students in western Iran. Methods: In this self-report descriptive cross-sectional study in the 2020 year, 135 undergraduate nursing students of semesters 3, 4, 6, and 8, who were taking training and internship courses, were enrolled. The standard UBCNE questionnaire with 20 questions based on the Likert scale and subscales of exclusionary, hostile/rude, and dismissive behaviors constituted research tools. Data were analyzed using SPSS version 21 and descriptive and inferential statistics. Results: 103 (76.3%) trainees and 32 (23.7%) interns with a mean age of 21.53 years (1.60) participated in this study. According to the results of the Kruskal-Wallis test, the mean scores of hostile/rude, exclusionary, and dismissive behaviors and the total score in different semesters were significantly different (P < 0.001). In terms of the semester, these behaviors had the highest rate in semester 6 students and the lowest in semester 8 students. There was no statistically significant relationship between gender and the mean incidence of these behaviors in students. Conclusions: The results show the students’ experience with different behaviors in clinical settings according to different contexts. Further research is required to understand these behaviors in clinical settings better and to provide strategies to minimize such behaviors.

Trust crisis: New frontline nurse managers' ethical experience in their units

PURPOSE

To explore the ethical experiences of new nurse managers when working at their units and propose response strategies accordingly.

DESIGN AND METHODS

A qualitative approach was taken at a Grade 3A hospital in Shandong, China. Data were collected via semi-structured long interviews and analyzed using interpretative phenomenological analysis. A total of 19 new frontline nurse managers participated in the study.

FINDINGS

The sample consisted of 17 females and two males, with an age range of 40.11 ± 2.71 years and each worked in a variety of units. Trust crisis, tests on capability, and conflicts with the administration were the main ethical issues of new nurse managers, and trust crisis was the most common, especially with nurses in the unit. Eleven subthemes were also involved in these three themes.

CONCLUSIONS

New nurse managers encountered a variety of ethical conflicts and dilemmas in their first year. They should enhance their leadership to cope with the issues, and policy support at the hospital level is also needed.

CLINICAL RELEVANCE

Senior hospital managers could use these findings to design interventions that might solve new frontline nurse managers' ethical issues. And medical staff might understand the ethical experiences of new nurse managers and support them in the most critical period of role transition. Findings are conducted in the hope of facilitating new nurse managers to quickly settle into the new position, establishing a good relationship with physicians and patients and improving the quality of nursing services.

Defining ethical challenge(s) in healthcare research: a rapid review

BACKGROUND

Despite its ubiquity in academic research, the phrase 'ethical challenge(s)' appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of 'ethical challenge(s)' and closely related terms as used in current healthcare research literature.

METHODS

Rapid review to identify peer-reviewed reports examining 'ethical challenge(s)' in any context, extracting data on definitions of 'ethical challenge(s)' in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher's Index, EMBASE, CINAHL) were searched from April 2016 to April 2021.

RESULTS

393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of 'ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to 'ethical challenge(s)' within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study.

CONCLUSIONS

Only 12/72 studies contained an explicit definition of 'ethical challenge(s)', with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research.

Nurses' ethical challenges caring for people with COVID-19: A qualitative study

Background:

Ethical challenges are common in clinical nursing practice, and an infectious environment could put nurses under ethical challenges more easily, which may cause nurses to submit to negative emotions and psychological pressure, damaging their mental health.

Purpose:

To examine the ethical challenges encountered by nurses caring for patients with the novel coronavirus pneumonia (COVID-19) and to provide nurses with suggestions and support regarding promotion of their mental health.

Research design and method:

A qualitative study was carried out using a qualitative content analysis. The participants were 18 nurses who agreed to attend an interview and describe their own experiences of providing care to COVID-19 patients in China. They were purposively sampled, and structured, in-depth interviews were performed. Data were iteratively collected and analyzed from February to March 2020.

Ethical considerations:

The proposal was approved by the Research Ethics Committee of the Second Hospital of Shandong University, China.

Findings:

The findings revealed three main themes and 10 categories. The themes were the following: (1) ethical challenges (people with COVID-19, inequality, professional ethics, and job competency); (2) coping styles (active control and planning, seeking support as well as catharsis, and staying focused); and (3) impacts on career (specialized nursing skills, scientific research ability, and management skills).

Conclusion:

Nurses faced ethical challenges on multiple fronts in caring for COVID-19 patients. The results may help nurses with more safety, ethics, and humanistic care in nursing practice.