Opportunities for Nursing Science to Advance Patient Care in the Time of COVID-19: A Palliative Care Perspective

Effects of COVID on Mandated Child Abuse Reporting Among Nurses: The Mediating Role of Compassion Fatigue

Because COVID triggered elevated rates of child abuse, but diminished rates of child abuse reporting, we explored predictors of nurses' attitudes toward reporting suspected child abuse during the COVID pandemic. In particular, we expected that compassion fatigue and compassion satisfaction would mediate the effects of COVID-related stressors (i.e., exposure to COVID patient death and suffering; COVID-related family income loss; frequent direct care of COVID patients; and parental burnout) on nurses' negative attitudes toward reporting suspected child abuse. Employing chain-referral sampling, we recruited a sample of 244 registered nurses (83% White; 87% women). Supporting hypotheses, compassion fatigue mediated the effects of job-related COVID stressors (exposure to COVID patient death and suffering; COVID-related family income loss; and frequent direct care of COVID patients) on nurses' negative attitudes toward reporting suspected child abuse. In addition, among nurses who were also parents, nurses' self-reported parental burnout mediated the relation between compassion fatigue and negative attitudes toward reporting suspected child abuse. In addition, compassion satisfaction mediated the effect of nurses' parental burnout on nurses' negative attitudes toward reporting suspected child abuse.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives

BACKGROUND

Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges.

AIMS

To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves.

RESEARCH DESIGN

A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network.

ETHICAL CONSIDERATIONS

The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded.

FINDINGS

The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care.

CONCLUSIONS

Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.

COVID-19 patient care predicts nurses' parental burnout and child abuse: Mediating effects of compassion fatigue

BACKGROUND

Nurses who are also parents may be at risk not only for professional compassion fatigue, but also parental burnout - a reliable and valid predictor of child abuse and neglect. In support, recent research reveals that parents' COVID-19 related stressors predicted elevated potential for child abuse (Katz and Fallon, 2021).

OBJECTIVE

We explored the harmful effects of the COVID-19 pandemic on nurses' parental burnout, child abuse, and child neglect, as mediated by compassion fatigue (i.e., a combination of job burnout and secondary traumatic stress).

PARTICIPANTS AND SETTING

Participants were 244 nurses (M age = 32.4; 87% female) who were parents of young children (age 12 or under) recruited via chain referral sampling.

METHODS

Participants completed an anonymous survey assessing the extent to which they care for COVID-19 patients, are exposed to patients suffering and dying from COVID-19, and have lost family income due to COVID-19. We also measured their compassion fatigue, compassion satisfaction, substance abuse, spouse conflict, parental burnout, child abuse, and child neglect.

RESULTS

As hypothesized, direct care of COVID-19 patients, exposure to patient death and suffering due to COVID-19, and family income loss due to COVID-19 predicted greater compassion fatigue, which in turn, predicted greater parental burnout, child abuse, child neglect, spouse conflict, and substance abuse, (IEs ≥ 0.06, all ps < 0.05). Also, as compassion satisfaction increased, parental burnout, child abuse, child neglect, spouse conflict, and substance abuse decreased, rs ≥ -0.203, ps < 0.01.

CONCLUSIONS

Theoretical implications and practical implications for medical practice and child abuse prevention are discussed.

Empowering Nurses to Meet Challenges and Lead Palliative Care for Achieving Triple Billion Targets

Objectives

Nurses provide care to patients in all contexts and at all stages of their lives. Their contributions are crucial to meeting global goals like Universal Health Coverage (UHC) and the Sustainable Developmental Goals (SDG) which present challenges and opportunity to improve nursing services including rehabilitation and palliative care. This study identifies challenges for empowering nurses to lead palliative care and achieve triple billion targets'. Determine reasons for challenges to empower nurses. Recommends strategies to overcome challenges in order to empower nurses to lead palliative care and achieve triple billion targets'.

Materials and methods

Multiple brainstorming sessions were conducted through the Zoom platform among the three authors to 'identify challenges for empowering nurses to lead palliative care and achieve triple billion targets' and recommend strategies to overcome those challenges. Narrative literature review was conducted and experts' opinions were elicited. Identified aspects were discussed in further brainstorming sessions.

Result

Challenges and reasons for empowering nurses to lead palliative care and achieve triple billion targets' were identified and strategies to overcome those challenges were recommended.

Conclusion

Equitable, competent and compassionate palliative care is a primary tool to relieve serious health-related suffering. There is a pressing necessity to provide available, accessible, acceptable, quality, and cost-effective palliative nursing care. WHO proposed the triple billion targets to improve the health of billions where palliative care is an essential element that can be achieved only with proper identification of challenges and meticulous planning and implementation of strategies to overcome those challenges.

Nursing interventions for patients with COVID-19: A medical record review and nursing interventions classification study

PURPOSE

To describe the nursing interventions provided to patients with COVID-19 using the Nursing Interventions Classification.

METHOD

This is a retrospective study involving the review of 1,344 patient records of adults admitted to a specialty hospital for COVID-19 in Tabriz, Iran. The nursing intervention was used to classify documented nursing care and interventions provided to COVID-19-positive patients from February 20 to August 20, 2020. Data were analyzed descriptively using SPSS16.

FINDINGS

The 10 most frequently documented nursing interventions across in-patient (ward) and intensive care unit (ICU) contexts included Admission Care (7310), Environmental Management (6486), Health Education (5510), Infection Protection (6550), Medication Administration (2300), Positioning (0840), Respiratory Monitoring (3350), Vital Signs Monitoring (6680), Nausea Management (1450), and Diarrhea Management (0460). No records of distraction, relaxation techniques, or massage for anxiety reduction were documented.

CONCLUSION

This study used a common language to describe nursing interventions for patients with COVID-19 admitted to a tertiary hospital.

IMPLICATIONS FOR NURSING PRACTICE

The most commonly identified nursing interventions for COVID-19 identified in this study provide evidence-based insight into nurses' scope of practice in the COVID-19 in-patient context.

Experiences of Hospice and Palliative Nurses in Response to the COVID-19 Pandemic: A Qualitative Study

Purpose

This study aimed to explore the experiences of hospice and palliative care (HPC) nurses at inpatient hospice centers in South Korea during the coronavirus disease 2019 pandemic.

Methods

Data collection was conducted through individual interviews with 15 HPC nurses using face-to-face interviews, telephone calls, or Zoom videoconferencing. Data were analyzed using the thematic analysis method.

Results

This study found that HPC nurses experienced practical and ethical dilemmas that reinforced the essential meaning and value of hospice and palliative care. The participants emphasized their practical roles related to compliance with infection prevention measures and their roles as rebuilders of hospice and palliative care.

Conclusion

The findings of this study indicate that inpatient hospice centers must mitigate the practical and ethical dilemmas experienced by nurses, consider establishing explanation nursing units, and provide education to support nurses' highlighted roles during the pandemic. This study can be used to prepare inpatient hospice centers and the nurses that work there for future infectious disease outbreaks.

Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Music Therapy and Nursing Cotreatment in Integrative Hospice and Palliative Care

Integrative hospice and palliative care is a philosophy of treatment framing patients as whole persons composed of interrelated systems. The interdisciplinary treatment team is subsequently challenged to consider ethical and effective provision of holistic services that concomitantly address these systems at the end of life through cotreatment. Nurses and music therapists, as direct care professionals with consistent face-to-face contact with patients and caregivers, are well positioned to collaborate in providing holistic care. This article introduces processes of referral, assessment, and treatment that nurses and music therapists may engage in to address family support, spirituality, bereavement, and telehealth. Clinical vignettes are provided to illustrate how cotreatment may evolve and its potential benefits given diverse circumstances. As part of this framing, music therapy is positioned as a core-rather than alternative or complementary-service in hospice that satisfies the required counseling services detailed in Medicare's Conditions of Participation for hospice providers. The systematic and intentional partnering of nurses and music therapists can provide patients and caregivers access to quality comprehensive care that can cultivate healthy transitions through the dying process.

The Dual Epidemics of 2020: Nursing Leaders' Reflections in the Context of Whole Person/Whole Systems

The Greater Boston Nursing Collective, a consortium composed of university nursing deans and chief nursing officers within academic medical centers and specialty hospitals in Boston, Massachusetts, was formed in 2014. Since the group's inception, our mission has been to create and reinforce whole-person/whole-system healing environments to improve the health of all communities. Through our collaboration in navigating the dual epidemics of COVID-19 and structural racism within our respective organizations, and across the United States and the world, we share experiences and lessons learned. Our common mission is clearer than ever: to create safe and joyful work environments, to protect the dignity of those we are privileged to serve, and to generate policies to advance health equity to rectify societal forces that have shaped this dual epidemic. We are humbled by the many who persist despite limited rest and respite, and whose stories, innovations, and leadership we are honored to witness and share. They have defined our generation, just as nurses in earlier crises have done: leading through service to others as our purpose and privilege.

Challenges and opportunities in health care and nursing management research in times of COVID-19 outbreak

Aim

To reflect upon the concrete implications of the COVID‐19 outbreak regarding ongoing health service and nursing management research (NMR) and to identify possible research priorities for the current and post‐pandemic era.

Background

Health service research and the nursing management research debate have received little attention to date, despite their relevance in responding to the increased demand of care during the COVID‐19 outbreak.

Methods

A critical analysis on experiences was performed while leading international‐funded studies at different degrees of complexity and targets, involving nurse managers, nurses, care processes and health care services in the last year.

Results

Ongoing research projects have been profoundly affected by the COVID‐19 outbreak in their aims, methods, management processes, feasibility and outcomes.

Conclusions

The COVID‐19 outbreak is an unprecedented stress test for the health care sector and for the nursing services. Its onset and persistence have rendered more easily to see what prevails in terms of effectiveness and what fails in our health care services.

Implications for Nursing Management

Nurse managers have lived and are still living through this crisis, given their omnipresence in the health care systems. Therefore, setting NMR priorities and working together to imagine and design the post‐COVID‐19 era is essential.