A grounded theory of clinical nurses' process of coping during COVID-19

A Psychometric Development and Evaluation of the Flow State Scale for Caregiving Tasks Among Clinical Nurses

BACKGROUND

The extensive research already conducted in numerous non-healthcare disciplines has consistently demonstrated the effectiveness of flow in alleviating work-related stress and boosting employee engagement in the workplace. Despite the potential benefits to nursing of improving flow, no valid instrument is currently available to measure the work-related flow experience of clinical nurses.

PURPOSE

This study was designed to develop the Flow State Scale for Caregiving Tasks (FSS-CT) and to evaluate its psychometric properties in the context of clinical nurses.

METHODS

This study, guided by the flow theory of Mihaly Csikszentmihalyi (1975), employed a three-phase approach to developing and evaluating the psychometric properties of the FSS-CT. Five hundred thirty-six full-time clinical nurses working in hospitals of various levels in Taiwan were recruited via cluster random sampling to participate in an anonymous online survey. The content validity of the developed scale was established through expert panel verification, criterion-related validity was assessed by correlating the scale with the Work-related Flow Inventory, and construct validity was evaluated via explanatory and confirmatory factor analyses. Scale reliability was determined using Cronbach's α coefficient.

RESULTS

The FSS-CT, a 12-item Likert scale comprising four domains, was developed. These domains capture the elements of nurses' work-related flow, including professional confidence, merging of action and awareness, balance between skill and challenge, and autotelic experience. The FSS-CT demonstrated high content validity (content validity index > .90) and satisfactory criterion-related validity (coefficient = .55, p < .001). Furthermore, the scale was found to have excellent internal consistency (Cronbach's α = .91). Factor analyses yielded a four-factor structure accounting for 69.34% of the total variance, indicating a good fit for the final model based on recommended goodness-of-fit indices.

CONCLUSIONS

The FSS-CT is a viable and dependable instrument for assessing the work-related flow experiences of nurses, with the measured outcomes offering to nursing administrators valuable insights into or directions for personnel development and work allocation initiatives.

Nurses on shacking ground-A qualitative study of Danish dermatology and allergology nurses' experiences of relocation during the COVID-19 pandemic

AIM

To investigate dermatology and allergology nurses' experiences of relocation from an outpatient clinic to a newly established COVID-19 infectious disease ward.

DESIGN

A phenomenological-hermeneutical approach was applied.

METHODS

Three focus groups with nurses were conducted from June to August 2020. Data were analysed in accordance with Ricoeur's theory of interpretation.

RESULTS

The relocation represented a challenging period that involved uncertainty and evoked feelings of excitement and dedication towards the nursing profession. Nurses felt obligated to help; however, they also experienced that they did not have a say in the relocation. The placement on the infectious disease ward was characterized by adaptations in three areas: unfamiliar working environment, unfamiliar team competencies and inadequate nursing training. E-learning training was experienced as insufficient, as it did not enhance the nurses' specific competencies or confidence in caring for patients with COVID-19.

CONCLUSION

The relocation of nurses from an outpatient clinic to a new COVID-19 infectious disease ward created a dilemma between nurses' sense of duty and their right to self-determination. A prompt relocation into a newly established unfamiliar field caused frustrations because there were no unspoken rules to rely on. Managers should take nurses' experiences and perceptions under careful consideration and strive for more involvement in future scenarios.

PATIENT OR PUBLIC CONTRIBUTIONS

No patient or public contribution.

The process through which nurses providing care to COVID-19 patients recognize professional growth: A Trajectory Equifinality Model

AIM

This study investigated the ways in which nurses caring for COVID-19 patients during the pandemic's early stages recognized professional growth through their experiences and continued working for several years, as well as the key experiences for identifying professional growth, external factors, and career intentions.

METHODS

We used a qualitative research method called the Trajectory Equifinality Model (TEM). The participants were nine nurses caring for COVID-19 patients during the pandemic's early stages and had already recognized professional growth through a series of experiences. We constructed a TEM diagram based on two interviews per participant (in February-March, and July-August 2022).

RESULTS

The process by which the participants recognized professional growth through a series of experiences was divided into Phases 1-4. The participants experienced adversity in Phases 1 and 3, and the following professional growth in Phases 2 and 4: gaining confidence as a nurse performing tasks of great social significance by acquiring the ability to fulfill my roles and realizing I could use the skills I had acquired by providing nursing care to COVID-19 patients in other situations, respectively. The key experiences for identifying professional growth as well as the inhibiting and facilitating factors of the process differed depending on the phase. The participants' career intention was wanting to continue to be involved in nursing by utilizing the skills and experience I have accumulated.

CONCLUSION

Managers and directors of nursing should provide appropriate support in each phase to help nurses recognize their professional growth during emerging epidemics.

Experiences of Pain Management Nurses during the COVID-19 Pandemic: A Qualitative Study

BACKGROUND

The knowledge and skills of pain management nurses positions them well to manage people's pain and provide critical services to patients with COVID-19.

AIM

To understand the personal and professional experiences and the support pain management nurses received during the COVID-19 pandemic.

METHODS

Between July 2020 and 2021, data were collected through semi-structured telephone interviews from members of the American Society for Pain Management Nursing. Content analysis was used.

RESULTS

Eighteen pain management nurses who worked during the early stages of the pandemic were interviewed. Three main categories were identified: experiencing stress and burden, pain management strategies changed, learning to cope with support. Pain management nurses reported fear of exposure, difficulties with staff shortages, the complex social milieu, and how pain management took a backseat to other symptoms of COVID-19. They coped through support from their colleagues, organizational leaders, and community members. Pain management nurses provided recommendations for future care of patients' pain during a pandemic.

CONCLUSIONS

Pain management nurses shared their professional and personal experiences and the support they received while managing patients' pain during the COVID-19 pandemic. Their experiences provided findings on the importance of pain management and to support nurses during personal and professional vulnerabilities during crises. Key recommendations on the care of patients' pain in future pandemics included developing expertise in pain management and health-related emergencies; engaging nurses in supportive mental health services, infectious disease testing, and vaccine efforts; and planning for surge capacity to reach out to underserved people living with pain.

Work-related psychosocial challenges and coping strategies among nursing workforce during the COVID-19 pandemic: a scoping review

BACKGROUND

Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O'Malley's review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them.

METHODS

We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria.

RESULTS

Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping.

CONCLUSIONS

The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

A Psychometric Validation of the Korean Version of Disaster Response Self-Efficacy Scale for Nursing Students

Nurses are very important healthcare providers in disaster situations, and from undergraduate nursing students to professional registered nurses, such practitioners should focus on strengthening their disaster-response-related self-efficacy and competency. The purpose of this study was to develop a Korean version of the Disaster Response Self-Efficacy Scale (DRSES-K) and evaluate its psychometric properties. The DRSES was translated into Korean and developed based on the translation and adaptation of instruments suggested by the World Health Organization. Data were collected from 30 October to 23 November 2020. A total of 209 undergraduate nursing students participated in this study. Psychometric properties were assessed using the programs SPSS/WIN 29.0, AMOS 26.0, and Winsteps 3.68.2, with which Rasch model analysis was carried out. The DRSES-K fit was sufficiently suitable for the unidimensional Rasch model with acceptable goodness of fit (χ2/df = 2.20 (p < 0.001), CFI = 0.92, IFI = 0.92, TLI = 0.91, AGFI = 0.82, and RMSEA = 0.07). The DRSES-K was significantly correlated with the measure of preparedness for disaster response, so concurrent validity was satisfied. The findings in this study suggested that the DRSES-K is a scale with verified validity and reliability. It is expected that the DRSES-K will be used for disaster nursing education to strengthen the competency of undergraduate nursing students.

Perspectives of family-centred care at the end of life during the COVID-19 pandemic: A qualitative descriptive study

AIM

To explore nurses' and family members' perspectives of family care at the end of life, during restricted visitation associated with the COVID-19 pandemic.

BACKGROUND

To minimise the transmission of COVID-19, stringent infection prevention and control measures resulted in restricted hospital access for non-essential workers and visitors, creating challenges for the provision of family-centred care at the end of life.

DESIGN

Qualitative descriptive approach based on naturalistic inquiry.

METHODS

At a large public hospital in Melbourne, Australia, individual semi-structured interviews were undertaken with 15 registered nurses who cared for patients who died during restricted visitation associated with the COVID-19 pandemic, and 21 bereaved family members. COREQ guidelines informed analysis and reporting.

RESULTS

Five themes developed from the data: (i) impact of visitor restrictions, which describes uncertain, ambiguous and arbitrary rules, onerous and inconsistent requirements; (ii) nurse-family communication; (iii) family-centred care and interrupted connections; (iv) well-being and negative emotions; and (v) suggestions for a better way, such as moving away from the black and whiteness of the rules, prioritising communication, compassion and advocacy.

CONCLUSIONS

Negative consequences for communication and the patient-family connection at the end of life were felt deeply. The evolving COVID-19 rules that were frequently revised and applied at short notice, and the subsequent consequences for clinical practices and care were felt deeply.

RELEVANCE TO CLINICAL PRACTICE

Technology-facilitated communication, innovation and increased resources must be prioritised to overcome the challenges described in this study. A family-centred approach to care and emphasising the patient-family connection at the end of life is fundamental to minimising trauma and distress associated with future public health emergencies.

PATIENT OR PUBLIC CONTRIBUTION

Bereaved family members contributed their first-hand experience. Members of the health service's patient experience team ensured the research was conducted in accordance with health service guidelines for patient and public contribution.

The moderating role of social support on workplace violence and stress among psychiatric nurses

Exposure to violent acts is considered one of the major stressful events psychiatric nurses are exposed to. Social support has been found to reduce nurses' stress and alleviate their experience of workplace violence; however, no accounts are available on whether social support moderates the relationship between workplace violence and stress. Therefore, the aim of this study was to examine the moderating role of social support on workplace violence and stress among psychiatric nurses. A cross-sectional descriptive and predictive design was utilized. A total of 195 psychiatric nurses were recruited from two governmental mental health hospitals. The results showed that psychiatric nurses were frequently exposed to violence, both verbally and physically, whether during their entire career or within the past 12 months. Verbal violence was more common among participants than physical abuse. Male nurses and nurses working mix-shift were more likely to experience violent acts. Regression analysis showed that only workplace violence and social support predicted psychiatric nurses' stress. On the other hand, social support did not moderate the relationship between workplace violence and stress. Further research is needed to investigate whether similar findings will conform with the results of this study. Meanwhile, healthcare institutions need to implement strategies to reduce or prevent nurses' exposure to workplace violence and lower their stress levels. Mobilizing and activating social support resources at work are considered other avenues to reduce stress experienced by psychiatric nurses.

United States nurses' experiences during the COVID-19 pandemic: A grounded theory

OBJECTIVE

The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored.

DESIGN

A qualitative study design was used.

METHODS

Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty-three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study.

RESULTS

The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self-care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping.

CONCLUSIONS

Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses face added distress as frontline at-risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions.

Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies

Background

Aim

Method

Results

Conclusion

COVID-19-A Qualitative Orthopaedic Nurse Perspective

In response to a March 2020, New York State mandate, our elective surgery center began a physical and operational transformation to provide inpatient care to COVID-19 patients. Research study aims included (1) a description of the orthopaedic nurses' experience during the pandemic, and (2) tactics used to cope with related stress. Researchers used a descriptive, qualitative design to achieve study aims. During April to December 2020, nine nurses responded to seven open-ended, study prompts asking them to journal their thoughts about the pandemic. The majority (66%) of participants were experienced nurses and all provided direct patient care. Nurses provided 51 journal entries that generated 12 themes, which encapsulated their experience living through the pandemic: (1) Whirlwind, (2) War, (3) Control, (4) Death and Dying, (5) Staying Safe, (6) Loss, (7) Looking for Meaning, (8) Whatever It Takes, (9) Adaptability and Resilience, (10) What I Have Learned, (11) The New Normal, and (12) When Will This Be Over? Orthopaedic nurses in this study pivoted to the needs of patients requiring them to draw on all their training and resources. Nurses described the enormity and taxing nature of the viral threat and their ability to manage their well-being while caring for patients and loved ones, amidst social distancing and need for aggressive infection control. Support from peers and leadership were paramount factors in nurse coping. Positive thinking and personal resilience were considered essential. Most participants described personal growth; however, decreased participation in journal responses overtime, suggested emotional strain. Future studies should examine nurses' observations about the impact of changes to their practice brought on by the pandemic, and reliance on technology.

Factors affecting the professional functioning of health care workers during the COVID-19 pandemic: A cross-sectional study

AIM

To examine personal and organisational factors related to professional functioning of nurses and physicians during the COVID-19 pandemic.

BACKGROUND

Exposure to COVID-19-related stressors has been associated with lower self-reported professional functioning among health care workers.

METHODS

A cross-sectional study among 115 hospital workers during the COVID-19 pandemic in Israel was designed to explore (a) personal professional functioning, (b) clarity of guidelines, (c) work organisation by the management, and (d) health care workers' feeling of contribution to a global effort.

RESULTS

A feeling of contribution to a global effort while treating patients with COVID-19 mediated the relationships between work organisation by the management and professional functioning (β = .05, p < .05). The clarity of guidelines for routine procedures (β = .21, p < .05) and a feeling of β contribution to a global effort (β = .34, p < .01) positively predicted professional functioning of nurses and physicians during COVID-19 pandemic (R2  = .19, p < .01).

CONCLUSIONS

In order to achieve optimal functioning of health care workers in an emergency, managers should provide clear guidelines and promote workers' feelings of contribution to a global effort.

IMPLICATIONS FOR NURSING MANAGEMENT

The provision of clear guidelines and protocols is essential for efficient emergency management. Expressing appreciation for health care workers and providing positive feedback may improve professional functioning.

The Helicopter Transports of Patients Critically ill with COVID-19

Objective

The aim of our study was to describe specialist nurses’ experiences with the helicopter transport of patients critically ill with COVID-19.

Method

Our study followed a descriptive qualitative design anchored in the naturalistic paradigm and was based on qualitative content analysis. The study followed the consolidated criteria for reporting qualitative research.

Results

Six semi-structured interviews were conducted with specialist nurses who have cared for patients critically ill with COVID-19 during helicopter transport. The analysis of the interviews resulted in three themes—designing new routines before transport, working under new conditions and post-transport and reflections—with 11 categories. The goal of the intensive care transport of patients with COVID-19 was twofold: to prevent the spread of infection by using personal protective equipment and to prevent the contamination of the helicopter.

Conclusion

For the nurses, working in personal protective equipment created a feeling of distance from patients that compromised patient–nurse intimacy. Our results suggest that ensuring the sufficiency of equipment required in the event of major accidents and pandemics is critical.

Critical care nurses’ moral sensitivity during cardiopulmonary resuscitation: Qualitative perspectives

Background

Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients’ unconsciousness. In such circumstances, nurses’ ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance.

Objective

This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR.

Research design and methods

This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach.

Participants and research context

In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed.

Ethical considerations

This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences.

Findings

Four themes and 12 sub-themes were extracted from the analysis of the data, including “Consciously and compassionate attention to resuscitate the patient,” “Awareness of families’ anxiety,” “Understanding the teamwork and interactive guidance of the CPR process,” and “Compulsory violation of moral principles.”

Discussion

It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR.

Conclusion

identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions.

Hospital nurses' experiences of and perspectives on the impact COVID-19 had on their professional and everyday life-A qualitative interview study

Aim

To explore how hospital nurses experienced their work situation during the COVID‐19 pandemic and how this affected the conduct of their professional and their everyday life.

Methods

Interviews using critical psychology. A total of 24 nurses participated, representing departments of both medicine and surgical specialties. All nurses worked either in the department where they are usually stationed or were recruited from other departments to the COVID‐19 department.

Results

Five themes were identified: (1) COVID‐19 had importance to nurses' sense of self as a nurse; (2) a new solidarity developed; (3) professional reflections—caring for patients; (4) the importance of recognition and humiliation and (5) COVID‐19 had consequences for the nurses' conduct of everyday life.

Conclusion

The findings showed that some nurses caring for patients with COVID‐19 experienced a new solidarity with their colleagues. Other nurses found it to have a negative impact on their conduct of their professional life.