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Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-171. [PMID: 38662367 DOI: 10.3310/twdu4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. Aim To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. Methods Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines. Data sources First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied. Results We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors. Conclusions Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being. Future work Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs. Limitations The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample. Study registration This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Justin Jagosh
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon Briscoe
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Naomi Klepacz
- School of Health Sciences, University of Surrey, Guildford, UK
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Karen Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Lloyd B, Bradshaw C, McCarthy J, Tighe SM, Noonan M, Atkinson S. Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study. Midwifery 2023; 127:103861. [PMID: 37948792 DOI: 10.1016/j.midw.2023.103861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme. DESIGN A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. SETTING AND PARTICIPANTS To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FINDINGS Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.
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Affiliation(s)
- Barbara Lloyd
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Jan McCarthy
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | | | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Sandra Atkinson
- Department of Nursing and Midwifery, University of Limerick, Ireland
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Zhang C, Wu X, Yuan Y, Xiao H, Li E, Ke H, Yang M, Zhu X, Zhang Z. Effect of solution-focused approach on anxiety and depression in patients with rheumatoid arthritis: A quasi-experimental study. Front Psychol 2022; 13:939586. [PMID: 36582330 PMCID: PMC9792673 DOI: 10.3389/fpsyg.2022.939586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Anxiety and depression are common psychological problems in rheumatoid arthritis (RA) patients. However, few effective nursing intervention models have been designed specifically to improve anxiety and depression in RA patients. Solution-focused approach (SFA) is an effective intervention method for psychosocial issues. There have been no studies involving SFA yet in RA patients. This study investigated the effects of SFA-based nursing intervention on anxiety and depression in RA patients. Methods A quasi-experimental study using a convenience sampling of RA patients was conducted. The 48 RA patients were divided into the control group (n = 24) and the experimental group (n = 24). The control group received routine nursing intervention, while the experimental group received SFA-based nursing intervention. The scores on the self-rating anxiety scale (SAS), self-rating depression scale (SDS), arthritis self-efficacy scale-8 (ASES-8), and questionnaire on patient satisfaction with nursing care were collected before and after nursing interventions. Results Between-Group Comparison: Before the nursing intervention, there was no statistically significant difference in the SDS, SAS, and ASES-8 scores between the two groups (p > 0.05). However, after the nursing intervention, the SDS and SAS scores of the experimental group were statistically significantly lower than those of the control group (p < 0.05). In contrast, the ASES-8 score of the experimental group was statistically significantly higher than that of the control group (p < 0.05). In addition, patient satisfaction with nursing care of the experimental group was better than that of the control group (p > 0.05). Within-Group Comparison: There was no statistically significant difference in the SDS, SAS, and ASES-8 scores in the control group before and after routine nursing intervention (p > 0.05). However, in the experimental group, the SDS and SAS scores before SFA-based nursing intervention were statistically significantly higher than those after SFA nursing intervention (p < 0.05), and the ASES-8 score before SFA-based nursing intervention was considerably lower than that after SFA nursing intervention (p < 0.05). Discussion SFA-based nursing intervention can effectively improve anxiety, depression, and arthritis self-efficacy of RA patients. This study broadens clinical psychological nursing intervention models for RA patients. SFA may be an effective nursing model for various psychosocial problems in the current medical context.
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Affiliation(s)
- Chunli Zhang
- Department of Nursing, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Xuehua Wu
- Department of Nursing, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Ying Yuan
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huamei Xiao
- Department of Nursing, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Erhui Li
- Department of Neonatology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Hongyan Ke
- Department of Neurology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Mei Yang
- Department of Endocrinology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Xiaodong Zhu
- Department of Oncology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China,Xiaodong Zhu,
| | - Zhicheng Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Zhicheng Zhang,
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García-Vivar C, Rodríguez-Matesanz I, San Martín-Rodríguez L, Soto-Ruiz N, Ferraz-Torres M, Escalada-Hernández P. Analysis of mental health effects among nurses working during the COVID-19 pandemic: A systematic review. J Psychiatr Ment Health Nurs 2022; 30:326-340. [PMID: 36270926 PMCID: PMC9874873 DOI: 10.1111/jpm.12880] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/28/2022] [Accepted: 10/16/2022] [Indexed: 01/27/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Working on the frontline during the pandemic has had a negative impact on the mental health of health professionals. A significant proportion experienced anxiety, insomnia, posttraumatic stress or depression. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Analysis and synthesis of the evidence of the impact of the COVID-19 pandemic on the mental health of nurses based on their work context. There exists a gap in the literature as no studies were found that analysed the effects on nurses' mental health according to the level of care they worked in (hospital-primary care-nursing home). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is an urgent need to assess and respond to the impact of COVID-19 on the physical and mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions. ABSTRACT: Introduction Health professionals have suffered negative consequences during the COVID-19 pandemic. No review has specifically addressed the impact of the pandemic on the mental health of nurses exclusively according to the work context. Aim To analyse the impact of the COVID-19 pandemic on the mental health of nurses who have worked in hospitals, primary care centres and social health centres. Method PubMed, CINAHL, PsychINFO and Cochrane databases were searched (Prospero number: CRD42021249513). Out of 706 papers, 31 studies (2020-2021) were included in the systematic review. A qualitative synthesis method was used to analyse the data. Results Most studies were conducted in hospitals or frontline settings. The prevalence of moderate-to-severe symptoms was for anxiety 29.55%, depression 38.79%, posttraumatic stress disorder 29.8%, and insomnia 40.66%. Discussion This review highlights the mental health effects among nurses working in acute hospital settings. It also evidences a data gap on mental health effects among nurses working in primary health care and in nursing homes. Implications for practice In the post phase of the pandemic, there is an urgent need to assess and respond to the impact on the mental well-being of nurses, and to monitor international policies for the improvement of nurses' working conditions.
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Affiliation(s)
- Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Irati Rodríguez-Matesanz
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain.,Primary Care Research Group, BioDonostia Health Research Institute, IIS Biodonostia, Donostia - San Sebastián, Spain
| | - Leticia San Martín-Rodríguez
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marta Ferraz-Torres
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Akgül-Gündoğdu N, Selçuk-Tosun A. Examining the relationship between solution-focused thinking skills and self-efficacy levels of nursing students in Turkey. J Prof Nurs 2021; 37:1180-1186. [PMID: 34887038 DOI: 10.1016/j.profnurs.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Learning and developing communication skills fundamental to solution-focused thinking increases the confidence of nursing students towards individuals and improves their self-efficacy, thereby enabling these students to plan appropriate care. PURPOSE To evaluate solution-focused thinking skills and self-efficacy levels of nursing students and to determine the factors affecting these variables as well as the relationship among them. METHOD This was a descriptive and correlational study. The study was conducted between March and June 2019 with 337 nursing students from two universities with different curricula. Data were collected using a "personal information form," the "solution-focused inventory," and the "self-efficacy scale." RESULTS A statistically significant positive relationship was observed in the total scores on the solution-focused inventory and self-efficacy scale and the mean scores on the completing behavior and dealing with obstacles on the self-efficacy scale. In addition, a moderate relationship (r = 0.447, p < 0.01) was observed between the total solution-focused inventory scores and mean scores of completing behavior on the self-efficacy scale. CONCLUSIONS The nursing students had above-average mean scores on the solution-focused inventory and self-efficacy scales. However the students can further enhance their problem-solving ability by improving their solution-focused skills and self-efficacy.
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Affiliation(s)
- Nurcan Akgül-Gündoğdu
- Department of Public Health Nursing, Faculty of Health Science, University of Bandirma Onyedi Eylul, Bandirma, Balikesir, Turkey.
| | - Alime Selçuk-Tosun
- Department of Public Health Nursing, Faculty of Nursing, University of Selçuk, Konya, Turkey
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Zhang D, Liao H, Jia Y, Yang W, He P, Wang D, Chen Y, Yang W, Zhang YP. Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: a quasiexperimental study. BMJ Open 2021; 11:e048611. [PMID: 34551944 PMCID: PMC8460527 DOI: 10.1136/bmjopen-2021-048611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To develop a virtual reality simulation training programme, and further verify the effect of the programme on improving the response capacity of emergency reserve nurses confronting public health emergencies. DESIGN A prospective quasiexperimental design with a control group. PARTICIPANTS A total of 120 nurses were recruited and randomly divided into the control group and the intervention group. INTERVENTION Participants underwent a 3-month training. The control group received the conventional training of emergency response (eg, theoretical lectures, technical skills and psychological training), while the intervention group underwent the virtual reality simulation training in combination with skills training. The COVID-19 cases were incorporated into the intervention group training, and the psychological training was identical to both groups. At the end of the training, each group conducted emergency drills twice. Before and after the intervention, the two groups were assessed for the knowledge and technical skills regarding responses to fulminate respiratory infectious diseases, as well as the capacity of emergency care. Furthermore, their pandemic preparedness was assessed with a disaster preparedness questionnaire. RESULTS After the intervention, the scores of the relevant knowledge, the capacity of emergency care and disaster preparedness in the intervention group significantly increased (p<0.01). The score of technical skills in the control group increased more significantly than that of the intervention group (p<0.01). No significant difference was identified in the scores of postdisaster management in two groups (p>0.05). CONCLUSION The virtual reality simulation training in combination with technical skills training can improve the response capacity of emergency reserve nurses as compared with the conventional training. The findings of the study provide some evidence for the emergency training of reserve nurses in better response to public health emergencies and suggest this methodology is worthy of further research and popularisation.
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Affiliation(s)
- Dandan Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Hongwu Liao
- Institute of Clinical Research, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yitong Jia
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Wenren Yang
- Institute of Clinical Research, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Pingping He
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Dongmei Wang
- Institute of Clinical Research, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yongjun Chen
- Institute of Clinical Research, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Wei Yang
- Institute of Clinical Research, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yin-Ping Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Selçuk Tosun A, Akgül Gündoğdu N, Taş F. Anxiety levels and solution-focused thinking skills of nurses and midwives working in primary care during the COVID-19 pandemic: A descriptive correlational study. J Nurs Manag 2021; 29:1946-1955. [PMID: 33838066 PMCID: PMC8250172 DOI: 10.1111/jonm.13334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/28/2023]
Abstract
AIMS To determine the state-trait anxiety levels and solution-focused thinking skills of primary care nurses/midwives during the COVID-19 pandemic, and to evaluate the factors affecting these variables and the determinants of state-trait anxiety levels. BACKGROUND The COVID-19 outbreak has created intense anxiety in nurses/midwives that may affect the care they provide. Nurses and midwives may manage anxiety using solution-focused thinking skills. METHODS This descriptive correlational study included 170 nurses/midwives at 61 family health centres evaluated from 1 August to 14 September 2020. RESULTS The participants' state and trait anxiety scores were above average, indicating a moderate level of anxiety and the mean total solution-focused inventory scores were at a moderate level. It was determined that 47.9% of the variance in state anxiety scores could be explained by trait anxiety, age, years of professional experience, chronic illness, type of work shift during the pandemic, follow-up of patients diagnosed with COVID-19 using computed tomography or a COVID-19 test, and whether the institution was taking necessary measures against COVID-19. There was a negative relationship between state anxiety and solution-focused inventory total score. CONCLUSION Nurses/midwives displayed a moderate level of anxiety and solution-focused thinking skills during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT Steps should be taken to improve nurses' solution-focused thinking skills to enable them to organise quickly and manage care processes successfully in extraordinary circumstances such as pandemics. Moreover, personal empowerment programmes should be recommended for nurses and midwives to help them cope with anxiety.
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Affiliation(s)
- Alime Selçuk Tosun
- Department of Public Health Nursing, Faculty of Nursing, University of Selçuk, Konya, Turkey
| | - Nurcan Akgül Gündoğdu
- Department of Public Health Nursing, Faculty of Health Science, University of Bandirma Onyedi Eylul, Bandirma, Turkey
| | - Filiz Taş
- Department of Public Health Nursing, Faculty of Health Science, University of Kahraman Maraş Sütçü İmam, Kahramanmaraş, Turkey
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