Exploring nursing managers' perceptions of nursing workforce management during the outbreak of COVID-19: a content analysis study

Comparison of Alabama Nurse Experiences Between Practice Areas During the Early COVID-19 Pandemic

BACKGROUND

According to the Total Worker Health® framework, safety culture including a reasonable workload among healthcare workers is essential to the security and well-being of patients, staff, and healthcare organizations. Evaluating the impact of the pandemic on the nursing workforce in different practice areas is critical for addressing workforce health and sustainability. The purpose of this study was to compare work and selfcare experiences among Alabama nurses between practice areas and the early pandemic years (2020 vs. 2021).

METHODS

A secondary analysis of cross-sectional Alabama State Nurses Association (ASNA) survey data was conducted. Kruskal-Wallis analysis of variance, Wilcoxon rank, and false discovery rates were examined.

RESULTS

There were 1,369 and 2,458 nurse survey responses in 2020 and 2021, respectively. By 2021, nurses reported worsening staff shortages, a greater need for retired and new graduate nurses to help with the workload burden, and perceptions of heavier emergency department workloads. Lower proportions of nurses reported the ability to engage in self-care activities and satisfaction with state and federal crisis management. Intensive care nurses were more likely to report staffing shortages while also reporting the lowest ability to engage in self-care.

CONCLUSIONS

Overall, the Alabama nursing workforce perceived worsening work conditions in 2021 compared to when the pandemic began. Practice areas varied greatly in their responses, with acute and intensive care areas perceiving more difficult work conditions. Total Worker Health® programs should be designed to promote and support nurses' well-being based on their experience and the needs of specific practice areas.

Exploring the effects of the COVID-19 pandemic on nurse managers

BACKGROUND

Research shows that front-line nurses' workload and stress levels increased during the coronavirus disease 2019 (COVID-19) pandemic, however, there is little research of these factors in relation to nurse managers. Previous research undertaken in Austria found that some nurse managers working in nursing homes undertook clinical as well as managerial functions during the pandemic, a double burden that could have increased their stress levels and have had adverse psychological, physical and social consequences.

AIM

To investigate the effects of the COVID-19 pandemic on nurse managers' workload, perceptions of teamwork and stress levels, and the physical, psychological and social consequences of working during the pandemic.

METHOD

A cross-sectional design was used. Respondents (n=238) were sent an online questionnaire during the second wave of the pandemic (which in Austria was November 2020 to March 2021) containing questions on demographics and fear of infection, their current workload compared with pre-pandemic workload, their perceptions of the influence of the pandemic on teamwork, their levels of stress measured using the Perceived Stress Scale (PSS), and the physical, psychological and social consequences of working during the pandemic.

RESULTS

Most respondents (95%) had to undertake more or much more work than usual during the pandemic, while just over half (52%) perceived that the influence of the pandemic on teamwork had been positive throughout or partially positive. Overall, the respondents' level of stress was moderate, as measured by the PSS. Around 28% of respondents were afraid of infecting someone other than themselves, notably their families, employees and patients. Fear for themselves, their families and their patients or residents were commonly reported psychological consequences of working during the pandemic, while confusion due to information overload was the second most commonly reported psychological consequence.

CONCLUSION

Comparing results with previous research is difficult due to the lack of research of nurse managers' experiences of the pandemic. Fear appears to have been a major issue for nurse managers during the pandemic, particularly in relation to infection and information overload. This emphasises the need for healthcare organisations to focus on the mental health and well-being of nurse managers, as well as front-line staff, during and after crisis situations such as a pandemic. Organisations may consider reworking and adopting already-established COVID-19 regulations, schedules and local guidelines, particularly in terms of communication and infection control, which could help to reduce nurse managers' fear in future crisis situations.

Structural Equation Modeling Analysis on Associations of Moral Distress and Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of Healthcare Professionals

OBJECTIVE

Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)-perceived psychological safety, ethical climate, patient safety-and healthcare professionals' perception of moral distress.

DESIGN

Cross-sectional survey.

SETTING

Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States.

PARTICIPANTS

Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study.

MAIN OUTCOME MEASURES

Three dimensions of OCHC were measured using validated questionnaires: Olson's Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality's Patient Safety Culture Survey, and Edmondson's Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM).

RESULTS

Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (β= -0.357, p <.001) and patient safety culture (β = -0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (β = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82).

CONCLUSIONS

We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations.

Ethical Challenges to the Self-care of Nurses during the Covid-19 Pandemic

BACKGROUND

The emerging working conditions triggered by the COVID-19 pandemic have imposed numerous ethical challenges on the nurses, which, in turn, can negatively impact the nurses' physical and mental health, and thus their work performance through intensifying negative emotions and psychological pressures.

AIM

The purpose of this study was to highlight the nurses' perceptions of the ethical challenges that they faced regarding their self-care during the COVID-19 pandemic.

RESEARCH DESIGN

A qualitative, descriptive study with a content analysis approach.

PARTICIPANTS AND RESEARCH CONTEXT

The data were collected through semi-structured interviews with 19 nurses working in the COVID-19 wards of two university-affiliated hospitals. These nurses were selected using a purposive sampling method and the data were analyzed using a content analysis approach.

ETHICAL CONSIDERATIONS

The study was approved by the TUMS Research Council Ethics Committee under the code: IR.TUMS.VCR.REC.1399.594. In addition, it is based on the participants' informed consent and confidentiality.

FINDINGS

Two themes and five sub-themes were identified, including ethical conflicts (the conflict between self-care and comprehensive patient care, prioritization of life, and inadequate care) and inequalities (intra- and inter-professional inequalities).

CONCLUSION

The findings demonstrated that the nurses' care is a prerequisite for the patients' care. Considering that the ethical challenges faced by nurses are related to unacceptable working conditions, organizational support, and lack of access to facilities such as personal protective equipment, it seems essential to support nurses and provide adequate working conditions to provide patients with quality care.

Insights from the pandemic: an autoethnography of nursing clinical placement teams

BACKGROUND

Designated placement staff, including academics, professional clinical support teams and stakeholder clinical teams, are responsible for organising students' clinical placements. Disciplines have reported sustained innovations in the way placement staff work following the pandemic. There are few published reports from nursing placement staff. Aim: Understand how challenges during the pandemic, may have led to disrupting the status quo for nursing placement staff.

DESIGN

Nine academic, professional and industry nursing placement staff reflected on their daily work practices and team culture post the pandemic disruptions. The reflections were analysed using a descriptive thematic approach.

RESULTS

Staff described "a double-edged sword" balancing fatigue from the dynamic situation increasing their workloads with wanting to seize opportunities to challenge the status quo. Three themes were identified.

CONCLUSION

Clinical placement staff shared reflections are useful for identifying workplace initiatives that may enhance nursing and other disciplinary placement staff team culture and ways of working.

A test-based strategy for early return to work for health-care workers with COVID-19 during the Omicron wave, Brunei Darussalam, 2022

Objective

This paper summarizes and evaluates a test-based strategy for early return to work for health-care workers (HCWs) with mild coronavirus disease in Brunei Darussalam during the Omicron wave in February 2022 and compares the characteristics of HCWs by how long it took them to return to work.

Methods

The early return-to-work strategy involved testing on day 3 of infection with reverse transcription-polymerase chain reaction and with a rapid antigen test on days 5 and 6 or days 5 and 7. Data about infected HCWs were extracted from the Ministry of Health's public health surveillance database. Percentages and proportions were used for descriptive statistics, and Pearson's χ2 test and the paired t-test were used to compare return-to-work patterns with demographic factors and vaccination status of the HCWs, as well as between cycle threshold (Ct) values and occupational groups of HCWs.

Results

From 15 February to 15 March 2022, a total of 1121 HCWs were notified as being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Of these, 175 (15.6%) were able to return to work on day 4 of their infection, 153 (13.6%) on day 6 and 268 (23.9%) on day 7; 525 (46.8%) required 10 days of home isolation. Statistically significant associations were observed between return-to-work periods and occupational group (P < 0.01) and Ct value (P < 0.01), but not between return to work and age, sex or vaccination status.

Discussion

This test-based strategy ensured a balance between mitigating a shortage of HCWs and enabling them to return to work early without compromising their safety and that of their patients.

Perspectives of Frontline Nurses Working in South Korea during the COVID-19 Pandemic: A Combined Method of Text Network Analysis and Summative Content Analysis

PURPOSE

This study aimed to explore the perspectives of frontline nurses working during the novel coronavirus disease 2019 (COVID-19) pandemic.

METHODS

An online qualitative study was conducted using a pragmatic approach. The data were collected in August 2021. Registered Korean nurses who provided direct nursing care to patients with confirmed COVID-19 were eligible for this study. An online survey was used to gather free-text data, which were then analyzed using machine-based network analysis and summative content analysis.

RESULTS

The analysis examined the responses of 126 participants and led to the identification of six prominent themes. These themes were further classified into three distinct levels: personal, task, and organizational. The identified themes are as follows: "collapse of personal life," "being overwhelmed by the numerous roles required," "personal protective equipment was sufficiently provided, but that is not enough," "changes in interprofessional collaboration," "inappropriate workforce management," and "diverted allocation of healthcare services and resources."

CONCLUSION

Our findings highlight areas for improvement in resources, systems, and policies to enhance preparedness for future pandemics.

Nursing and Maternity in the Pandemic: A Qualitative Study from Turkey

OBJECTIVES

This study was conducted to examine the experiences and perceived challenges of nurses who are also mothers having a child during the coronavirus disease (COVID-19) pandemic.

METHODS

A descriptive phenomenological design. The study was conducted with 18 nurse mothers working at COVID-19 clinics in Turkey.

RESULTS

Nurse mothers missed their children and are worried about infecting their children. Based on content analysis, the themes of the study were determined as follows: (1) Nursing Care Process, (2) Disruption of Family Processes, (3) Nurse Mother's Perspective: Being a Child in a Pandemic, and (4) Coping with Challenges-"Searching for a solution."

CONCLUSIONS

Necessary conditions should be provided for nurses with children or family members in need of care and protocols should be made with relevant institutions.

Refining core competencies of first-line nurse managers in the hospital context: A qualitative study

Objectives

As the world moves towards a new normal, challenges continue to emerge while simultaneously inspiring us with new solutions. Strengthening the skills of first-line nurse managers (FLNMs) to fulfill a wide range of complex roles and responsibilities effectively necessitates refining core competency guidelines or standards. This study aimed to explore the perceived core competencies of Indonesian FLNMs within the context of the post-pandemic era.

Methods

The study employed a qualitative descriptive design. Face-to-face interviews were conducted in a public hospital in Indonesia from January 2022 through August 2022. Seven head nurses with direct experience managing a unit during the COVID-19 pandemic were selected. The interviews were audio-recorded, transcribed verbatim, and validated by re-listening. Data were analyzed using thematic analysis.

Results

Four main themes of the core competencies developed, including 1) managerial core competencies, 2) clinical core competencies, 3) technological core competencies, and 4) socio-emotional skills/personal traits consisting of the following: be brave, fast, patient, optimistic, consistent, and responsible.

Conclusions

The findings demonstrate that the managerial and clinical core competencies of the FLNMs must be aligned, while technological core competencies are the mediating component of both. Personal traits are essential for FLNMs as they undergird the other three core competencies and the success of the FLNMs.

Human resource management (HRM) strategies of medical staff during the COVID-19 pandemic

Healthcare workers are at the forefront of fight against COVID-19 and the managers of medical centers should develop coping strategies for the challenges caused by COVID-19, especially for health human resources in order to improve the performance of healthcare organizations. Hence, the purpose of this study is to investigate the human resource management strategies of medical staff during the COVID-19 to help them cope with the new strains of COVID-19 or epidemics of viral diseases that may occur in the future. In this study, a search was performed in the international Web of Science electronic database, using keywords such as human resource management and COVID-19. As a result, a total of 1884 articles published between January 1st, 2020 and October 22nd, 2021 were extracted. After screening the articles based on inclusion and exclusion criteria, 24 articles were selected to enter the study. Then, a scientometric analysis was performed on the content of selected articles and the results were presented in the form of tables and conceptual models. In total, 9 strategies were extracted from the selected articles including development of organizational culture, staff screening, policy-making, infection control training and monitoring the implementation of learned materials, patient management, human resource management, psychological and motivational support, communication and coordination, and digital health services. Employing comprehensive strategies to maintain the health of healthcare workers during the COVID-19 can play an effective role in reducing burnout, improving productivity and employee satisfaction, and in increasing the resilience of healthcare workers. It also has a positive effect on the patient's safety. Revision and reengineering of human resource management strategies in health and treatment organizations according to different cultures and contexts require research and investment in creative and innovative strategies.

The Experiences of Faculty Members and Medical Students of Basic Medical Sciences of Characteristics of a Competent Professor: A Qualitative Study

Background

The instructor is one of the key factors in attaining educational goals in medical education, and the instructor's competencies facilitate students' educational achievement. The present study is an attempt to explain the experiences of faculty members and students of characteristics of competent professors who play an influential role in the academic achievement of basic medical sciences students in universities of medical sciences across the country.

Methods

The present study is a conventional qualitative content analysis. Fifteen faculty members and students of medicine from Iranian universities of medical sciences from different regions of the country were selected using a purposive and then theoretical sampling. A semi-structured interview was used for data collection.

Results

In this study, four themes and nine sub-themes were extracted from interviews. The themes included "clinical knowledge", "teaching competency", "monitoring students' performance", and "cognitive-psychological arousal". The sub-themes were "clinical knowledge' including "Non-applied teaching of basic sciences and unfamiliarity of instructors of basic sciences with the clinic"; "teaching competency" including "having instructional design skills, teaching based on the psychology of learning, and professional development"; "monitoring students' performance" including "fair evaluation and valid evaluation", and "cognitive-psychological arousal" including "student support and reinforcement".

Conclusion

The present study identified the important characteristics of the competencies of professors of basic medical sciences working in Iranian medical universities. The competency of professors is essential in promoting students' educational achievement and training efficient and professional students in the field of medicine to render quality health services. The results of this study will assist administrators and educational policymakers in planning for the promotion of professors and medical education.

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.

The early impact of COVID-19 on intensive care nurses' personal and professional well-being: A qualitative study

OBJECTIVE

To describe the impact of the COVID-19 pandemic on intensive care nurses personal and professional well-being.

RESEARCH METHODOLOGY/DESIGN

A descriptive, qualitative design was used. Two nurse researchers conducted one-on-one interviews via Zoom or TEAMS using a semi-structured interview guide.

SETTING

Thirteen nurses who were working in an intensive care unit in the United States participated in the study. A convenience sample of nurses who completed a survey in the larger parent study provided an email and were contacted by the research team to participate in interviews to discuss their experiences.

MAIN OUTCOME MEASURES

An inductive approach to content analysis was used to develop categories.

FINDINGS

Five major categories emerged from the interviews: (1) We are not heroes, (2) inadequate support, (3) helplessness, (4) exhaustion, and (5) Nurses the second victim.

CONCLUSION

The COVID-19 pandemic has taken a physical and mental health toll on intensive care nurses. The impact of the pandemic on personal and professional well-being has serious implications for retaining and expanding the nursing workforce.

IMPLICATIONS FOR CLINICAL PRACTICE

This work highlights the importance for bedside nurses to advocate for systemic change to improve the work environment. It is imperative for nurses to have effective training including evidence-based practice and clinical skills. There needs to be systems in place to monitor and support nurses' mental health and encourage bedside nurses to use self-care methods and practices to prevent anxiety, depression, post-traumatic stress disorder and burnout.

Stress management protocol for nurses working in the COVID-19 wards

Purpose

Due to necessity of immediate support strategies for nurses during COVID-19 pandemic and lack of comprehensive and applied standard guidelines, the present study was conducted to develop stress management protocol for nurses working in COVID-19 wards with an approach based on the best scientific evidences.

Methods

This descriptive methodological and validation study was conducted with evidence-based approach based on Stetler model in two hospitals of Iran in 2020. In order to identify the resources of stress and the solutions provided to deal with it to design the protocol, a comprehensive literature review was performed. After extracting evidence, they were ranked based on the levels of evidence and designed as a protocol. Quality appraisal of guideline was done using AGREEII instrument by an expert panel. The applicability of the protocol was assessed by a group of nurses through focus group discussion.

Results

Out of 184 studies, 28 articles related to the topic were selected. According to the expert panel, in the AGREEII domains, Scope and Purpose (87.5%) and Applicability (70.5%) were the highest and the lowest scores respectively. The "Stress Management Protocol for Nurses Working in COVID-19 Wards" was designed in six sections, which was elaborated relative to each stress resources. Members of the focus group mostly considered the evidence-based recommendations feasible by making suggestions to some items.

Conclusion

This study emphasized the important role of proper planning by health care system officials according to the designed protocol to manage stress and increase the self-efficacy of nurses in critical situations.

Nurses' perception of solutions proposed by nurse leaders in face of COVID-19 pandemic: A cross-sectional study

AIM

To evaluate the perception of bedside nurses regarding the implementation of solutions proposed by nurse leaders for patient and employee care during the COVID-19 pandemic.

BACKGROUND

Nurse leaders have proposed solutions to better manage the challenges of the pandemic. However, multiple factors influence the transposal of actions from the tactical to the operational levels.

METHOD

This cross-sectional study was carried out in a 620-bed non-profit institution. Participants were bedside nurses who completed an online survey.

RESULTS

One hundred sixty-eight nurses participated in the study. Most of the proposed solutions were very effective and easily identified by the nurses. These solutions included adaptations of the physical structure, availability of medical supplies and adequacy of institutional protocols. The actions that stood out with low perception were adequate integration of new employees and the availability of remote work, hotel accommodations for frontline health care workers and day care for children whose parents worked at the hospital.

CONCLUSION

Bedside nurses were able to recognize most of the solutions proposed by their nurse leaders during the COVID-19 pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Tactical-level nurse leaders need constant proximity to bedside nurses and continuous elucidation of the objectives to be achieved by the strategies adopted.

Nurse managers' challenges and opportunities in the COVID-19 pandemic crisis: A qualitative descriptive study

AIM

The study was conducted to understand the experiences of nurse managers with regard to the difficulties and opportunities they encountered during the pandemic.

BACKGROUND

Although many studies have been carried out to understand how nurses were affected in the COVID-19 pandemic, there are few studies that treat the experiences of nurse managers.

METHODS

In this qualitative descriptive study with 19 nurse managers working in pandemic management at a university hospital in Turkey during the first three waves of the pandemic, data were collected between April and July 2021 using the semi-structured interview method. Content analysis was performed to analyse the data.

RESULTS

Six themes were identified with respect to the experiences of nurse managers during the pandemic. These themes were initial reactions to the crisis, ineffective crisis management, excessive workload, the moral burden in decision-making, support of colleagues and other multidisciplinary team and nurse manager empowerment.

CONCLUSIONS

The nurse managers had difficulties in their managerial roles during the pandemic. However, they also viewed the crisis as an opportunity because they were able to note the deficiencies in management at all levels of the hospital and their leadership and decision-making roles took on more importance.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers may use the results of this study to be prepared for the continuing COVID-19 pandemic and any other emergency circumstances that they may have to face in the future.

Exploring midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective: A qualitative study

AIM

The aim of this study is to explore midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective.

BACKGROUND

The World Health Organization announced the Covid-19 outbreak to be a pandemic in March 2020. Midwives worldwide were affected by this outbreak, working in risky environments, confronting the anxiety and fear of childbearing women.

METHODS

A qualitative study using thematic analysis was conducted using semi-structured interviews done over the telephone. Thirteen Labour Ward Head Nurses were interviewed, and the texts were analysed. The study took place in April 2020 during the first Covid-19 lockdown in Israel.

RESULTS

Three main themes were generated in the coding process: (a) stress, fear and anxiety, (b) joint efforts and (c) frustration.

CONCLUSION

Our study illustrates the difficulties that arose at the beginning of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use the current research to learn about actions that may assist in improving staff resilience and cohesion during times of crisis.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding the psychological impact of the Covid-19 pandemic among health care professionals is crucial for guiding policies and interventions to maintain staff's psychological well-being.

The experience of moral distress by chief nurse officers during the COVID-19 pandemic: A descriptive phenomenological study

AIM

The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic.

BACKGROUND

Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders.

METHODS

It is a descriptive phenomenological study that used content analysis.

RESULTS

Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress.

CONCLUSION

Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Extraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision-making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

Background

This study explores emergency care (EC) and other frontline healthcare worker (HCW) experiences responding to the COVID-19 pandemic in the Pacific region. The crisis has reinforced the crucial role well-trained, resourced, and supported EC providers play in supporting vital health systems and services in all global regions not only during 'business as usual' periods, but in times of tremendous stress and surge.

Methods

Qualitative data were collected from EC providers and relevant stakeholders in three research phases in 2020 and 2021. Data on the World Health Organization's (WHO) Human Resources Building Block, adapted for the Pacific EC context, was thematically analysed. Key findings were further analysed to identify enablers and barriers to effective EC pandemic management.

Findings

116 participants from across the Pacific region participated in this study. Five themes emerged: (1) EC providers performed multiple pandemic roles; (2) Importance of authorities' valuing frontline HCWs; (3) HCW mental health and exhaustion; (4) HCW tension managing stigma, personal/professional expectations, and chronic health needs; and (5) Building health and human resource capacity.

Interpretation

This study significantly contributes to the limited scientific literature on HCW experiences responding to COVID-19 across the Pacific. Recommendations arising out of this research align with consensus priorities and standards that were identified pre-pandemic by health stakeholders across the Pacific for enhancing EC system development. With limited HCWs available for many Pacific nations, it is imperative the dignity and welfare of local HCWs is genuinely prioritised.

Funding

Epidemic Ethics/WHO, Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.

Death anxiety, moral courage, and resilience in nursing students who care for COVID-19 patients: a cross-sectional study

Background

Being on the frontline of the battle against COVID-19, nurses and nursing students have been under considerable psychological stress and pressure. The present study is done to explore death anxiety, moral courage, and resilience in nursing students caring for COVID-19 patients in the south of Iran.

Methods

The present study is cross-sectional research conducted between September and December 2021. A total of 420 senior nursing students (nursing interns) who were undergoing their clinical training courses were invited to participate in the study by convenience sampling method from three hospitals affiliated with the University of Medical Sciences of Southern Iran. Data were collected using a demographics survey, Nurses’ Moral Courage Questionnaire, Connor-Davidson Resilience Scale, and Templer’s Death Anxiety Scale. 

Results

The nursing students participating in this study had a death anxiety mean score of 12.78 ± 1.17. The results showed that there was a significant and indirect correlation between death anxiety on the one hand and moral courage (r = -0.91, p < 0.001) and resilience (r = -0.89, p < 0.001) on the other in nursing students caring for patients with COVID-19. Also, it was found that there was a significant and direct correlation between the students’ resilience and moral courage scores (r = 0.91, p < 0.001).

Conclusion

The nursing students caring for COVID-19 patients had experienced high levels of death anxiety in the past few months. Considering the persistence of the COVID-19 crisis in Iran and other countries, there is an urgent need for measures to preserve and improve the physical, mental, and spiritual health of nursing students, enhance their moral courage and resilience and reduce their death anxiety.

Stress management in nurses caring for COVID-19 patients: a qualitative content analysis

BACKGROUND

Being in the frontline of the battle against COVID-19, nurses need to be capable of stress management to maintain their physical and psychological well-being in the face of a variety of stressors. The present study aims to explore the challenges, strategies, and outcomes of stress management in nurses who face and provide care to COVID-19 patients.

METHODS

The present study is a qualitative descriptive work that was conducted in teaching hospitals affiliated with Shiraz University of Medical Sciences, Iran, from June 2020 to March 2021. Sixteen nurses who were in practice in units assigned to COVID-19 patients were selected via purposeful sampling. Data were collected through semi-structured, individual interviews conducted online. The collected data were analyzed using MAXQDA 10 according to the conventional content analysis method suggested by Graneheim and Lundman.

RESULTS

The data collected in the interviews resulted in 14 subcategories under 4 main categories: providing care with uncertainty and anxiety, facing psychological and mental tension, creating a context for support, and experiencing personal-professional growth.

CONCLUSIONS

The nurses caring for COVID-19 patients needed the support of their authorities and families to stress management. Providing a supportive environment through crisis management training, providing adequate equipment and manpower, motivating nurses to achieve psychological growth during the pandemic can help them manage stress.

Lessons learned and recommendations from the COVID‐19 pandemic: Content analysis of semi‐structured interviews with intensive care unit nurse managers in the United Arab Emirates

Aim

Background

Method

Results

Conclusions

Implications for Nursing Management

Management Strategies During the COVID-19 Pandemic Crisis: The Experiences of Health Managers from Iran, Ardabil Province

OBJECTIVE

The coronavirus disease 2019 (COVID-19) outbreak is the most threatening public health challenge in the 21th century, and more than 200 countries are affected. Considering that Iran was one of the first countries influenced by the COVID-19 pandemic, this study aimed to explain the crisis management strategies during the COVID-19 pandemic in Ardabil province.

METHODS

This study used a qualitative method using content analysis in which 12 health-care managers or decision-makers involved in the management of the COVID-19 crisis were recruited through purposeful sampling. In-depth, semi-structured interviews were used to collect data, which continued until data saturation.

RESULTS

Data analysis led to nine categories, including prior preparation for the COVID-19 crisis; challenges and management of workforce shortages; benefiting from the participation of volunteer staff; challenges and strategies for physical space, supplies, and personal protective equipment (PPE); designation of referral centers for COVID-19; protocolized patient transport; benefiting from donations and charity support; management of information about COVID-19; and learning from the prior stages of crisis.

CONCLUSION

This study revealed that, in critical situations, managers use multiple and, to some extent, unique strategies for decision-making and crisis control. Therefore, the health system can use the findings of the current study for proper response to similar crises and training of future managers.

Nurse workforce scheduling: A qualitative study of Indonesian nurse managers' experiences during the COVID-19 pandemic

Background

The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources.

Objective

This study aimed to explore the experiences of nurse managers in managing staff nurses' work schedules during the COVID-19 pandemic.

Methods

A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study.

Results

Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff.

Conclusion

The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.

A systematic review of de-escalation strategies for redeployed staff and repurposed facilities in COVID-19 intensive care units (ICUs) during the pandemic

BACKGROUND

Intensive care units (ICUs) experienced a surge in patient cases during the COVID-19 pandemic. Demand was managed by redeploying healthcare workers (HCWs) and restructuring facilities. The rate of ICU admissions has subsided in many regions, with the redeployed workforce and facilities returning to usual functions. Previous literature has focused on the escalation of ICUs, limited research exists on de-escalation. This study aimed to identify the supportive and operational strategies used for the flexible de-escalation of ICUs in the context of COVID-19.

METHODS

The systematic review was developed by searching eight databases in April and November 2021. Papers discussing the return of redeployed staff and facilities and the training, wellbeing, and operational strategies were included. Excluded papers were non-English and unrelated to ICU de-escalation. Quality was assessed using the mixed methods appraisal tool (MMAT) and authority, accuracy, coverage, objectivity, date, and significance (AACODS) checklist, findings were developed using narrative synthesis and thematic analysis.

FINDINGS

Fifteen papers were included from six countries covering wellbeing and training themes encompassing; time off, psychological follow-up, gratitude, identification of training needs, missed training catch-up, and continuation of ICU and disaster management training. Operational themes included management of rotas, retainment of staff, division of ICU facilities, leadership changes, traffic light systems, and preparation for re-expansion.

INTERPRETATION

The review provided an overview of the landscape of de-escalation strategies that have taken place in six countries. Limited empirical evidence was available that evaluated the effectiveness of such strategies. Empirical and evaluative research from a larger array of countries is needed to be able to make global recommendations on ICU de-escalation practices.

Experiences of Nurse Managers during the COVID-19 Outbreak in a Selected District Hospital in Limpopo Province, South Africa

The South African health care system was hard hit by the second wave of Coronavirus disease (COVID-19), which affected nurse managers as healthcare facilities became overwhelmed due to an increased workload emanating from the overflow of admissions. Therefore, this study sought to explore and describe the nurse managers’ experiences during COVID-19 in order to identify gaps and lessons learnt. A descriptive phenomenological research approach was used to explore the experiences of ten nurse managers who were purposively selected from different units of a selected district hospital. Data was collected through telephonic unstructured individual interviews and analysed using Colaizzi’s seven steps method. The study revealed that nurse managers experienced human resource related challenges during COVID-19, worsened by the fact that vacant posts were frozen. It also emerged that there was a shortage of material resources that affected patient care. Nurse managers also indicated that COVID-19 brought a lot of administrative duties plus an additional duty of patient care. Also, nurse managers who had previously contracted COVID-19 experienced stigma and discrimination. The government needs to address resource related challenges in rural public hospitals and provide continuous support to nurse managers, particularly during a pandemic like COVID-19.

Professional and psychological perceptions of emergency nurses during the COVID-19 pandemic: A qualitative study

AIM

To explore the changing roles and responsibilities, difficulties, feelings, and coping strategies of emergency nurses during the COVID-19 pandemic.

METHODS

This study was conducted as a qualitative study using a phenomenological approach. A total of 12 emergency nurses were recruited using purposive sampling from a COVID-19-designated hospital in Konya, Turkey for qualitative study. Data were collected through semi-structured individual interviews in January 2021. The data were analyzed using the content analysis method with the MAXQDA 2020 software program. The study conforms to the consolidated criteria for reporting qualitative research checklist.

RESULTS

Four theme categories emerged from the data analysis: (a) "Increasing roles and responsibilities as an emergency nurse"; (b) "Difficulties of working in pandemic conditions"; (c) "Emotional responses in the pandemic"; and (d) "Strategies for coping with the effects of the pandemic". In this study, it was determined that emergency nurses had increased roles and responsibilities due to physicians being in the background, fulfilled their roles and responsibilities in a chaotic working environment, experienced many positive and negative feelings together or gradually, and applied individual coping strategies.

CONCLUSIONS

This study indicated that emergency nurses fulfilled their increasing roles and responsibilities on the frontlines in a chaotic working environment during the pandemic. Despite many negative feelings, it was determined that they tried to show psychological adjustment and resilience with a strong professional commitment and social support.

Nursing Students' Willingness and Confidence to Volunteer in a Pandemic

Introduction

The current coronavirus disease 2019 pandemic may result in shortages of health care workers in some areas of the health care system. With adequate support, nursing students could potentially play a role in easing health worker shortages.

Objective

To describe and explore nursing students' willingness and confidence to contribute to the health care workforce during a pandemic.

Methods

A mixed-methods descriptive survey design was used to explore the perspectives of second-year nursing students at an Australian University. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using directed content analysis.

Results

A total of 280 nursing students were invited to complete the survey with a response rate of 32%. The majority of the participants showed moderate to high levels of willingness to volunteer in a pandemic. Of the participants, 50% reported slight confidence that their knowledge and skills would assist them during their volunteering. Reasons that influenced students' willingness to volunteer included perception of lack of personal protective equipment, need for incentives, fear of transmitting infection to family members, barriers to volunteering, inadequate knowledge and skills to handle a pandemic situation, study and clinical placement arrangements, and disease hazardousness.

Conclusion

Most nursing students have a level of willingness to volunteer but low confidence that their knowledge and skills would assist them while volunteering in pandemic situations. Universities and health care organizations can benefit from these findings by developing strategies to increase students' willingness to volunteer, as well as their confidence in their knowledge and skills.

Exploring senior managers' perceptions of the COVID-19 Crisis in Iran: a qualitative content analysis study

BACKGROUND

Identification of the experience of senior managers in tackling biological crises can be a roadmap for future crisis management planning. The aim of the present study was to investigate the experiences of senior managers during the COVID-19 crisis.

METHODS

This is a descriptive qualitative research. Data were collected using in-depth and semi-structured individual interviews. Accordingly, 20 senior managers of medical universities with experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. Data were collected from February 2020 to May 2021. For data analysis, qualitative content analytical approach was used.

RESULTS

According to the results, 4 main themes and 10 sub-themes were obtained; they included dealing with issues and challenges in the face of COVID-19 disease (Structural challenges, Cultural challenges, Educational challenges, COVID-19 complexity); individual and managerial competencies (Individual competencies, Managerial competencies); comprehensive, accountable, and efficient management (Comprehensive and accountable management, efficient management); and professional and organizational self-efficacy (Professional self-efficacy, organizational self-efficacy) were obtained.

CONCLUSIONS

In the present study, a number of senior managers' experiences in the COVID-19 crisis management were identified. Managers and policymakers of the health system are suggested to use the results of the present study to effectively manage the crisis and improve crisis management in various health-related areas by providing an effective cultural and organizational context.

Nurses Who Are More Willing to Participate in the Fight against COVID-19: Evidence from China

When facing an infectious disease disaster, nurses’ willingness to work is critical. Nurses’ lack of willingness to work during a pandemic may worsen the shortage of health care personnel. The purpose of this study is to assess the willingness of nurses to participate in the fight against COVID-19 in China and to identify factors associated therewith. This cross-sectional study examines nurses working in 11 Chinese cities including Macau, Hong Kong, Shenzhen, Dongguan, Huizhou, Guangzhou, Zhaoqing, Foshan, Jiangmen, Zhongshan, and Zhuhai. Questionnaires were collected from 19 May to 7 August 2020. A total of 8065 questionnaires were received, of which 8030 valid questionnaires were included for analysis. A total of 53.4% of participants reported that they had signed up to support the COVID-19 pandemic response. Multivariate logistic regression analysis revealed that being single (OR = 0.72, 95% CI: 0.60–0.87), having no children (OR = 0.81, 95% CI: 0.68–0.97), possessing higher professional qualifications (OR = 1.25, 95% CI: 1.14–1.37), having a more prestigious professional title (OR = 1.68, 95%CI: 1.50–1.90), being an administrative supervisor (OR = 0.53, 95% CI: 0.45–0.63), having a higher caring dimensions inventory score (OR = 1.01, 95% CI: 1.01–1.01), working in a hospital (OR = 0.53, 95% CI: 0.39–0.72), and receiving employer-provided care training (OR = 0.77, 95% CI: 0.68–0.87) were predictive of nurses’ willingness to participate in the fight against COVID-19. We suggest that unmarried nurses should be given priority when recruiting to fight an epidemic and, for married nurses with children who are recruited to fight an epidemic, supporting measures should be provided for childcare. We suggest strengthening workplace training of caring for nurses in order to better retain and recruit qualified support for an epidemic outbreak of infectious diseases.

Impact of the COVID-19 Pandemic on Clinical Schedules and Physical and Mental Well-Being of Gastroenterology Nonphysician Healthcare Workers: A Nationwide Survey

COVID-19 was declared a pandemic in March 2020 by the World Health Organization. To minimize exposure and because of limited personal protective equipment resources, most gastroenterology practices were curtailed/modified during the surge, with slow reopening to a normal/semi-normal schedule. Gastroenterology healthcare workers have been impacted greatly by COVID-19, resulting in job and wage insecurity. The aim of our study was to understand the impact of COVID-19 on gastroenterology healthcare workers across the United States. A web-based survey, consisting of 40 questions, was disseminated among gastroenterology practices across the United States via en masse e-mails and direct contact by authors. In total, 223 gastroenterology healthcare workers completed the survey; 56.1% were from academic settings. COVID-19 impacted the work schedule of 85.2% of participants, with reduced weekly work hours (38.1%), duty reassignment (22.4%), and furlough (13.9%). Uncertainty about job and/or future wages/benefits after reopening was noted in 41%, which was significantly associated with the presence of physical (p = .021) and mental/emotional symptoms (p = .045). Worsening of pre-existing physical and/or mental/emotional conditions was observed in 53%. Inadequate personal protective equipment availability, lack of temporary housing and/or childcare facilities, as well as job insecurity appear to be the important factors leading to worsening physical/mental/emotional conditions among gastroenterology healthcare workers.

Experiences of critical care nurses fighting against COVID-19: A qualitative phenomenological study

Aim

This study sought to describe the experiences of critical care nurses caring for patients infected by coronavirus disease 2019 (COVID‐19).

Design

A qualitative phenomenological design was used.

Methods

We enrolled 15 nurses who provided care for patients infected by COVID‐19 purposively and through snowballing, using a phenomenological approach in critical care units of Iran's public hospitals between May and June 2020. The semi‐structured interviews were carried out either via face‐to‐face or telephone and were analyzed using the 7‐step method of Colaizzi.

Results

The experiences of nurses caring for patients infected with COVID‐19 were categorized into four challenges, including psychological (eight subthemes), organizational (six subthemes), social (six subthemes), and professional (five subthemes). In general, based on the current classification, there seems to be a mixture of positive and negative effects on the psychological, social, and professional challenges and the negative effect only on the organizational challenges.

Conclusions

Positive and negative emotions and experiences have coexisted for the critical care nurses since the COVID‐19 outbreak. Emotional support and psychological counseling play an important role in maintaining nurses' optimal mental health during the COVID‐19 crisis. Adequate protective equipment, financial and nonfinancial supports, effective communication, training and hiring of staff, and appropriate work shifts are also required to reduce nurses' negative experiences when providing care for the affected individuals.

A qualitative study on the experiences of the first nurses assigned to COVID-19 units in Turkey

AIM

To explore the experiences of the first nurses assigned to work in COVID-19 units with the onset of the outbreak in Turkey.

BACKGROUND

Even though the risks faced by nurses while performing a dangerous task during the epidemic are similar, their experiences may differ.

METHOD

This qualitative study was carried out with 17 nurses. The interviews were carried out individually and online. The data were analysed using Colaizzi's phenomenological method.

RESULTS

From the analyses of the data, four key themes have emerged as follows: 'needs', 'anger', 'questioning' and 'decision'. Needs include visibility, support, adaptation and sleep/rest. Nurses were angry because of their unmet expectations, feelings of injustice, and selfish and insensitive behaviours they faced. They questioned their profession and decided to either alienate from the profession or continue with the gains they had made.

CONCLUSION

This study found that nurses perceived an imbalance between their efforts and their achievements.

IMPLICATIONS FOR NURSING MANAGEMENT

This study provides evidence for nursing managers to anticipate problems that may arise both during and after the outbreak. Nurses should be made to feel that they are valued members of the health care institution, and effective strategies should be implemented to improve their perceptions of organisational justice.