Taking care. Nursing towards Covid-19 patients during the pandemic emergency in Italy: a qualitative study

Research on missed nursing care during the COVID-19 pandemic: A scoping review

BACKGROUND

Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care.

AIM

This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic.

METHODS

This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer.

RESULTS

We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes.

LINKING EVIDENCE TO ACTION

Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.

Experiences of newly hired nurses during the Covid-19 emergency: descriptive qualitative research

BACKGROUND AND AIM OF THE WORK

The Covid-19 pandemic led to an increased demand for healthcare professionals, particularly nurses. The Piacenza Local Health Service, Northern Italy, issued several calls for tenders in order to recruit nurses and the University anticipated graduation sessions, so several new graduates nurses found themselves facing their first work experience in the middle of the pandemic emergency. It is well known that being a first-time employee causes stress, but there are few studies yet investigating the perception of newly employed nurses during the pandemic. The aim of this research is therefore to describe the experience of these nurses.

METHODS

A descriptive qualitative study was conducted through interviews. The research was approved by the 'Area Vasta Emilia Nord Ethics Committee.

RESULTS

14 nurses were interviewed and nine themes were found. Emotions, awareness, job opportunities, professional liability, organisational aspects and relationship with the other.

CONCLUSIONS

Our study shows how stress, anxiety and feelings of inadequacy characterise new nurses' entry into the workplace. Emotional support strategies, such as counselling and emergency preparedness training, could help early career professionals to cope with complex and emotionally charged clinical care situations with greater resilience.

STUDY REGISTRATION

ClinicalTrials.gov Identifier: NCT05110859.

Nurse-patient interaction during the Covid-19 pandemic: Creating and maintaining an interactive space for care

AIMS

To explore nurse-patient interactions during the Covid-19 pandemic from both nurses' and patients' perspectives.

DESIGN

Qualitative study using constructive grounded theory.

METHODS

A total of 34 patients and 49 nurses from acute and home care settings participated in individual or focus group interviews between December 2020 and May 2021. Data were analysed by a team of researchers using coding, memo-writing, theoretical sampling and constant comparison and integration.

RESULTS

We identified the creation and maintenance of an interactive space as the main social process. This interactive space was shaped by the care context and the course of the pandemic. For nurses, four factors were key, namely protecting oneself and others, navigating communication barriers, adapting nursing actions to the evolving situation, and providing emotional care work. Patients experienced attentive caring relationships with nurses and felt that, for the most part, their individual needs had been met despite the pandemic challenges.

CONCLUSION

Nurses and patients created an interactive space in which they were able to provide and receive the necessary care. Maintaining the interactive space was often challenging, and required an intentional effort by nurses, particularly in acute care settings. The findings illustrate that nurses ensured the provision of necessary care even during a public health crisis, thereby enabling patient access to good quality care.

IMPACT

Nurse-patient relationships are important for effective, person-centred care delivery. Despite the pandemic challenges, nurses managed to uphold their caring imperative and ensure quality care. Findings provide further insights on the importance of nurse-patient interaction in maintaining quality care. They inform models of nursing care delivery and strategies to support quality care during public health crises.

The COVID-19 pandemic response and its impact on post-corona health emergency and disaster risk management in Italy

Background

The COVID-19 pandemic has profoundly impacted societies, influencing countries' Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the COVID-19 pandemic, focusing on the changes made to the existing H-EDRM system, with an emphasis on human resources, health service delivery, and logistics and the forward-looking strategies for the next health emergencies and disasters.

Methods

We performed a retrospective observational case study using qualitative methodology. Data was collected via semi-structured interviews and analyzed considering the World Health Organization (WHO) H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian response to COVID-19. Stakeholders from five different sectors (policy-making, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, and Veneto) were interviewed, for a total of 15 respondents.

Results

Results on human resources revolved around the following main themes: personnel, training, occupational health, and multidisciplinary work; results on health service delivery encompassed the following main themes: public health, hospital, and primary care systems; results on logistics dealt with the following themes: infrastructures, supplies, transports, and communication channels. Lessons learned stressed on the importance of considering pragmatic disaster preparedness strategies and the need for cultural and structural reforms. Stakeholders mentioned several implications for the post-pandemic H-EDRM system in Italy.

Conclusions

Findings highlight that the interconnection of sectors is key in overcoming pandemic-related challenges and for future disaster preparedness. The implications for the Italian H-EDRM system can inform advancements in disaster management in Italy and beyond.

Stress and Occupational Burnout of Nurses Working with COVID-19 Patients

COVID-19 pandemic brings many challenges to the daily work of nurses. While carrying out professional tasks for patients infected with the SARS-CoV-2 virus, nurses experience tremendous psychological pressure due to their workload in a high-risk environment. This causes severe stress and leads to occupational burnout. The purpose of this study was to assess the level of stress and occupational burnout among surveyed nurses working with patients with COVID-19. A total of 118 nurses working with patients infected with SARS-CoV-2 virus participated in the study. Among the respondents, there were 94.9% women and 5.1% men. The average age of the respondents was 38.1 +/- 2.1. The survey was conducted between April and May 2022. The research tool was a survey questionnaire, consisting of three parts: sociodemographic data and self-administered survey questionnaire containing questions about the specifics of working with COVID-19 patients. The third part was a standardized tool: the MBI Burnout Questionnaire by Christina Maslach. Participation in the study was anonymous and voluntary. Statistical analysis for independence of variables used the Chi-square test. On the other hand, coefficients based on the Phi test and Kramer's V test, as well as non-parametric Mann-Whitney U-test (for 2 samples) and Kruskal-Wallis test (for more than 2 samples) were used to determine the strength of the relationship. During these analyses, in addition to standard statistical significance, the corresponding "p" values were calculated using the Monte Carlo method. The results obtained allow us to conclude that surveyed nurses working with COVID-19 patients are exposed to various stressors leading to occupational burnout. The vast majority of respondents, i.e., 90.7%, believe that stress is an integral part of the nursing profession and the average of MBI burnout among respondents was 55.67 +/- 9.77 pts., emotional exhaustion 24.74 +/- 6.11, depersonalization 12.42 +/- 2.99 and a sense of personal achievement 18.52 +/- 4.50 which means that only slightly more than half of the nurses surveyed noticed symptoms of occupational burnout themselves. The research has revealed that working with a patient who is positive for COVID-19 is a cause of stress and is related to experiencing symptoms of burnout in the group of surveyed nurses.

Pandemic perspectives from the frontline-The nursing stories

AIM

To describe the experiences of registered nurses working in a US healthcare system during the COVID-19 pandemic.

DESIGN

This qualitative thematic analysis study is a secondary analysis of stories submitted by nurses to a repository established by the parent study.

METHODS

Registered nurses working in various roles in a healthcare system submitted stories (N = 45) to open-ended prompts via an online repository between June 2020 and February 2021. A team of three nurse scientists coded the stories using Dedoose software. Initial codes were then reviewed by the team to synthesize initial coding into themes. The COREQ checklist was used to ensure research reporting guidelines were met.

RESULTS

Thematic analysis revealed three themes in a global theme of COVID-19 pandemic-related personal and professional evolution: (1) The art and science of pandemic nursing, (2) Persisting despite challenges; and (3) Learning as we went. Each of the three organizing themes were supported by basic themes.

CONCLUSIONS

Identified themes affirm some of nursing's long-standing core values, such as the central role of human connectedness in restoring health, but findings also reflect new evolutionary processes of moral identity formation that occurred among nurses and the nursing profession during the COVID-19 pandemic.

IMPACT

Findings from this study describe the processes by which nurses' moral identity evolved during a segment of the COVID-19 pandemic. Collectively, these evolutions represent important shifts in the nursing profession. Using findings from this study, nurse educators, nurse managers and healthcare administrators will be able to implement effective, sustainable policies and processes that meet the needs of both the community and the workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This study was designed to capture the experiences of nurses employed by one healthcare organization. However, it was not conducted using input or suggestions from the public or the patient population served by the organization.