The COVID-19 Pandemic and nursing challenges: A review of the early literature

Intern nursing students' experiences in the COVID-19 vaccination unit and views on the COVID-19 vaccine: A phenomenological qualitative study

BACKGROUND

Improving acceptance of the COVID-19 vaccine among nursing students is an important strategy for both preventing infection and building public confidence in the vaccine.

OBJECTIVE

The aim of this study was to describe the views of intern nursing students on the COVID-19 vaccine and to evaluate their experiences in the COVID-19 vaccination unit.

METHODS

This was a phenomenological qualitative study with a descriptive design. The 46 intern nursing students included in this study were all trained in the COVID-19 vaccination unit. The data was collected at focus group interviews conducted during June 2021 and October 2021.

RESULTS

The mean age of intern nursing students was 22.78±0.91. From the focus group interviews, two themes were identified regarding the views of intern nursing students on the COVID-19 vaccine and their experiences in the COVID-19 vaccination unit: Theme 1. Positive views; Theme 2. Negative views. Intern nursing students described that they trust the COVID-19 vaccine and believe in its protection. Intern nursing students who performed their clinical practices in COVID-19 vaccination unit stated that they realized their responsibilities toward patients and the community.

CONCLUSIONS

From the INSs' point of view, confidence in the vaccine, responsibility towards patients, their families and the community, and VU practice experience, the health risk associated with COVID-19 positively affected their decision to be vaccinated against COVID-19. The participation of intern nursing students in clinical practice during the pandemic influenced both intern nursing students and population in terms of the uptake of COVID-19 vaccines.

Exploring US Nursing Leadership During the Initial COVID-19 Pandemic Response: A Qualitative Descriptive Study to Guide Leadership Development for Future Emergent Situations

OBJECTIVE

This study aimed to describe the experiences of nurse leaders during the 1st wave of the COVID-19 pandemic to enhance understanding in preparation for future disasters.

BACKGROUND

The COVID-19 pandemic has posed significant challenges to the healthcare system globally. Nurse leaders play an essential part and have a significant impact on the efficacy of disaster management in future emergent situations.

METHODS

The parent study conducted interviews with 100 nurses in the United States across specialty areas. This article presents a subgroup analysis of interview data from 13 self-identified nurse leaders. The research team used qualitative descriptive methodology and thematic analysis to identify patterns within the data.

RESULTS

Five themes were identified for effective nurse leadership during an emerging pandemic: 1) responsiveness; 2) anticipating needs; 3) care innovations; 4) collaboration; and 5) adaptability.

CONCLUSION

Supporting nurse leaders to exhibit effective leadership during periods of crisis is imperative to increase preparedness for future health events, protect population health, and create a pipeline of future nursing leadership. Involving nursing in developing and reforming policy is integral.

Do internship students do well in a clinical environment? A qualitative naturistic study

Background

The internship year marks the culmination of the nursing program across all Saudi universities, bridging theoretical learning and practical application. The significance of the internship year lies in the application of skills acquired during the preceding years of study. Understanding interns' experiences, identifying influences, and sharing their recommendations for best practices become crucial.

Objective

This study aimed to explore the experiences of internship students and address the challenges they encountered in a clinical environment.

Methods

A qualitative naturistic descriptive approach was employed, involving 20 purposively selected participants from internship students in two regions in Saudi Arabia. Data were collected in January 2023 through semi-structured interviews, focus group discussions, and observation. A conventional content analysis approach was used for data analysis.

Results

Four major themes were generated: 1) Transferring Shock, 2) Self-Learning, 3) Supportive Environments, and 4) Factors Facilitating Learning. Transferring Shock comprised two subthemes: feeling lost and feeling left out.

Conclusion

Internship students acknowledged the utility of orientation and mentorship programs in advancing the practical skills of new nurses and enhancing patient safety. The findings also indicated that those with prior preparation and robust communication skills reported a positive experience. Consequently, integrating communication courses into the nursing education curriculum could be beneficial. Establishing a supportive learning environment for nursing interns is imperative to address challenges and ensure the delivery of safe and effective patient care.

Physical and psychological repercussions on Nursing workers' health in COVID-19 units: A mixed-methods research study

OBJECTIVE

to analyze how Nursing workers in COVID-19 hospital units perceive the physical and psychological repercussions of work on their health, as well as to identify the factors associated with their perceptions.

METHOD

a parallel-convergent mixedmethods study conducted with 359 Nursing workers from COVID-19 units in seven hospitals. For the collection of quantitative data, a questionnaire containing sociodemographic and labor variables and related to perceptions of physical and psychological repercussions were used, and for qualitative data, semi-structured interviews were used. For the analysis, inferential statistics and thematic content analysis were used.

RESULTS

daytime workers, who had more than one employment contract and worked more than 41 hours/week perceived more moderate/intense physical repercussions, reporting overload and time off deficits. Nurses and CLT workers perceived psychological repercussions more moderately/intensely, mentioning managerial overload and job dissatisfaction. Women were 97% more likely to perceive physical repercussions and three times more likely to perceive psychological repercussions when compared to men, reporting household and family overloads.

CONCLUSION

work and family overloads, intensified by the pandemic context, were associated with the intensity with which Nursing workers perceived physical and psychological repercussions.

The impact of COVID-19 related lockdown restrictions on musculoskeletal health: a systematic review

There is limited empirical evidence on whether Coronavirus disease 2019 (COVID-19) related lockdown restrictions precipitate or perpetuate musculoskeletal (MSK) disorders. This study was aimed to synthesis literature that assessed the impact of COVID-19 related lockdown restrictions on MSK health. A literature search was conducted using MEDLINE, CINAHL, PsycINFO, Allied and Complementary Medicine Database (AMED), Web of Science, and Scopus databases. Studies meeting the following criteria were included in the review: the condition being considered was MSK health, the intervention was COVID-19 related lockdown restrictions, cross sectional studies, cohort studies, case controlled, prospective studies and retrospective studies. Data were extracted by 2 independent researchers. Risk of bias was assessed by the Newcastle-Ottawa quality assessment scale. Evidence from included studies was summarised using narrative synthesis. Fourteen studies comprising 22,471 participants of the general population from Turkey (n = 5), Italy (n = 1), Poland (n = 1), Australia (n = 2), Jordan (n = 1), Bangladesh (n = 1), Estonia (n = 1), the Netherlands (n = 1) and Saudi Arabia (n = 1) have met the inclusion criteria. The sample size of populations studied ranged from 91 to 1054. The included studies used questionnaire, visual analogic scale, or growth mixture modelling. Except for one study, all the included studies reported increased prevalence and incidence of MSK disorders due to COVID-19 related lockdown restrictions. The findings suggest that COVID-19 related lockdown restriction led to increased MSK disorders. Home-based strategies such as physical activity programmes and ergonomic workspace could potentially guide public health authorities to avoid MSK health problem.

Hospital Readiness and Perceived Health Professional Challenges to Prevent Pandemics in Gedeo Zone, Ethiopia: A Mixed-Method Study

Background

Pandemics pose serious threats to health, society, and economy worldwide. Ethiopia has been affected by the COVID-19 pandemic, which has caused millions of deaths and disrupted essential health services. The readiness of health systems and the challenges that health professionals face in delivering pandemic-related services are crucial for preventing and controlling pandemics. However, these aspects have not been adequately assessed in low-income countries like Ethiopia, where poor prevention techniques and challenging work conditions can increase the transmission of diseases and overwhelm the weak healthcare system. This study aimed to assess hospital readiness and health professional challenges to prevent pandemics in Ethiopia.

Methods

A mixed-methods study design was used to collect data from 24 health professionals and four public hospitals using interviews and a checklist which explored the challenges and barriers of health professionals in preventing pandemics and assessed the hospital readiness. Data were analyzed thematically with open code software and descriptively with SPSS software.

Results

The study revealed the alarming gaps in the hospitals' readiness and the health professionals' capacity to prevent and control pandemics. Most of the hospitals had insufficient preparedness in terms of administrative activities, infection prevention and control (IPC) activities, emergency room preparedness, outpatient services, and logistics and supplies. The health professionals faced multiple challenges, such as lack of resources, training, personal protection, psychological support, and workload. The most critical challenges were the lack of personal protective equipment (PPE) and training, which compromised their safety and effectiveness.

Conclusion

The study underscored the need to enhance the hospitals' readiness and the health professionals' capacity to prevent and control pandemics and health professionals faced various challenges in preventing and controlling pandemics. These challenges include lack of resources, training, psychological support, and lifestyle changes which may compromise their quality of care, safety, and well-being.

Factors Associated With Physical Activity in Hospitalized Patients With Dementia

Older adults continue to spend little time engaged in physical activity when hospitalized. The purpose of this study was to (a) describe activity among hospitalized older adults with dementia and (b) identify the association between specific factors (gender, ambulation independence, comorbidities, race, and hospital setting) and their physical activity. This descriptive study utilized baseline data on the first 79 participants from the Function Focused Care for Acute Care using the Evidence Integration Triangle. Multiple linear regression models were run using accelerometry data from the first full day of hospitalization. The participants spent an average of 83.7% of their time being sedentary. Male gender, ambulation independence, and hospital setting (the hospital in which the patient was admitted) were associated with greater activity. This study reports on the limited time spent in activity for older adults with dementia when hospitalized and highlights patient profiles that are particularly vulnerable to sedentary behavior in the hospital setting.

Evaluation of work conditions of nurses employed in a shift system in hospital wards during the COVID-19 pandemic

BACKGROUND

Nurses work in a shift system that determines the provision of round-the-clock care of a patient in hospital conditions; however, it entails health consequences.

OBJECTIVE

The aim of the study was the evaluation of work conditions of nurses engaged in shift work in hospital wards during the COVID-19 pandemic.

METHODS

The study was conducted in 2020, and included 108 nurses working in a shift system in hospital wards. The research method was a diagnostic survey, using an author-constructed questionnaire.

RESULTS

88.9% nurses reported a negative effect of shift work on their physical health: 'musculoskeletal pain', 'elevated arterial blood pressure', and 'hormonal disorders' - 54.5% of respondents used pharmacological treatment. The causes of physical disorders were: 'microclimate', 'physical effort', 'noise', and 'forced body position'. Shift work exerted a negative effect on psychological health of the majority of respondents (75.0%): 'deconcentration', 'sleep disorders', 'feeling of occupational burnout' - treatment in 38.9% of respondents. Psychological health disorders were caused by: 'circadian rhythms disturbance by shift work', 'chronic stresses, and 'conflicts at work'. 69.7% of respondents reported that their shift work was disturbed by organizational factors, including: a 'badly planned work schedule', 'enhanced pace of work due to staff shortage', 'ambiguous division of duties, rights, responsibilities', 'shortages of equipment at the workplace'.

CONCLUSION

The examined nurses experienced a negative effect of shift work on their physical and psychological health which, for some of them, was the cause of pharmacological treatment. Many organizational factors hindered the work of nurses in a shift system in hospital wards.

Psychometric properties and factor structure of the Vietnamese Copenhagen Burnout Inventory

OBJECTIVES

This article examines the validity and reliability of the Vietnamese version of the Copenhagen Burnout Inventory (CBI-V) among hospital nurses in Vietnam in 2022.

METHODS

This article examined data from 587 nurses in two city hospitals in Vietnam in 2022. The reliability was determined via internal consistency (Cronbach's alpha coefficient) and test-retest reliability (Intraclass correlation coefficient). Factorial and construct validity of CBI-V were explored with confirmation factor analysis (CFA), exploratory factor analysis (EFA), and correlations with other mental health outcomes (measured by the depression, anxiety, and stress scale), job performance (Work Health Performance Questionnaires), work engagement (Utrecht work engagement), and quality of life (EQ-5D-5L). Statistical analyses were performed using SPSS 20.0 and AMOS 20.0.

RESULTS

Cronbach's alpha coefficients of CBI-V's three subscales showed good internal consistency (from 0.87 to 0.91). CFA showed a good fit of the three-factor model with the current data. EFA results showed that all items were loaded in accordance with the CBI's original three constructs, excluding work burnout item 7, forming the fourth factor with a single item. All of CBI-V's three subscales correlated with other constructs in expected directions.

CONCLUSION

The CBI-V showed good validity and reliability among hospital nurses. It can be a reliable tool to measure burnout among nurses in a low- and middle-income country in Vietnam during such a crisis as COVID-19. Future studies should examine the construct of the Copenhagen Burnout Inventory in different occupation groups.

Further psychometric evaluation of the Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire: Practical implications in healthcare settings

BACKGROUND

Scientific research has identified a lack of psychometrically well-tested methods for evaluation of the work environment in healthcare settings. The Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire has been evaluated and has shown good content validity, as well as intra-rater and test-retest reliability. There are, however, still unknowns regarding the psychometric properties. If the SMET questionnaire is to be used in practical occupational health service (OHS) work and scientific research in healthcare settings, further psychometric evaluation is needed.

OBJECTIVE

The aim of this study was to gain further understanding of the psychometric properties of the SMET questionnaire when used in research and clinical OHS practice in healthcare settings.

METHODS

The psychometric evaluation was conducted using classical test theory (Cronbach's alpha, explorative factor analysis) and Rasch analysis (measurement targeting, category threshold order, person separation index) on data previously collected in development projects within the healthcare sector.

RESULTS

The results support the use of the SMET questionnaire as a psychometrically well-tested method for evaluation of the work environment in healthcare settings. They support the use of the initial 1-10 scale since all 10 steps are used. The results also support the trichotomization procedure since the trichotomized scale captures the construct of the work environment with good measurement targeting and good category threshold order.

CONCLUSION

The results of this study support the use of the SMET questionnaire as a psychometrically well-tested method for a broad multifactorial evaluation of the work environment in healthcare settings.

Influence of Different Protection States on the Mental Fatigue of Nurses During the COVID-19 Pandemic

Background

COVID-19 has brought greater workload pressures to the medical field, such as medical staff being required to wear personal protective equipment (PPE). While PPE can protect the safety of staff during the pandemic, it can also accelerate the accumulation of fatigue among operators.

Objective

This study explores the influence of different protection states on the mental fatigue of nurses.

Methods

In this study, 10 participants (5 males and 5 females) were randomly selected among applicants to monitor mental fatigue during the nurses’ daily work in four different PPE states (low temperature and low protection; low temperature and high protection; high temperature and low protection; high temperature and high protection). The NASA subjective mental fatigue scale was used for subjective evaluation. Reaction time, attention concentration, attention distribution, memory, and main task completion time were used for objective evaluation.

Results

The results demonstrated a significant difference in the effects of different protection states on mental fatigue. The state of high temperature and high protection had the greatest influence on mental fatigue, the state of low temperature and low protection had the least, and states of high (low) temperature and low (high) protection had intermediate effects on mental fatigue. Furthermore, the correlation between the subjective and objective fatigue indices was analyzed using a multiple regression model.

Conclusion

This study clarified the influence of different protection states on the mental fatigue of nurses, and verified that nurses require more time and energy to complete the same work as before under high protection states. It provides a basis for evaluating the mental fatigue of nurses in the unique period of the COVID-19 pandemic and specific ideas for optimizing the nursing process.

Emerging Nurse Manager’s Resilience and Their Empowering Behavior during COVID-19

Background: The COVID-19 pandemic exacerbated tensions and tested the resiliency of many nursing leaders. Resilience enables head nurses to cope with their work environment challenges, and maintain healthy psychological activity. Moreover, their empowering behavior represents the vehicle to transform traumatic events such as the COVID-19 pandemic to create a high-quality work environment. Aim: To explore the relationship between nurse manager resilience and empowering leader behavior during COVID-19. Method: This is a descriptive correlational study. The study subjects consisted of two groups: head nurses (44) and staff nurses (284). The study was conducted at Benisuef University Hospital. Two tools were used for collecting data; nurse managers’ resilience scale, and staff nurses’ perceived empowering behavior during the COVID-19 pandemic via questionnaire. Results: In total, 50% of nurse managers had high resilience skills levels, about one-third of them (34.1%) had moderate levels and only 15.9% had low resilience skills levels. Furthermore, with regard to empowering leadership behavior levels as perceived by staff nurses during COVID-19; 66.9% of them perceived it high, 29.2% reported a moderate level of empowering behavior, and only 3.9% perceived low levels. Finally, there was a highly statistically significant positive correlation between nurse manager’s resilience skills levels and staff nurses’ perception of empowering behavior during COVID-19. Conclusions: Half of the nurse managers had high resilience skills, and only 15.9% had low levels. Two-thirds of staff nurses perceived high levels of their nurse manager’s empowering behavior during COVID-19, in comparison to only 3.9% who perceived low levels. There was a highly statistically significant positive correlation between nurse manager’s resilience skills levels and perceived empowering behavior during COVID-19.

Supporting the well-being of nursing students and student midwives during the COVID-19 pandemic

Throughout the coronavirus disease 2019 (COVID-19) pandemic the Queen's University Belfast Connections (QUB Connections) project has provided online well-being support to nursing students and student midwives. The project, which was co-designed and led by students and academic staff, provided an online well-being service for students who took on front-line roles during the early part of the pandemic and for those who had to pause their studies. Insights gained from responses to an evaluation of the support sessions suggested that some students felt stigmatised, frightened, lost, isolated and abandoned during this period, but that QUB Connections gave them a sense of 'being held' and 'attended to' in a time of uncertainty. The evaluation findings are a reminder of the need to continue to help nursing and midwifery students and newly qualified staff develop self-care and support mechanisms. QUB Connections is now embedded in the university's school of nursing and midwifery pre-registration programmes to support students and those new to nursing and midwifery practice.

How do care environments shape healthcare? A synthesis of qualitative studies among healthcare workers during the COVID-19 pandemic

OBJECTIVE

To investigate how care is shaped through the material practices and spaces of healthcare environments during the COVID-19 pandemic.

DESIGN

Critical interpretive synthesis (CIS) of qualitative research.

PARTICIPANTS

Studies included qualitative research investigating the experiences of healthcare workers involved in the care of individuals during the COVID-19 pandemic.

RESULTS

134 articles were identified in the initial sampling frame with 38 studies involving 2507 participants included in the final synthesis. Three themes were identified in the analysis: (1) the hospital transformed, (2) virtual care spaces and (3) objects of care. Through the generation of these themes, a synthesising argument was developed to demonstrate how material spaces and practices of healthcare shape care delivery and to provide insights to support healthcare providers in creating enabling and resilient care environments.

CONCLUSIONS

The findings of this study demonstrate how healthcare environments enable and constrain modes of care. Practices of care are shaped through the materiality of spaces and objects, including how these change in the face of pandemic disruption. The implication is that the healthcare environment needs to be viewed as a critical adaptive element in the optimisation of care. The study also develops a versatile and coherent approach to CIS methods that can be taken up in future research.

Influence of different protection levels of PPE on nurses' physical fatigue during the COVID-19 pandemic

BACKGROUND

The continuous spread of COVID-19 globally has led to busier medical practices and nurses are having to provide medical services to patients while suffering from high levels of fatigue.

OBJECTIVE

This study experimentally investigated the influence of different levels of personal protection equipment (PPE) on nurses' physical fatigue.

METHODS

We collected data from 12 participants by simulating a series of nursing tasks. The participants wore one of three different protection levels of PPE, and data recording their heart rate (HR), oral temperature, task completion time, and subjective fatigue were collected. Following this, relationship models between subjective fatigue and objective fatigue indices was established using multiple linear regression analysis.

RESULTS

By analyzing the variation trends of single indices of HR, oral temperature, task completion time, and subjective fatigue, it was found that the higher the level of protection levels of PPE worn by the participants, the higher the degree of fatigue experienced by them. In addition, taking subjective fatigue variation as the dependent variable and objective fatigue indices as independent variables, relationship models of the three different protection levels of PPE were established.

CONCLUSIONS

The results confirmed the influence of different protection levels of PPE on nurses' physical fatigue levels. They also provide a basis for medical administrators to monitor the degree of fatigue experienced by nurses, attempt to arrange nurses' work content accordingly, and schedule suitably to combat and manage recorded increases in fatigue.

The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic

BACKGROUND

In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance.

OBJECTIVE

This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis.

RESULTS

The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014).

CONCLUSION

The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.