Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic

Introduction:In the context of the global pandemic of the SARS-CoV-2 coronavirus (COVID-19), healthcare providers (HCPs) have experienced difficult moral and ethical dilemmas. Research is highlighting the importance of moral injury (MI)–a trauma syndrome related to transgressing personal morals and values–in understanding the psychological harm and occupational impairment experienced by HCPs. To date, MI treatments have largely been developed for military personnel and veterans and rely on in-person one-on-one psychotherapy.Purpose:This project aims to explore the feasibility and acceptability of an evidence-informed online Acceptance and Commitment Therapy-based group therapy for MI in HCPs called “Accepting Moral Pain and Suffering for Healthcare Providers” (AMPS-HCP).Method:This feasibility and acceptability study included three separate phases with the first two phases focused on the development of the psychotherapeutic intervention and the third phase focused on the evaluation of the psychotherapeutic intervention. Eight participants (including registered nurses, practical nurses and respiratory therapists) completed seven 90-min sessions in an online group format. The focus of these sessions included ACT and MI psychoeducation and experientials. Qualitative semi-structured interview data was thematically analyzed while demographic and quantitative self-reported outcome data underwent descriptive analysis and non-parametric testing.Results:Results show that the intervention was highly feasible and acceptable to healthcare providers who worked on the frontline during COVID-19. Feasibility (referrals, eligibility, retention, participation engagement) was strong (8 out of 10 participants; 80% vs. desired >70% eligibility) and overall, 80% of participants completed 71% of the intervention. Data further supported the applicability and acceptability of the intervention. Preliminary data suggests that AMPS-HCP may supports HCPs to address MI.Discussion:This study is the first to report on the development and evaluation of an online MI group intervention for registered nurses, registered practical nurses, and respiratory therapists working during COVID-19. Results showed the use of both the online and group components of the intervention were acceptable and feasible during the third wave of COVID-19.

Challenges for nurses in caring for patients with acute encephalitis: lack of knowledge, time and rehabilitation

Aim: To explore the experiences of registered nurses providing care to adult patients affected by encephalitis, from admission into hospital through to discharge. Study design: A qualitative phenomenological methodology was used. Sample and setting: Eight registered nurses in a city centre teaching hospital. Methods: Data collection took place using in-depth, semi-structured interviews. Data were analysed and themes identified using framework analysis. Findings: Three key findings were identified: nurses felt that they lacked knowledge of encephalitis, lacked time to give these patients the care they needed, and they lacked access to rehabilitation for patients with encephalitis. Conclusion: This study provides the first evidence on nurses' experiences of providing care to patients affected by encephalitis. It has shown that they often lack the knowledge and time to give adequate support to patients. They also lack access to rehabilitation for these patients.

The Influence of Organizational Factors on Registered Nurses’ Work Attitudes in Nigeria

This study examined the influence of competence development, work-life balance, perceived organizational support and organization’s commitment to employees on job satisfaction, affective commitment and turnover intention among registered nurses in Nigeria’s Ondo State. The sample consisted of 220 registered nurses from six public hospitals in Ondo State. Data analysis was conducted using multivariate regressions, Pearson’s product-moment correlation and descriptive statistics to determine the influence of organizational factors on nurses’ job satisfaction, affective commitment and turnover intention. The results indicated that competence development practices, work-life balance policies and practices, perceived organizational support and the organization’s commitment to employees were positively correlated to job satisfaction and affective commitment but negatively correlated to registered nurses’ turnover intention. This study identified the importance of organizational factors in promoting nurses’ job satisfaction, affective organizational commitment and intention to stay which may inform hospital administration, health care institutions and the Ondo State Government about the significant role of organizational factors in improving nurses' job satisfaction, affective commitment and turnover intention. 

Knowledge, Attitude, and Perceived Barriers of Newly Graduated Registered Nurses Undergoing Standardized Training in Intensive Care Unit Toward Early Mobilization of Mechanically Ventilated Patients: A Qualitative Study in Shanghai

Aim: To explore the knowledge and attitudes of newly graduated registered nurses, who have undergone standardized training in the intensive care unit, about the early mobilization of mechanically ventilated patients and identify perceived barriers to the application of early mobilization.Background: Early mobilization of mechanically ventilated patients has been gradually gaining attention, and its safety and effectiveness have also been verified. Nurses in intensive care units are the implementers of early mobilization, and the quality of their care is closely related to patient prognosis. However, the knowledge and attitude of newly graduated registered nurses undergoing standardized training, in intensive care units, on the early mobilization of mechanically ventilated patients and the obstacles they face in clinical implementation are still unclear.Methods: This qualitative study utilized the phenomenological method to explore the experiences of 15 newly graduated registered nurses undergoing standardized training in intensive care units in a 3rd hospital in Shanghai, China. Semi-structured face-to-face interviews were conducted in June 2020. The Colaizzi seven-step framework was used for data analysis.Findings: A total of 15 new nurses comprised the final sample after data saturation. Three main themes emerged from the analysis and seven subthemes: perceived importance, low implementation rate, and perceived barriers.Conclusions: Newly graduated registered nurses undergoing standardized training in intensive care units have a high level of awareness of the importance of early mobilization of mechanically ventilated patients and are willing to implement it. However, there is a lack of relevant knowledge and other obstacles that restrict clinical implementation. Early mobilization should be included in the standardized training of new nurses in intensive care units.

The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh

Background: Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms.Nurses’ workplace stress is also linked to increased absenteeism and decreased job satisfaction. Objectives: The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms. Methods: A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses’ workplace stress, coping strategies, and depressive symptoms. Results: More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items. Conclusion: Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses’ work experiences and the unique contribution that workplace stressors have on their physical and mental health.

Inpatient COVID-19 Mortality Rates: What are the predictors?

Objective: This study aims to investigate the relationship between registered nurses and hospital-based medical specialties staffing levels with inpatient COVID-19 mortality rates. Methods: We rely on data from AHA Annual Survey Database, Area Health Resource File, and UnitedHealth Group Clinical Discovery Database. We use linear regression to analyze the association between hospital staffing levels and bed capacity with inpatient COVID-19 mortality rates from March 1, 2020, through December 31, 2020. Results: Higher staffing levels of registered nurses, hospitalists, and emergency medicine physicians were associated with lower COVID-19 mortality rates. Moreover, a higher number of ICU and skilled nursing beds were associated with better patient outcomes. Hospitals located in urban counties with high infection rates had the worst patient mortality rates. Conclusion: Higher staffing levels are associated with lower inpatient mortality rates for COVID-19 patients. A future assessment is needed to establish benchmarks on the minimum staffing levels for nursing and hospital-based medical specialties during pandemics.

The Work-Related Stress Experienced by Registered Nurses at Municipal Aged Care Facilities: A Qualitative Content Analysis

Background Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways. Aim The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities. Methods Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study. Results The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute to work-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment. Conclusion This study showed the everyday experiences of registered nurses’ stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study in order to reduce the risk of further increasing the work-related stress experienced by registered nurses working in municipal aged care.

Relationship between Job Satisfaction, Pay, Affective Commitment and Turnover Intention among Registered Nurses in Nigeria

This study aims to examine the relationship between job satisfaction, pay, affective commitment, and turnover intentions of public hospitals-based Registered Nurses in Ondo State, Nigeria. Using the quantitative, cross-sectional survey design, data from 220 Registered Nurses were analysed. Results indicate that pay and job satisfaction have significant positive relationship with nurses’ affective commitment; pay has significant positive relationship with their job satisfaction but pay, job satisfaction and affective commitment have negative relationship with turnover intentions. Job satisfaction is of critical importance in gaining nurses’ affective commitment and enhancing retention. Pay is often considered as a hygiene factor in theories of motivation – meaning, even though pay decreases might cause dissatisfaction, pay increases would not increase satisfaction. This does not appear to be the case in Nigeria. These findings have implications for health human resource management in general and the management of nursing staff in the public hospitals of Ondo State, Nigeria in particular.

Multi-source feedback following simulated resuscitation scenarios: a qualitative study

Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.