Nursing Support Research Articles

Moral distress during COVID-19: The importance of perceived organizational support for hospital nurses.

Moral distress, or the inability to act congruent with moral beliefs, has been of concern for healthcare professionals especially since the COVID-19 pandemic. Hospital nurses are particularly affected in their roles with mounting administrative pressures and demands. We examined whether general and COVID-specific support in employing healthcare organizations predicted moral distress in a sample of inpatient hospital nurses. A total of 248 nurses completed the Measure of Moral Distress for Healthcare Professionals, Survey of Perceived Organizational Support, COVID Organizational Support survey, and the Hospital Ethical Climate Scale. We found that general and COVID-related organizational support were predictors of moral distress after controlling for age, gender, working in an intensive care unit setting, and ethical climate. Findings support the need for a comprehensive strategy to address moral distress, including institutional efforts to convey support and commitment. Strategies moral distress may be experienced differently based on gender identity.

A Conceptual Model of Nurses' Turnover Intention.

The World Health Organisation predicts a lack of 15 million health professionals by 2030. The lack of licenced professionals is a problem that keeps emerging and is carefully studied on a global level. Strategic objectives aimed at stimulating employment, improving working conditions, and keeping the nurses on board greatly depends on identifying factors that contribute to their turnover. The aim of this study was to present a conceptual model based on predictors of nurses’ turnover intention. Methods: A quantitative, non-experimental research design was used. A total of 308 registered nurses (RNs) took part in the study. The Multidimensional Work Motivation Scale (MWMS) and Practice Environment Scale of the Nursing Work Index (PES-NWI) were used. Results: The conceptual model, based on the binary regression models, relies on two direct significant predictors and four indirect significant predictors of turnover intention. The direct predictors are job satisfaction (OR = 0.23) and absenteeism (OR = 2.5). Indirect predictors that affect turnover intention via job satisfaction are: amotivation (OR = 0.59), identified regulation (OR = 0.54), intrinsic motivation (OR = 1.67), and nurse manager ability, leadership and support of nurses (OR = 1.51). Conclusions: The results of the study indicate strategic issues that need to be addressed to retain the nursing workforce. There is a need to ensure positive perceptions and support from managers, maintain intrinsic motivation, and promote even higher levels of motivation to achieve satisfactory levels of job satisfaction.

Distress, support and psychological resilience of psychiatric nurses as second victims after violence: A cross-sectional study.

The aim is to explore the impact of violence and psychological resilience on psychiatric nurses as second victims. Workplace violence is a public health concern, seriously influencing medical staff's physical and mental health. However, few pieces of research have concentrated on psychiatric nurses as second victims. The socio-demographic data, violence-related data, psychological resilience scale, the Chinese version of the Second Victim Experience and Support Tool were applied to conduct a cross-sectional survey on nurses from psychiatric hospitals. The multiple linear regression model identified significant variables associated with violence-related injury and resilience. A total of 683 nurses completed the survey, of whom 88.3% were women. The average scores of the second victims' experience and support, support and distress were 3.45 ± 0.43, 3.71 ± 0.57 and 3.19 ± 0.67, respectively. Physical violence, psychological violence, psychological influence and nursing work environment were positively correlated with the experience and support of the second victims, and innocuous violence was a negative factor, which explains 20.6% of the variation. Moreover, physical injury, nursing work environment, resilience restructuring, physical violence, psychological violence, psychological impact and disagreement about the existence of violence explained 14.8% of the distress. The innocuous violence, psychological violence and nursing work environment explained 46.2% of the support. Our findings suggest that nurses who are second victims after the violence mainly suffer from severe psychological distress and receive the least support for the same. The study provides clues to help nursing managers' emphasis on the distress and support of second victims and provides targeted intervention based on the relevant factors and these results. The article is a cross-sectional study of psychiatric nurses, which has been approved by the ethics committee of the hospital before the survey. All the nurses who participated in the survey have been informed and agreed.

Intervention tool for general registered nurses providing palliative care in the cardiovascular ward

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by JST SPRING. Background Palliative care for patients with heart failure (HF) has benefits such as reducing physical and mental distress and decreasing medical costs. Nevertheless, the palliative care provision rate for patients with HF is merely 0.7%–4%. Palliative care by healthcare professionals in cardiology is recommended for patients with HF, particularly in inpatient wards. To promote palliative care, general registered nurses (GRNs) should be encouraged to practice it, although 99% of them do not have professional qualifications in this field. However, there is no intervention tool for GRNs that provides specific guidelines on palliative care. Therefore, appropriate intervention tools for GRNs are needed to promote palliative care. This study reports a nursing practice model and intervention tool developed before an intervention study in which GRNs practiced palliative care in a cardiovascular ward. Purpose To develop a practice model and intervention tool for GRNs providing palliative care to patients with HF in the cardiovascular ward. Methods This study reports the development of nursing practice models and intervention tools using a comprehensive development approach for nursing intervention development as the methodology and Corbin's (1998) disease trajectory model as the theoretical basis. We conducted a literature review on the needs of and limitations to HF palliative care. We staged the timing of hospitalized patients with HF. A nursing practice model showing suitable nursing support for each stage was constructed. We then created an intervention tool based on the nursing practice model. Results The intervention tools included a pocketbook, an HF palliative care practice material that could be used as a checklist, and an information-sharing notebook that allowed patients to review and record their symptom screening results and end-of-life decisions. The uniqueness of the intervention tool was that it classified hospitalized patients with HF into three stages: symptom-focused stage, cognitive recovery stage, and behavioral recovery stage; each stage included seven nursing support practices. In addition, the intervention tool clarified the criteria for referral to specialized palliative care that could be used before the end-of-life stage and described specific measures for end-of-life decision support that general nurses could implement. Conclusion This study created a pocketbook, an HF palliative care practice material, and a patient notebook as intervention tools. We started the intervention studies in December 2021, and we will report the results later.

The Impact of Organizational Supports on Nurses’ Occupational Stress in COVID‐19 Pandemic: A Partial Least Squares Multigroup Analysis

Background: The safety and mental health issues of frontline nurses working during the coronavirus global outbreak must be a first/top priority. The present study aimed to investigate the association between nurses’ occupation stress and organizational support in both infectious and non-infectious intensive care units (ICUs) wards during the COVID-19 crisis. Methods: This was a descriptive-analytical and cross-sectional study. The study population comprised nurses caring for COVID‐19 patients in Imam Reza Hospital complex in Mashhad City, Iran. The sample size was 129 nurses selected through random quota sampling and examined with a standard questionnaire. To analyze the information and test the hypothesis, the structural equation modeling approach using Smart PLS 2.0 software has been used. Descriptive and analytical statistical tests were used in this study. Results: The results indicated a significant negative correlation between stress and perceived organizational support for ICU nurses (P<0.001). Considering subscales in stress, the highest mean occupational stress scores were related to the “death and dying” dimension (n=21, 13.98%). Also, the difference between the two groups of nurses was statistically significant in different workloads (P<0.001) and lack of support (P<0.001). Conclusion: The results of the present study highlighted the importance of organizational support to reduce stress in nurses. To get through this unprecedented situation, nurses need their employers and organizations to support them with action, planning, and resources.

Elementary School Teachers' Perceptions of COVID-19-Related Restrictions on Food Allergy Management.

(1) Background: Approximately 7% of Canadian children live with a food allergy (FA). Pre-COVID-19, ~20% of anaphylactic reactions occurred in schools. Yet, teachers reported poor FA-related knowledge, and experiences during the COVID-19 pandemic are not well-studied. Additionally, teachers’ management approaches vary widely. We aimed to describe elementary school teachers’ perceptions about FA management during the COVID-19 pandemic; (2) Methods: Using a semi-structured interview guide, English-speaking elementary school teachers in Winnipeg, Canada were interviewed virtually. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically; (3) Results: Most teachers were female and taught in public schools. Two themes were identified. Theme 1, COVID-19 restrictions made mealtimes more manageable, capturing the positive impacts of pandemic restrictions such as seating arrangements and enhanced cleaning. Limited lunchtime supervision prompted some teachers to assume this role. Theme 2, Food allergy management was indirectly adapted to fit changing COVID-19 restrictions, describing how changing restrictions influenced FA-related practices. FA training was offered virtually with less nursing support. Class cohorts and remote learning decreased teachers’ perceived risk and FA-related management responsibility; (4) Conclusions: COVID-19-related practices were perceived as positively influencing in-school FA management, although unintended consequences, such as increased supervisory roles for teachers and reduced nursing support, were described.

The Effect of Different Nutritional Nursing Support on the Nutritional Status and Disease Recovery of Elderly Patients with Gastrointestinal Tumors during the Perioperative Period.

Objective This study explored the effect of different nutritional nursing support on nutritional status, immune function, postoperative bowel motility, and complications in elderly patients with gastrointestinal tumors during the perioperative period. Methods 300 patients with gastrointestinal tumors treated in the Department of Gastroenterology and anorectal surgery of Hangzhou First People's Hospital Affiliated with the Medical College of Zhejiang University from February 2018 to March 2020 were selected as the research objects in this study. Patients were divided into the early enteral nutrition (EEN) and total parenteral nutrition (TPN) groups (150 cases in each group) according to the principle of odd and even admission numbers. The patients in the EEN and TPN groups were given enteral nutrition nursing support and parenteral nutrition nursing support, respectively. The nutritional status, immune function, postoperative bowel motility, and complication rate of the two groups were evaluated 7 days after the operation. Results The nutritional indexes decreased 3 days after the operation and gradually recovered 7 days after the operation in both groups with different nutritional nursing support. The Hb, TRF, PAB, and ALB indexes in the TPN group were significantly lower than those in the EEN group (P < 0.01). On the 7th day after the operation, the indexes of peripheral blood immunoglobulin (IgG, IgM, and IgA) were significantly lower than those in the TPN group, and T lymphocyte subsets (CD4, CD8, and CD4/CD8) demonstrated that the immunological indexes of patients in the EEN group were significantly higher than those in the TPN group (P < 0.01). In terms of intestinal peristalsis, the time of first exhaust and first defecation in the EEN group was significantly shorter than that in the TPN group (P < 0.01) during the perioperative period. Furthermore, both groups had different degrees of complications, while patients demonstrated a lower complication rate in the EEN group compared to those in the TPN group, suggesting a safer postoperative mode. The results of subgroup analysis showed that the nutritional indexes of the gastric cancer group 7 days after operation were significantly higher than those of the colorectal cancer group under EEN and TPN nutritional support modes. Conclusion Clinical results have suggested that enteral nutrition nursing support can improve the perioperative nutritional status of elderly patients with gastrointestinal tumors by enhancing the immune function and promoting intestinal peristalsis. Meanwhile, the postoperative EEN mode reduces the rate of complications and demonstrates higher safety. Therefore, it has a high clinical application value.

983 LEARNING FROM THE EXPERIENCES OF NURSES IN CARE HOMES DURING COVID-19 (THRIVE STUDY): STEERING THE SHIP THROUGH THE STORM

Abstract Background Nurses practising in older people’s care homes are often the only trained nurse on shift, undertaking leadership roles while also supporting residents with complex clinical needs. The study aimed to explore Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in older people’s care homes during the COVID-19 pandemic. Method Recruitment used direct contact with care homes, social media and links provided by national partners, then purposive sampling for age, gender, type of care home and location. Data collected through one-to-one on-line interviews using a topic guide developed collaboratively with care home nurses, focusing on how COVID-19 impacted on nurses’ resilience and mental well-being. Data were analysed thematically. Results 18 nurses interviewed between March–July 2021: female 16, majority aged between 46–55 years; mean time registered with NMC 19 years (range 18 months-45 years); one had not nursed residents with COVID-19. Preliminary findings indicate that nurses developed enhanced clinical skills, which increased their professional standing. Many nurses were in leadership roles responsible for processing and sharing rapidly-changing guidance, making judgements on how to manage infection risk within the home. Nurses reported balancing information-assimilation and reporting with providing direct care due to staff shortages. All nurses provided emotional support to other staff. They sought support from their peers, namely nurses inside and outside their workplace. As leaders, many of the nurses spoke about the emotional impact of having to manage relatives’ expectations and make decisions on whether a relative could be with a dying resident. Conclusion Understanding the types of support that might best increase resilience and well-being for nurses in care homes now and in the future is essential to maintain a healthy, stable workforce. Support for nurses will likely benefit other care workers either directly through wider roll-out, or indirectly through improved well-being of the nurse leaders.

Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study.

Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.

Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor

ObjectivesPerceived organizational support was a benefit for the work performance of nurses, which may affect emotional labor and the development of professional values. This study aimed to explore the relationship between nurses’ perceived organizational support and professional values, and investigate the mediating role of emotional labor.MethodsThis was a cross-sectional study. The study was conducted in 3 tertiary hospitals in Wuhan from October 2020 to January 2021. The data were collected by a questionnaire consisting of demographic characteristics, the Emotional Labor Scale for Nurses, the nurses’ Perceived Organizational Support Scale, and the Nursing Professional Values Scale (NPVS-R). A convenience sample of 1017 nurses responded to the questionnaire survey. Pearson’s correlation analysis was used to test the relationship between variables. Predictor effects were tested using hierarchical multiple regressions. The structural equation model (SEM) was used to test the mediation effect of emotional labor on the pathway from perceived organizational support to professional values.ResultsA positive moderate correlation was observed between the perceived organizational support and emotional labor (r = 0.524, P < 0.01), and a positive strong correlation was observed between perceived organizational support and professional values (r = 0.609, P < 0.01). Emotional labor and perceived organizational support were positive predictors of professional values (B = 0.531, 95%CI = 0.414 ~ 0.649; B = 0.808, 95%CI = 0.715 ~ 0.901, respectively). The association between perceived organizational support and professional values was mediated by emotional labor.ConclusionsResults showed that perceived organizational support was positively related to nurses’ emotional labor, which was in turn associated with high professional values. For nurses, improving organizational support and training nurses to engage in emotional labor through providing multiple support systems, establishing appropriate incentive mechanisms, and training nurses to regulate emotions can be effective ways to promote nurses’ professional values.

Textual Organization of Hemodialysis Nursing Practice: An Institutional Ethnography.

Nursing today deals with organizational changes and reforms within the increased demands of care amid competing resources. In some developing countries, dealing with text documents is a challenge in hemodialysis service organizations. This study aimed to explicate the social organization of textual nursing practices in a hemodialysis unit of a public university hospital in Nepal. This is a qualitative study that followed institutional ethnography design. Ten registered nurses who worked for at least six months in the hemodialysis unit were included for in-depth interviews. Data were also collected through 167 hours of observations, field notes, and two focus groups. Texts including policy, protocols, and record documents were incorporated in the analysis. Data analysis followed Smith's (1987) institutional ethnographic analysis. Nepalese nursing work in a hemodialysis unit was mainly organized by the free hemodialysis policy of the government which was not available to the nurses at the hemodialysis unit, but it determined most of the nursing activities of patient care and documentation. Hemodialysis record form, hemodialysis schedule, and free hemodialysis claim form also had a great influence on nursing work. However, the nurses were not quite aware of how the textual documents determined their practices to meet the politico-economic interests of the hospital and government. The hospital and Nepal's health ministry established the activities and recording requirements. Identification of texts and exploration of their influences on nurses' decisions, patient care, and documentation are essential to find the optimal solutions in daily care and determine the appropriate support for nurses in hemodialysis settings.

Canadian healthcare capacity gaps for disease-modifying treatment in Huntington’s disease: a survey of current practice and modelling of future needs

ObjectivesDisease-modifying therapies in development for Huntington’s disease (HD) may require specialised administration and additional resource capacity. We sought to understand current and future capacity for HD management in Canada considering...

947-P: Needs Assessment for a Collaborative Patient-Centered Digital Health Application for Pediatric Diabetes Care in British Columbia

There has been a rapid rise in digital health applications to support diabetes self-management to improve patient-centered outcomes such as engagement and satisfaction. TrustSphere is a collaborative single point of access digital health application that has been developed using principles of co-creation and participatory design with health care providers (HCP) and patients/families. Our objective is to describe HCP perspectives on current challenges and ideas for digital application features. A survey was distributed to pediatric diabetes HCP across British Columbia, Canada (n=50; 36% diabetes nurse educators, 24% nursing support services, 18% pediatricians, 12% dietitians, 8% pediatric endocrinologists) . HCP identified access to mental health support (84%) , diabetes management technologies (53%) , clinical information (39%) , and support for diabetes care at school (35%) as key challenges. Qualitative data revealed struggles with staying up to date with diabetes technology and empowering patients to self-manage their diabetes between visits. HCP reported TrustSphere should include information on the type of insulin regimen (87%) , insulin doses &amp; pump settings (76%) and patient-centered goals (41%) as well as integration of glucose meter (91%) , continuous glucose monitor (CGM) (93%) , and insulin pump data (91%) . Overall, HCP felt an integrated digital platform would greatly simplify their care for children with T1D (47%) . HCP perspectives were integrated into TrustSphere’s minimal viable product (MVP) . Via real-time connections, glucometer, CGM, and pump data have been integrated into the platform. Insulin doses, patient tasks, and management recommendations can be collaboratively entered by patients or HCP, optimizing personalized care. Educational resources and a mindfulness app to support mental health can also be accessed via TrustSphere. Next steps are a pilot study of the TrustSphere MVP with pediatric T1D patients. Disclosure F.S.Abdulhussein: None. S.Amed: Advisory Panel; Insulet Corporation, Lilly, Sanofi, Research Support; Dexcom, Inc., Novo Nordisk, Speaker's Bureau; Abbott Diabetes. S.Pinkney: None. Funding Canadian Digital TechnologySuperclusterUniversity of British Columbia

Public Health Nurse Tailored Home Visiting and Parenting Behavior for Families at Risk for Referral to Child Welfare Services, Colorado: 2018-2019.

Objectives. To examine public health nurse (PHN) intervention tailoring through the Colorado Nurse Support Program (NSP). Our 2 specific aims were to describe the NSP program and its outcomes and to determine the effects of modifying interventions on short- and long-term outcomes among NSP clients. Methods. In our retrospective causal investigation of 150 families in Colorado in 2018-2019, intervention effects were modeled via longitudinal modified treatment policy analyses. Results. Families served by PHNs improved in terms of knowledge, behavior, and status outcomes after receiving multidimensional, tailored home visiting interventions. Case management interventions provided in the first month of PHN home visits had lasting effects on behavior outcomes, and 2 additional case management interventions in the first month were estimated to have even more of an impact. Conclusions. Modern causal inference methods and real-world PHN data revealed a nuanced, fine-grained understanding of the real impact of tailored PHN interventions. Public Health Implications PHN programs such as the NSP and use of the Omaha System should be supported and extended to advance evaluations of intervention effectiveness and knowledge discovery and improve population health. (Am J Public Health. 2022;112(S3):S306-S313. https://doi.org/10.2105/AJPH.2022.306792).

Associations between job stress, social support, and nursing professionalism among nurses in postgraduate courses

Purpose: This study aimed to identify the associations between job stress, social support, and nursing professionalism among nurses taking postgraduate courses, and to explore the factors influencing their nursing professionalism. Methods: The participants were 121 nurses who were enrolled in graduate school master's or doctoral programs in Korea. Data were collected from June 30 to August 31, 2021, using an internet-based self-report questionnaire. The data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple regression analysis using the IBM SPSS 23.0 program. Results: The mean scores of job stress, social support, and nursing professionalism among the participants were 2.47 out of 4, 4.06 out of 5, and 3.47 out of 5, respectively. There were statistically significant differences in nursing professionalism among the participants according to the degree program (F=-2.76, &lt;i&gt;p&lt;/i&gt;=.007) and the length of nursing career (F=4.35, &lt;i&gt;p&lt;/i&gt;=.015). Their nursing professionalism showed a positive correlation with social support (r=.45, &lt;i&gt;p&lt;/i&gt;&lt;.001) and a negative correlation with job stress (r=-.43, &lt;i&gt;p&lt;/i&gt;&lt;.001). As a result of the multiple regression analysis, factors influencing nursing professionalism of the participants were found to be job stress (β=-.28, &lt;i&gt;p&lt;/i&gt;=.003), social support (β=.23, &lt;i&gt;p&lt;/i&gt;=.015), and the length of nursing career (β=.19, &lt;i&gt;p&lt;/i&gt;=.018). The explanatory power of the model was 28.0% (F=12.62, &lt;i&gt;p&lt;/i&gt;&lt;.001). Conclusion: The present study suggests that organized efforts are needed to alleviate job stress and to increase social support for nurses in postgraduate courses in order to ultimately improve their nursing professionalism.

Experience of violence, coping and support for nurses working in acute psychiatric wards

BackgroundAcute psychiatric wards are stressful working environments because of the nature of the mental illness of patients admitted. These patients present with a variety of complex psychiatric problems and social control that require skilled and competent nurses to manage them. The shortage of nurses, especially with advanced psychiatric qualifications or necessary experience, may create challenges for nurses as they navigate this stressful working environment.AimThe aim of this study was to explore and describe nurses’ experience of patient violence, coping strategies and received support whilst working in acute wards in psychiatric hospitals.SettingThis study was conducted in six acute wards of the three psychiatric hospitals in Cape Town, South Africa.MethodsA qualitative, explorative, descriptive design was conducted using semi-structured interviews to obtain data from 14 nurses working in acute wards in three psychiatric hospitals in the Western Cape.ResultsFive themes were generated using thematic analysis: violence perceived to be ‘part of the job’, contributing factors to patient violence, physical and psychological effects on nurses, adaptive and maladaptive coping strategies and perceived support from stakeholders.ConclusionParticipants normalised patient violent behaviour as being part of the job to minimise the physical and psychological effects of the traumatic experience. Adaptive and maladaptive coping strategies were used to cope with the traumatic experiences of being assaulted by patients. Recommendations allude to practising self-care and attendance of training in the management of aggressive patients for nurses, to enhance a variety of adaptive coping strategies.

Disciplinary processes for nurses, from organizational supervision to outcomes: A document analysis of a regulatory authority's decisions.

This study aims to explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority. Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses. This is a retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007 to 2016. The data were analysed using a quantitative design with descriptive statistics. We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under 1 month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety. This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organisations ensure patient safety when unprofessional conduct is suspected. Retaining nursing professionals is vital due to global shortages, and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

The impact of death and dying on the personhood of senior nurses at the National Cancer Centre Singapore (NCCS): a qualitative study

BackgroundA nurse’s role in caring for the dying is fraught with ethical, professional, and psychosocial challenges that impact how they perceive their roles as professionals. When unsupported, nurses caring for the dying experience burnout, career dissatisfaction and leave the profession. Better understanding of how caring for the dying affects the professional identity formation (PIF) of nurses will guide efforts to better support nurses.MethodsGuided by new data on the subject, we adopt the theoretical lens of the Ring Theory of Personhood (RToP) to evaluate how caring for the dying impacts the values, beliefs, principles, professional identities and personhood of nurses. We employ Krishna’s Systematic Evidence-Based Approach (SEBA) to guide the design and piloting of the semi-structured interview tool.ResultsAnalysis of interviews with eight senior nurses in Supportive, Palliative and Oncology care revealed three domains: Identity 1) Formation; 2) Conflict and 3) Refinement. Identity Formation occurs early in a nurse’s career, upon entering a new specialist field, and at the start of Supportive, Palliative and Oncology care. Identity Formation reveals significant changes to how self-concepts of professional identities are tied to individual concepts of personhood. Caring for the dying, however, resulted in Conflicts between values, beliefs, and principles within regnant concepts of personhood and their professional duties. These conflicts are captured as conflicts within (‘disharmony’) and/or between (‘dyssynchrony’) the rings of the RToP. These conflicts can result in changes to self-concepts of personhood and professional identities. Identity Refinement sees experience and timely support helping nurses attenuate the impact of difficult experiences. This reduces the risk of burnout and mitigates changes to their professional identities. Identity Refinement helps them develop a ‘rooted identity’ which remains relatively consistent in the face of adversity.ConclusionsOngoing Identity Construction amongst nurses, particularly in caring for the dying, underscore the host organisation’s role in ensuring structured, longitudinal, accessible, and personalised assessments and support of nurses, especially when they are prone to dyssynchrony and disharmony whilst caring for the terminally ill. Further study into assessment methods and the role of the environment is critical.

Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards.

Estimate the effect of nursing, shift, and patient characteristics on patients' aggression. Follow-up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression. The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive. These findings could stimulate support for nurses to prevent aggression.

How Effective is Clinical Supervision in Nursing? A Systematic Review

Background: Clinical Supervision (CS) is a process of learning and professional support for nurses and developing nursing practice through regular discussions with experienced and skillful colleagues. However, it remains challenging to ensure the effectiveness of its implementation across all healthcare organizations. This systematic review study aims to answer the question: What are the effects of CS on nurses’ perceptions and performance?. Methods: This systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and using a mixed method. The search was conducted in the online databases including PubMed, ScienceDirect, Cochrane library, Wiley Online Library, and ProQuest for studies related to effectiveness of CS published from 2000 to 2021. Additional studies were also added by reference/citation tracking. Methodological quality of the included studies was assessed using the McMaster Critical Review Form for both quantitative and qualitative studies (Version 2.0). Their risk of bias was assessed independently by two authors using the Cochrane Collaboration’s risk of bias assessment tool. The studies were qualitatively analyzed by the classification of their main findings, study design, and CS methods/models. Results: Of 1041 potentially relevant studies, 237 were removed due to being duplicates. After screening the titles and abstracts of the remaining, 793 removed and finally 11 studies that met the inclusion criteria were entered into the review process. The design of the studies was quasi experimental (n=3), randomized controlled trial (n=1), cross-sectional (n=5), and qualitative (n=2). All the included studies showed the significant effectiveness of CS presented in various methods used such as one-on-one CS and group CS. The CS increased nurses’ peer support and stress relief (restorative function), professional accountability (normative function) and skills and knowledge (formative function). Conclusion: CS is significantly effective in nursing practice. There is a growing need in the future for more experimental studies, taking into account the use of more appropriate methodologies.