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Reframing care while enduring the traumatic nature of witnessing disrupted family‐patient‐nurses' relationships during COVID‐19

Abstract

Aim

To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States.

Design

A phenomenological philosophical approach following the van Manen analysis method.

Methods

Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country.

Results

The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons.

Conclusion

The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time.

Impact

Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.

Decision‐making experiences related to mastectomy: A descriptive qualitative study

Abstract

Aim

To obtain an in-depth understanding of women's decision-making experiences related to mastectomy.

Design

A descriptive qualitative interview study.

Methods

Individual semi-structured interviews were conducted face-to-face with 27 Chinese women with breast cancer who underwent mastectomy at two tertiary hospitals in mainland China between September 2020 and December 2021 after obtaining the appropriate ethical approvals. Interviews were conducted in Mandarin. Data were analysed using inductive content analysis.

Results

Mean age of participants was 48 years (range 31–70). Most participants had low education, low monthly family income, had a partner and health insurance, had been diagnosed with early breast cancer, and had not undergone reconstructive surgery. Six categories related to decision-making experiences emerged: (1) Emotions affecting decision-making, (2) Information seeking for decision-making, (3) Beliefs about mastectomy and the breast, (4) Participation in decision-making, (5) People who influence decision-making, and (6) Post-decision reflection. Participants did not mention the role of nurses in their decision-making process for mastectomy.

Conclusions

This study adds valuable insights into the limited evidence on women's experience with decision-making about mastectomy from a Chinese perspective, which is important given the continuing high prevalence of mastectomy in many regions. Future studies from other countries and ethnic groups are recommended to gain diverse knowledge.

Impact

The findings of this study are useful for nurses and other healthcare professionals in the multidisciplinary team to better support women with breast cancer in their decision-making process regarding mastectomy. The findings could inform future interventions to support treatment decision-making and may be relevant to women living in similar socio-medical contexts to those in mainland China.

Reporting Method

The study was reported following the Standards for Reporting Qualitative Research checklist.

Patient or Public Contribution

No patient or public contribution.

Acute care nurse managers' definitions of and barriers to well‐being: A thematic analysis of open‐ended survey questions

Abstract

Background

During the COVID-19 pandemic, acute care nurse managers functioned in a critical role by helping to advance the mission and goals of their organization while navigating a rapidly evolving healthcare landscape. This resulted in high levels of ongoing job-related stress which is linked to negative physical, psychological, and job-related outcomes. Little is known about the perceptions regarding their own professional well-being during this time.

Aim

The aim of this study was to qualitatively describe acute care nurse managers' perceptions of and barriers to their professional well-being.

Methods

Using a qualitative descriptive approach, nurse managers from a hospital system in the southwestern United States responded to two short-answer, survey-based questions in 2022: (1) “Describe the definition of nurse-manager well-being in your own words” and (2) “What do you feel is your biggest barrier to professional well-being?” Reflexive thematic analysis was utilized to analyze participant responses (N = 80).

Results

Professional well-being is a complex concept influenced by the nurse manager's ability to navigate work–life balance; care for their own physical, emotional, and spiritual selves; give and receive support from stakeholders; and manage feelings of thriving vs. struggling in the role. Barriers most cited as influencing well-being included having too little time to get things done coupled with increasing workloads, feeling stuck in the middle among stakeholders, and coping with ongoing staffing challenges.

Linking Evidence to Action

The definition of and barriers to well-being are influenced by the specific needs and experiences of the nurse manager. While not all barriers can be immediately removed, the identification of individual and organization-specific barriers needs to be taken seriously, reviewed by those who can promote change, and evidence-based solutions for improvement piloted or implemented when feasible.

Intervenciones de enfermería en niñas y niños con trastorno del espectro autista que precisan atención sanitaria: una revisión de la literatura

Objetivo: Identificar las intervenciones de enfermería en niñas y niños con trastorno del espectro autista, y sus familias, que precisan atención sanitaria. Metodología: Revisión de literatura mediante una búsqueda bibliográfica en Pubmed, Scopus, Web of Science y CINAHL. Resultados: Se obtuvieron un total de 189 resultados, tras aplicar los criterios de exclusión se consideraron que 12 tenían relevancia para la revisión. Conclusión: La falta de estrategias de comunicación con el niño, los factores ambientales y la falta de conocimiento de intervenciones dificultan la atención sanitaria. Conocer los factores estresantes de los pacientes, las estrategias centradas en la familia y las técnicas de comunicación, además de la colaboración con los padres y la atención integral a la familia son esenciales para mejorar la calidad de los cuidados.

Percepción del proceso de trabajo de los técnicos de enfermería titulados

Objetive: analizar las percepciones, motivaciones y dificultades de los técnicos de enfermería titulados en enfermería. Metodología: Me-todología: Se trata de una investigación cualitativa, exploratoria descriptiva, la recolección de datos se realizó en un Hospital Municipal del Noroeste de Paraná, durante el primer semestre de 2020, mediante la aplicación de un guión semiestructurado con preguntas orien-tadoras y un cuestionario sociodemográfico. Resultados: El conocimiento adquirido en la graduación de enfermería fue uno de los facto-res facilitadores que contribuyó a una mejor ejecución de la atención brindada, y la mayor dificultad está relacionada con la aceptación de los colegas y supervisores, en relación a las opiniones y sugerencias sobre los procedimientos u organización de la Servicio. Las razones que llevaron a los técnicos de enfermería a cursar una carrera en el área en la que trabajan se deben a la necesidad de cono-cimientos y la búsqueda de un mejor futuro financiero. Conclusión: cuando el profesional tiene un título, se desarrolla con mayor destreza y eficacia en la asistencia proporcionada.

Agravios por causas externas en Servicio de Atención Móvel de Urgencia

Objetivo principal: Identificar la prevalencia de los agravios por causas externas en Servicio de Atención Móvil de Urgencia y factores asociados. Metodología: Estudio de datos secundarios, desarrollado a partir de recolección de datos en 2845 boletines de atención. Se utilizó un análisis de modelo de regresión de Poisson. Resultados principales: Los individuos con edad entre 21 y 40 años presentan aumento de 75% en la probabili-dad de sufrieren agravios por causas externas, 54% mayor probabilidad de presentaren una respiración alterada en el examen clínico, 105% mayor riesgo de rechazo de atención y 233% mayor riesgo de no estar en el local. Conclusión principal: Accidentes de transporte y caídas fueron los agravios por causas externas más prevalentes. Los factores asociados fueron: edad entre 21 y 40 años y presentar respiración alterada. Otros factores, también, se mantuvieron asociados por el rechazo en la atención y no estar presente para recibir la atención.

Evidencias bibliográficas sobre riesgos laborales en los pescadores artesanales: revisión integrativa de la literatura

Objetivo: Identificar en la producción científica los tipos de riesgos para enfermidades y agravos para acidentes em trabajadores de la pesca artesanal. Metodología: Revisión integrativa, realizada entre enero y marzo de 2018, por medio de la combinación de los descriptores "Occupational Health" y "Fisheries", en las bases de datos, Medline, LILACS, Scopus, SciELO e internet. Se encontraron 123 artículos. Después de la lectura y evaluación de los mismos, se obtuvo un resultado final para el análisis de 16 artículos. Resultados principales: La mayoría de los estudios se indexaron en la base de datos Medline (56,3%), en el idioma inglés (43,8), con un nivel de evidencia VI (100%). Se constató que los trabajadores de la pesca artesanal están expuestos a riesgos ergonómicos, químicos, físicos y de accidentes. Conclusión: Se constató carencia de publicaciones en el área de la pesca artesanal, inexistencia de publicaciones científicas realizadas por la enfermería y brechas en el conocimiento.

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