Tragedy or transformation? Online survey of nurse spirituality during the COVID pandemic.

AIM: To describe positive and negative spiritual responses to providing COVID-related nursing care among nurses working in hospitals. BACKGROUND: The COVID pandemic has intensified and publicised the threats to nurse well-being. Absent from the recommendations for promoting nurse well-being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well-being. DESIGN: Cross-sectional, descriptive observational, mixed methods study. METHODS: Data were collected from 523 registered nurses employed in three Southern California hospitals during March-May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale-Short Form, Moral Injury Symptom Scale-Healthcare Professionals, Post-traumatic Growth Inventory and demographic and work-related items. STROBE guidelines for cross-sectional observational studies were observed. RESULTS: The mean for religious/spiritual struggles was 1.98 (range of 1-5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%-36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1-10); applying established criteria indicated it was troubling for at least 50%. The mean for post-traumatic growth was 4 (on a scale of 0-6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. CONCLUSION: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. RELEVANCE TO CLINICAL PRACTICE: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy-and allow spiritual transformation.

Current interventions to promote safe and appropriate pain management.

PURPOSE: Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. SUMMARY: The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. CONCLUSION: Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.

Catheter-Associated Urinary Tract Infections: Implementing a Protocol to Decrease Incidence in Oncology Populations
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BACKGROUND: The impact of catheter-associated urinary tract infections (CAUTIs) on immunocompromised patients with cancer requires preventive intervention from bedside nurses.
. OBJECTIVES: This protocol aims to prevent CAUTIs in the inpatient oncology population by implementing an evidence-based, nurse-driven protocol for discontinuing indwelling urinary catheters (IUCs).
. METHODS: Following a literature review of 34 articles, a nurse-driven CAUTI prevention protocol was developed and implemented on two 26-bed oncology units. Unit staff were educated on the protocol and use of the audit tool.
. FINDINGS: Although CAUTI rates remained unchanged, infections per 1,000 IUC days decreased, and adherence among oncology nurses rose 66%-90% within the first two months. The protocol encouraged preventive intervention from RNs to protect patients with cancer from CAUTIs.

Educating Home Healthcare Nurses About Heart Failure Self-Care.

The ability of home healthcare nurses to effectively educate patients with heart failure (HF) on appropriate self-care is key to lowering the hospital readmission rates and other adverse outcomes. Evidence indicates, however, that nurses often lack current knowledge about HF self-care. Furthermore, patient education often fails to produce health literacy. Thus, this educational intervention for home healthcare nurses included content about key aspects of managing HF (e.g., diet, medications), as well as how to use the teach-back method during patient education. Pre- and posttesting (using the Nurses' Knowledge of HF Education Principles Questionnaire) and role-playing were used to evaluate the intervention delivered to 33 home care nurses. Findings exposed knowledge deficits regarding high-sodium foods, symptoms indicating deterioration, problematic weight gain, fluid management, as well as other topics related to HF. The education was partially effective in addressing these nurses' knowledge gaps. The evidence-based education for home healthcare nurses suggests that not only may nurses lack knowledge essential to teaching HF self-care; they may also lack effective patient education skills such as using the teach-back method.

Risks related to patient bed safety.

There is heightened public awareness of the inherent risks of hospitalization. The hospital bed itself, however, is often not where jeopardy is expected. This article examines 3 chief contributors to hazards associated with hospital bed systems: fire, entrapment, and pressure ulcers. Strategies to assess beds for safety risks are discussed.