Promoting End-of-Life Care and Healthcare Worker Well-Being: Implementing the 3 Wishes Project in an Oncology Intensive Care Unit.

This scholarly project implemented the 3 Wishes Project (3WP), which aims to fulfill the final wishes of dying critically ill patients, in a 16-bed tertiary intensive care unit (ICU). The project assessed outcomes through sur.

Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study.

BACKGROUND: Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence. OBJECTIVES: Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report. DESIGN: Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey. METHODS: Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models. RESULTS: Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence. CONCLUSIONS: Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety. REGISTRATION: Not registered. TWEETABLE ABSTRACT: Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Understanding Nursing Workplace Violence Trends for Safer Clinical Oncology Settings.

BACKGROUND: Workplace violence (WPV) against nursing professionals by patients and visitors occurs frequently, and rates of WPV increased during the COVID-19 pandemic. All nursing teams, including oncology nursing professionals, are at risk for WPV and need current WPV-related information applicable to their clinical experiences. OBJECTIVES: This overview aims to increase awareness of trends and personal safety issues related to clinical oncology nursing practice and provide strategies and resources to enhance personal safety in nursing practice. METHODS: This overview used literature reviews, publicly reported sources, other scholarly resources, and real-world examples to identify and synthesize WPV trends related to clinical nursing. FINDINGS: This overview's findings suggest that the COVID-19 pandemic contributed to the increased rate of WPV and subsequent harm to nursing staff victims. Oncology nursing professionals can implement best practices to reduce their risk of being harmed, and healthcare institutions can operationalize best practices by having systems and resources in place that prevent and mitigate WPV.

Why nurses do not report patient aggression: A review and appraisal of the literature.

AIM: To establish the current state of the science about why nurses do or do not report being the victim of patient aggression, a form of type II workplace violence. This aim includes identifying and analysing current gaps in the literature. BACKGROUND: It is increasingly more common for patients to instigate aggressive acts towards nurses, leading to significant consequences. Nursing victims often do not report acts of patient aggression to others, making it difficult for health care leaders and researchers to address this challenge. EVALUATION: The review process involved searching five databases, using the PRISMA framework to reduce 355 records to 65 sources for review and synthesis. KEY ISSUES: The findings of this review highlight key takeaways about why nursing victims do not report episodes of patient aggression, which include their fears, attitudes and abilities related to reporting; and their perspective of the patient aggression event. Workplace environments are central to most of these factors, emphasizing the importance of nursing and other health care leaders to put systems in place that promote nurse reporting behaviours. CONCLUSIONS: Patient aggression is a widespread problem with severe consequences. Review findings can inform future research while having practical relevance for health care leaders. IMPLICATIONS FOR NURSING MANAGEMENT: Health care leaders need to consider how workplace structures, practices, and cultures can encourage or stifle nurse reporting behaviours. By understanding nurse reporting behaviours, processes can be developed to promote nursing victim reporting and deter patient aggression.

Reducing Patient Aggression Through a Nonviolent Patient De-escalation Program: A Descriptive Quality Improvement Process.

BACKGROUND: Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem. AIM: To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de-escalating aggressive patient encounters. METHODS: This descriptive quality improvement process took place within two inpatient acute care departments using simulation-based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre- and post-intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed-rank test. RESULTS: This project mitigated patient aggression episodes by successfully designing and implementing an evidence-based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under-reporting in nursing. LINKING EVIDENCE TO ACTION: Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation-based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.

COVID-19 pandemic impact on experiences and perceptions of nurse graduates.

BACKGROUND: Transitioning from education to practice is stressful for new nurses and those entering new roles and can lead to workforce attrition and burnout. This dynamic is likely complicated when graduates are transitioning to practice during a pandemic. PURPOSE: The purpose of this study was to describe recent nurse graduates' perceptions of the impact of the COVID-19 pandemic on their transition from education to practice. METHODS: We conducted an online survey of BSN, RN-BSN, and DNP students who graduated between December 2019 and April 2020 (n = 82), including demographics, employment information, and free-response questions about the impact of the pandemic on their transition experiences, post-graduation plans, and perceptions of nursing. We used a qualitative descriptive approach to content analysis to synthesize and summarize the data. RESULTS: Participants expressed three overarching concerns: 1) altered plans such as difficulty finding employment; 2) logistical, system-related stressors including licensing delays and chaotic onboarding; and 3) feeling pride in profession despite perceiving ambivalence in public discourse. CONCLUSION: COVID-19 exacerbated challenges often experienced by new graduates. Common stressors, intensified during the pandemic, could exert long-term effects on the workforce. Educators and healthcare organizations must work to ensure nursing graduates receive the necessary support for a successful transition.

Escape from the diffusion of responsibility: A review and guide for nurses.

AIMS: This review aims to help nurse leaders and professionals to understand, recognize, and mitigate the phenomenon known as the diffusion of responsibility, while also bridging a gap in nursing literature by highlighting Milgram's and Zimbardo's research. BACKGROUND: Nurses are uninformed of how responsibility is diffused when obeying authority figures, fulfilling roles, and conforming in groups. It is important to recognize and address this potential for unethical practices, given the high risk for these behaviours to occur in health care settings. EVALUATION: Sources discussing the diffusion of responsibility were identified through databases using terms such as: "Diffusion of Responsibility," "Nursing," "Ethics," "Obedience," "Groupthink," "Bully," "Milgram," and "Zimbardo." KEY ISSUES: Social psychology examples of diffused responsibility from Milgram, Zimbardo, and Janis are explored, applied to the field of nursing, and leadership implications are discussed. CONCLUSION: Nurses can unintentionally ascribe accountability for personal action to others. It is therefore essential for nurses to escape the cycle of diffused responsibility. IMPLICATIONS FOR NURSING MANAGEMENT: Examples in this review provide important clues for addressing the negative effects of diffused responsibility. The onus is on nurses to personally enhance the ethics of their practice by surveying, pondering, and applying these concepts.

Can I relate? A review and guide for nurse managers in leading generations.

AIMS: The purpose of this review is to help the nurse leader develop an understanding of the five generations currently in the health care workforce by providing defining characteristics, general behaviours, and strategies for the nurse manager to employ for each generational cohort. BACKGROUND: Generations are groups of people born during the same 15-20 year time period who share similar experiences before adulthood, which shape long-term behaviours. Key descriptors and characteristics are provided. EVALUATION: The current generational cohorts in the health care workforce are Traditionalists (born between 1922 and 1945), baby boomers (born between 1946 and 1964), Generation X (born between 1965 and 1979), millennials (born between 1980 and 1995), and Generation Z (born after 1995). KEY ISSUES: Health care teams often comprise members of three or more generations. Intergenerational differences in team members can result in challenges; however, different perspectives provided by multiple generations can be used advantageously to strengthen the team's efficiency and outcomes. CONCLUSIONS: There are strengths in each generation. Key differences can be harnessed to build stronger teams through comprehensive communication strategies, customized reward systems, and workplace flexibility. Examples are provided for each area. IMPLICATIONS: Managers can use intergenerational differences to create a rich environment that bridges generational differences and fosters workforce cohesion.