"You always think the worst " Family members' experiences during the COVID-19 emergency: A qualitative descriptive study.

AIM: The aim of this study was to explore the experiences of family members of patients admitted to the intensive care unit (ICU) for COVID-19 during the first and second waves of the pandemic in Switzerland. DESIGN: A qualitative descriptive approach was used in this study. METHODS: Face-to-face in-depth semistructured interviews were used to explore the experiences of family members of surviving COVID-19 patients, who were admitted to the ICU. Interviews were transcribed verbatim and wereanalysed using Braun and Clarke thematic analysis. In our context, family visits were prohibited during the first and second waves of the pandemic. FINDINGS: Fifteen family members participated. Interviews were conducted between October 2020 and March 2021. Data analysis identified three main themes: (i) becoming a pillar of support for all; (ii) dealing with uncertainty; and (iii) a trajectory of emotions. Five subthemes are reported within these themes. The primary concern was the need for information due to visitation restrictions. This led to stress as many became the main communication source for other family members and friends. Coping strategies to support the ongoing uncertainty included daily routines, work, and prayer. The inability to visit and the lack of information led to a range of conflicting emotions, such as feeling of helplessness, which were countered by the gratitude that their loved ones had survived. CONCLUSION: This study highlights the profound impact of the COVID-19 pandemic on the family members of ICU patients. It emphasises their struggle for information, adaptation to new roles, and coping mechanisms amidst uncertainty. Although they experienced predominantly negative emotions, the recovery and return of their loved ones triggered a sense of gratitude. This study sheds light on the crucial role of social support. Such findings may have implications for nursing practice in effectively addressing the concerns and priorities of family members in similar emergency situations, thereby improving clinical outcomes.

Nursing Leaders' Knowledge and Awareness of Bullying and Lateral Violence: A Qualitative Study.

Introduction: Bullying and lateral violence are prevalent phenomena within the nursing profession, exerting significant impacts on patient safety, the nursing profession and the organisation. The pivotal role of nurse leaders is paramount in both the prevention and resolution of these issues. Aim: The aim is to explore the level of awareness and knowledge of bullying and lateral violence of nurse leaders in a public hospital in Switzerland. Methods: A qualitative descriptive study has been conducted. Data were collected from February to August 2020 using semi-structured interviews and focus groups that were recorded and transcribed verbatim. Two researchers independently utilised Braun and Clarke's thematic analysis to code, categorise and synthesise the data. The sample of nursing middle-management leaders was purposive. Results: The study involved 35 nurse leaders as participants. Through data analysis, 15 themes were identified, which were further grouped into five major themes: characteristics of the phenomena, facilitating and hindering factors, emotions/experiences, strategies and supports. The results highlighted that nurse leaders may have a lack of knowledge about these phenomena, leading to challenges in their identification. The awareness achieved by the nurse leaders highlighted their need to understand what they were 'fighting against'. Conclusion: It is essential to consider the impact of these phenomena on employees' well-being and their potential consequences for patient safety, quality of care and financial performance. A preventive approach by increasing nurse leaders' competence in observing everyday working realities and identifying strategies for addressing bullying is required. Further research on the construction and implementation of specific interventions is essential, aimed at preventing and addressing these phenomena comprehensively.

Interventions for Preventing and Resolving Bullying in Nursing: A Scoping Review.

Bullying in the workplace is a serious problem in nursing and has an impact on the well-being of teams, patients, and organisations. This study's aim is to map possible interventions designed to prevent or resolve bullying in nursing. A scoping review of primary research published in English and Italian between 2011 and 2021 was undertaken from four databases (Cochrane Collaboration, PubMed, CINAHL Complete, and PsycInfo). The data were analysed using Arksey and O'Malley's framework, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist was followed to report the study. Fourteen papers met the review eligibility criteria. The analysis revealed four main themes: educational interventions, cognitive rehearsal, team building, and nursing leaders' experiences. Interventions enabled nurses to recognise bullying and address it with assertive communication. Further research is needed to demonstrate these interventions' effectiveness and if they lead to a significant decrease in the short-/long-term frequency of these issues. This review increases the available knowledge and guides nurse leaders in choosing effective interventions. Eradicating this phenomenon from healthcare settings involves active engagement of nurses, regardless of their role, in addition to support from the nurse leaders, the organisations, and professional and health policies.

Nurses Response to the Physical and Psycho-Social Care Needs of Patients with COVID-19: A Mixed-Methods Study.

The COVID-19 pandemic heavily impacted nursing care. This study aimed to understand which nursing interventions were instrumental in responding to COVID-19 patients' needs by exploring the experiences of patients and nurses. In this mixed-method study with an explanatory sequential design, we involved nurses caring for COVID-19 patients in intensive and sub-intensive care units and patients. In the first phase, we collected data through a survey that assessed patients' needs from the perspective of nurses and patients, as well as patient satisfaction. In the second phase, qualitative data were collected through interviews with patients and nurses. In the third phase, we extracted quantitative data from patients' records. Our sample included 100 nurses, 59 patients, 15 patient records, and 31 interviews (15 patients, 16 nurses). The results from the first phase showed patients and nurses agreed on the most important difficulties: "breathing", "sleep/rest", and "communication". Nursing care was rated positively by 90% of the patients. In the second phase, four themes were identified through the patients' interviews: "my problems", "my emotions", "helpful factors", and "nursing care". Five themes were identified through the nurses' interviews: "the context", "nurses' experiences and emotions", "facilitators and barriers to patient care", "nursing care", and "the professional role". From the third phase, the analysis of the clinical documentation, it was not possible to understand the nursing care model used by the nurses. In conclusion, nurses adopted a reactive-adaptive approach, based on experience/knowledge, pursuing generalized objectives, and adapting their response to the clinical evolution. In difficult contexts, nursing care requires a constant competent technical-relational presence at the patient's bedside.

Experiences and Needs of Patients, Caregivers and Nurses during the COVID-19 Pandemic: Study Protocol for a Mixed-Methods Multicentre Study.

The COVID-19 pandemic is a major public health problem with millions of confirmed cases and deaths described. Nurses are among the health care professionals most involved at the front line, caring for those affected by COVID-19. Patients and families have been subjected to a high emotional burden of fear, anxiety, and uncertainty. The COVID-19 pandemic has had a significant impact on the approach to patients, the organisation of care, and communication with patients and their families, all requiring considerable adaptation on the part of nurses and health care professionals. The overall aim of this research was to find out the needs of patients with COVID-19, the nursing interventions provided and their outcomes, and to explore the experiences of the nurses, patients, and caregivers. A mixed method study will be performed with a convergent design. The study was divided into three phases. Quantitative methods involved nurses and patients affected by COVID-19 with a questionnaire. Qualitative methods involved nurses, patients, and caregivers with interviews and finally a quantitative analysis of the nursing documentation of the interviewed patients. We hope that this study will help us to understand and identify the main nursing and support needs expressed by patients and their families at different stages of their illness.

Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study.

INTRODUCTION: Patient advocacy, acting on behalf of patients' unmet needs, is fundamental to nursing, and the perception of the need for advocacy motivated this study. Nurses experience moral discomfort, which results from a divergent view regarding medical or caregivers' decisions about patients' clinical proceedings, in which patients' involvement in making those decisions is either doubtful or absent. OBJECTIVES: The aim of this study is to assess the need for advocacy and explore the perspectives of nurses engaged in the care of older patients. METHODS: The methodological orientation is that of a qualitative design, by using a purposive and criterion sampling. The sample was of 14 nurses of a ward of general medicine. Focus group as collecting data tool was used, followed by a thematic analysis. RESULTS: Nurses demonstrated a high level of moral sensitivity to ethical problems in clinical practice and on occasions, the courage to bring the problem to the physicians or patients' family's attention, or help patients develop self-determination. However, it is difficult to advocate because of insufficient communication between professionals, insufficient knowledge of ethics, and the emotional burden it places on nurses which results in emotional resignation in the face of interprofessional teams' lack of consideration of nurses' opinions. CONCLUSION: This research highlighted nurses' need for advocacy to promote patients' rights, wishes, and values. It is essential for nurses to be aware of their level of moral sensitivity and develop a strategy to regain courage to engage in advocacy. Therefore, ethics education and interprofessional ethical leadership is desired, which inspires healthcare professionals' work and allows the foundations of an ethical decisionmaking process to be laid through patients and their families' active involvement.