Healthcare team resilience during COVID-19: a qualitative study.

BACKGROUND: Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization. METHODS: We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. RESULTS: Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance. CONCLUSION: Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

Feasibility and Preliminary Impact of a Web-Based Mind Body Intervention for Older Dementia Caregivers.

BACKGROUND: Mind-body interventions focused on intentional breathing and movement have been found to mitigate the negative effects of caregiving such as such as stress, psychosocial distress, and emotional distress associated for persons living with Alzheimer's disease and related dementias. OBJECTIVE: The objective was to assess the feasibility and acceptability and preliminary impacts of our 12-week mind body intervention "Gentle Yoga and Yogic Breathing" for caregivers of persons living with dementia on health outcomes including mutuality, depression and anxiety, loneliness and social support, quality of life, and physical function. METHODS: We conducted a single-group cohort study in which 20 caregivers were enrolled. Data were collected at baseline and at the 12-week post-intervention endpoint. RESULTS: The intervention was acceptable; 75% (n = 15/20) completed the study; 16 completed post-study questionnaires. Very few experienced technical issues; 31% (n = 3) most commonly reported as poor internet connectivity, 75% (n = 12/16) perceived a health benefit, 88% (n = 14/16) perceived improved day-to-day mood, and 100% (n = 16/16) would recommend the intervention to other caregivers. Although there was minimal change from baseline to 12 weeks, for health outcomes, there were very small improvements noted in anxiety and overall health. There were no reported adverse events. CONCLUSION: The intervention was well received and is feasible and acceptable for future studies of stress and health management interventions for caregivers of persons living with dementia.Registered with https://www.ClinicalTrials.gov (NCT03853148).

Preliminary Findings of an Adapted Nurse-Led Palliative Care Intervention.

Context: Despite the increased number of people living with Alzheimer's disease and related dementias (PLWD), limited early palliative care interventions exist for this population. Adapting promising interventions for other progressive disease conditions may address this need. Few published studies have examined this topic using recognized adaptation frameworks. Objectives: To systematically adapt a nurse-led palliative care intervention for people with idiopathic pulmonary fibrosis and caregivers (A Program of SUPPORT™) for PLWD and caregivers before pilot/feasibility testing. Methods: The Step Framework guided the transformation of A Program of SUPPORT™ to A Program of SUPPORT-D™ (dementia). The Step Framework was modified to include key stakeholder feedback on the initial intervention adaptation using a qualitative approach with semistructured interviews conducted with 5 community support professionals (respite care leaders and staff) and 10 caregivers from the Southeastern United States. A prioritization matrix was created to analyze qualitative feedback and inform intervention refinements. Data were collected between November 2021 and March 2022. Results: The modified Step Framework was a feasible guide for intervention adaptation. Three main themes emerged: organization, terminology, and content. Eight subthemes were identified within the content theme: strategies for providing care, planning ahead, understanding the illness, resources, safety, symptom management, social support, and self-management. Moreover, all participants provided largely positive feedback for the initial adaptation including over 200 suggestions for revision. Majority of participants suggested revising existing adapted content rather than including additional new content. The prioritization matrix was very useful in guiding additional intervention refinements, incorporating suggestions deemed highly important and improving the clarity of SUPPORT-D™. Conclusion: Adapting existing interventions for use by PLWD and caregivers is a practical approach that can increase the speed of translation of applicable and effective interventions used in other populations. Early feedback, prioritized using a matrix, helped further refine the initial adaptation.

A National Survey of Nursing Faculty Resilience, Moral Courage, and Purpose.

BACKGROUND: High rates of nursing faculty burnout and moral distress fuel faculty attrition, which directly affects our ability to educate new nurses. This study investigated the relationships among resilience, moral courage, and purpose to inform strategies to promote well-being in nursing faculty. METHOD: A descriptive, correlational study was conducted using a convenience sample of nursing faculty in the United States and Canada (n = 690). Participants completed three surveys: the Connor Davidson Resilience Scale (CD-RISC), the Moral Courage Scale for Nursing Faculty (MCNF), and the Meaning of Life Questionnaire (MSQ), as well as a single open-ended question. RESULTS: Moral courage was moderately correlated to resilience, and the Meaning of Life Presence subscale was moderately correlated to resilience. Meaning of life presence and meaning of life search were moderately negatively correlated. CONCLUSION: Resilience, moral courage, and purpose are essential in promoting professional fulfillment and personal well-being in nursing faculty. [J Nurs Educ. 2023;62(7):381-386.].

An Analysis of the Perceptions of Incivility in Higher Education.

The aim of this study was to understand how incivility is viewed across multiple academic programs and respondent subgroups where different institutional and cultural power dynamics may influence the way students and faculty perceive uncivil behaviors. This study used the Conceptual Model for Fostering Civility in Nursing Education as its guiding framework. The Incivility in Higher Education Revised (IHE-R) Survey and a detailed demographic questionnaire were used to gather self-assessment and personal perspective data regarding incivility in the higher education setting. This approach aspired to collect a comprehensive perspective of incivility in higher education. With data from 400 students and 69 faculty, there was limited agreement between faculty and student participants about perceptions and experiences with incivility. Faculty and students did agree that the solution to incivility may be found with the creation of a code of conduct that defines acceptable and unacceptable behavior, role-modeling professionalism and civility, and taking personal responsibility and standing accountable for actions. Despite significant differences in participants' perceptions of incivility, they shared common solutions. With a shared goal, faculty and students can work toward cultivating civility in higher education.

Disruptive Academic Behaviors: The Dance Between Emotional Intelligence and Academic Incivility.

This study aims to better understand the perceptions and experiences related to incivility by students and faculty across multiple academic programs and respondent subgroups at a regional university in the southern United States. The study used a thematic analysis to examine student and faculty responses to three qualitative questions that focused on their perceptions of recent experiences and primary causes of incivility in higher education. Clark's (2007, revised 2020) Conceptual Model for Fostering Civility in Nursing Education and Daniel Goleman's (1995) Emotional Intelligence domains were used to give meaning and context to the study findings. For this group of respondents, the study found that incivility in higher education between faculty, students, and faculty and student relationships remain pervasive. Despite the global pandemic and social unrest occurring during the study period, these behaviors did not coalesce around a specific subgroup. Both faculty and students agreed that relationship management with a keen focus on communication could mitigate academic incivility. These findings can inform educators, students, and future researchers in planning meaningful interventions that address incivility in higher education. A relational approach centered on communication skill-building is needed to combat the persistent issue of incivility in higher education.

A systematic concept analysis of healthcare team resilience in times of pandemic disasters.

BACKGROUND: The concept of resilience has been used as a descriptor for individuals and organizations with the dominant themes of bouncing back and moving forward. AIMS: To examine the concept of resilience in providers and healthcare teams during pandemic disasters. RESEARCH DESIGN: Walker and Avant's eight-step concept analysis method. DATA SOURCE: CINAHL, EBSCO Host, PubMed, and SCOPUS were searched using the combined terms "resilience" or "resiliency" or "resilient" and "healthcare professionals," or "healthcare worker" or "healthcare team" or "physician" or "nurse" or "doctor" and "pandemic" or "disaster." METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used to review the literature and apply findings using the eight-step Walker and Avant method for concept analysis. RESULTS: Three clusters emerged as attributes of individual resilience that may be applied to healthcare teams in times of pandemic disasters: (1) resilience is a dynamic contextual process, (2) resilience stabilizes the team to maintain a routine level of function, and (3) resilience is a catalyst for the actualization of innate or acquired skills and ability within the healthcare team. CONCLUSION: This analysis suggests that resilience enhances the healthcare team's ability to maintain function during acute changes created by pandemic disasters. Resilience in healthcare teams during pandemics requires future research to explore the phenomenon.

The Effect of Academic Nurse Leaders' Toxic Behaviors.

BACKGROUND: A growing nursing faculty shortage, despite recruitment and retention efforts, is negatively affecting the nursing shortage. This study explored the relationships between academic nurse leaders' (ANL) toxic behaviors, job satisfaction, and anticipated turnover, and identified specific behaviors that affect faculty members' intent to stay. METHOD: A descriptive, correlational, mixed-methods study was conducted using a convenience sample of nursing faculty (N = 58). Participants completed the Toxic Leadership Scale, the Anticipated Turnover Scale, and the Minnesota Satisfaction Questionnaire Short-Form and also answered two open-ended questions. RESULTS: Moderate negative correlations between toxic leadership and intrinsic satisfaction, extrinsic factors, and general satisfaction were revealed, as well as specific behaviors causing faculty to want to leave. CONCLUSION: Increased awareness about the nature and influence of ANL toxic behaviors is needed to effectively address toxic behaviors and promote ANL accountability. Results indicate faculty are more satisfied in their role when ANL demonstrated open, honest, and transparent communication. [J Nurs Educ. 2022;61(2):88-92.].

A Qualitative Protocol to Examine Resilience Culture in Healthcare Teams during COVID-19.

Resilience allows teams to function at their optimal capacity and skill level in times of uncertainty. The SARS-CoV-2 (COVID-19) pandemic created a perfect opportunity to study resilience culture during a time of limited healthcare team experience, protocols, and specific personal protective equipment (PPE) needed. Little is known about healthcare team resilience as a phenomenon; existing definitions and empiric referents do not capture the nature of healthcare team resilience, as the traditional focus has been placed on individual resilience. This qualitative research protocol provides the rationale and methodology to examine this phenomenon and builds a bridge between resilience engineering and individual resilience. The sample is composed of healthcare team members from the US. This research may add to the body of knowledge on resilience culture in healthcare teams during the COVID-19 pandemic. This qualitative research protocol paper outlines the rationale, objective, methods, and ethical considerations entailed in this research.

Relational Quality of Registered Nurses and Nursing Assistants: Influence on Patient Safety Culture.

Registered nurses (RNs) working within acute care hospitals have an incredible responsibility to provide safe care in a complex environment which requires trust, teamwork, and communication. Nursing assistants (NAs) play a critical role in working with RNs to meet these growing demands of inpatient care. Minimal evidence exists exploring the relational quality between RNs and NAs within hospitals. The aim of this study is to explore RN and NA behaviors and experiences that promote patient safety and teamwork and enhance communication between RNs and NAs within the hospital environment. Qualitative analysis was used, with two focus groups which included six participants within each group (three RNs and three NAs) from two separate inpatient units. Transcripts were reviewed and coded for themes. Collaborative teamwork and two-way communication were commonly reported as behaviors that promote patient safety. Trust between RNs and NAs was identified as a key component of positive relationships between RNs and NAs. Participants identified four common behaviors that build trust, which were accountability, effective conflict resolution, collaborative teamwork, and prioritizing patient needs. Finally, teamwork was identified as a common strategy to increase communication effectiveness between RNs and NAs. High relational quality (RQ) between the RN and NA is an important component of teamwork and patient safety culture.

Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review.

AIMS: To understand the strategies to influence patient outcomes by synthesizing existing evidence on effective interventions for teamwork, delegation and communication between registered nurses and nursing assistants. BACKGROUND: Three-quarters of deaths in hospitals are related to breakdowns in teamwork and communication. Acute care systems utilize teams of registered nurses and nursing assistants for primary delivery of nursing care. Research has been conducted to improve the partnership between the dyad. Literature reviews are needed to synthesize the effectiveness of delegation and communication interventions between registered nurses and nursing assistants on patient outcomes. METHODS: The authors applied Whittemore and Knafl's integrative review methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed along with reference searches. Included articles were intervention studies related to teamwork, delegation or communication between registered nurses and nursing assistants, and published from 2000 to 2019. Methodological quality was assessed utilizing the Mixed Methods Appraisal Tool. The Systems Engineering Initiative for Patient Safety model 2.0 was applied as a guiding framework to analyse the findings. RESULTS: Seven articles met the inclusion criteria. The interventions in these articles focused on building a foundation of trust and respect through simulation, education and mindful communication. Four of the seven articles measured patient outcomes including patient falls, hospital-acquired pressure injuries and patient satisfaction. Three articles reported decreased patient falls, two articles reported increased patient satisfaction, while one article reported a reduction in pressure injury. Five of the studies reported improved teamwork and/or communication, and two studies reported improved job satisfaction. CONCLUSIONS: There has been limited research on the impact of the registered nurse-nursing assistant relationship on patient safety and care outcomes. The existing research demonstrates a need for interventions to foster a dynamic and effective relationship between registered nurses and nursing assistants. There is a need for more interventional studies linking improved teamwork, delegation and communication between the registered nurse and nursing assistant to patient outcomes such as falls and hospital-acquired pressure injury. IMPLICATIONS FOR NURSING MANAGEMENT: Several interventions exist to improve teamwork and communication between the registered nurse-nursing assistant dyad. Leaders need to assess their own culture and develop interventions to build and maintain high-functioning teams. Future research is necessary to develop interventions aimed at improving delegation from registered nurses to nursing assistants for applicable activities.

Negative Behavior Among Healthcare Professionals: Integrative Review of Instruments.

BACKGROUND: Behaviors that undermine a culture of safety pose a serious threat to the overall wellbeing of healthcare workers as well as to patient outcomes. PURPOSE: The purpose of this integrative review is to compare reported psychometrics, feasibility, and identify commonalities among available instruments measuring negative behaviors among healthcare professionals. METHODS: Whittemore and Knafl's integrative review methods were used to analyze pertinent instruments designed to measure negative behaviors among healthcare professionals. Multiple computerized databases including CINAHL, MEDLINE, and Scopus databases were searched in the fall of 2017 without date restrictions. RESULTS: Violence, incivility, and bullying are the most frequently measured behaviors in healthcare workers, and a robust number of valid and reliable instruments are available. CONCLUSIONS: To date a comprehensive review of psychometric properties and feasibility of administration is lacking. This review synthesizes the instruments measuring these behaviors, providing a resource for future research focused on mitigation and intervention strategies.

The Negative Behaviors in Healthcare Survey: Instrument Development and Validation.

BACKGROUND AND PURPOSE: Examine the psychometric properties and factor structure of the Negative Behaviors in Healthcare (NBHC) Survey. METHODS: A principal axis factor analysis with varimax rotation was conducted utilizing the 2012 NBHC survey data (n = 1,918) to explore the underlying structure of the NBHC instrument. A confirmatory factor analysis using AMOS 23 (Arbuckle, 2014) was then conducted using the 2014 NBHC survey data (n = 1,479). RESULTS: Internal consistency reliability was supported for four of the five identified factors, while construct validity for a five factor solution was established with acceptable model fit indices (Goodness of Fit Index [GFI] = 0.98; Relative Fit Index [RFI] = 0.98, Normed Fit Index [NFI] = 0.98, Root Mean Square Residual [RMR] = 0.05). CONCLUSIONS: The NBHC instrument is a valid reliable instrument to assess negative behaviors among interprofessional healthcare team members, adding to a select few available instruments measuring negative behavior among interprofessional healthcare workers.

Examining the presence and sources of incivility within nursing.

AIMS: Examine the presence and various sources of incivility among nursing staff working within an academic medical centre utilizing the Nurse Incivility Scale (NIS). BACKGROUND: Evidence suggests various forms of negative behaviour including incivility exist among nurses. Established consequences of these behaviours include increased employee turnover rates, decreased job satisfaction, decreased productivity and increased absenteeism. METHODS: A descriptive survey design was used which included the NIS instrument to measure the presence of incivility within the nursing workforce and specific sources of these behaviours among 414 nurses in an academic medical centre. RESULTS: Hospital nurses working within the intensive and intermediate care unit experienced significantly greater incivility from patients and families than other participants within the study [F (3, 413) 8.62, p = .001]. No other significant differences existed in sources of incivility between various levels of direct care. CONCLUSIONS: Nursing staff working within high-risk areas for incivility such as the intensive care and intermediate care units may require additional interventions to reduce perceptions of incivility from patients/families. IMPLICATIONS FOR NURSING MANAGEMENT: Findings suggest further research is necessary to develop targeted interventions for nurses practicing within intensive care and intermediate units to alleviate the perceived burden of incivility from patients/families.

Negative Behaviors among Healthcare Professionals: Relationship with Patient Safety Culture.

Behaviors that undermine a culture of safety within hospitals threaten overall wellbeing of healthcare workers as well as patient outcomes. Existing evidence suggests negative behaviors adversely influence patient outcomes, employee satisfaction, retention, productivity, absenteeism, and employee engagement. Our objective was to examine the presence of negative behaviors within a healthcare system and the influence of negative behaviors among healthcare workers on perceptions of patient safety culture. Using a cross-sectional design, the negative behaviors in healthcare survey (NBHC) and selected composites of the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS) were combined within an electronic survey which was administered to physicians, clinical and managerial staff. Exposure to contributing factors of negative behaviors was moderately correlated with elements of HSOPS, including perceptions of teamwork within units, management response to error, and overall patient safety grade. Use of aggression and fear of retaliation were moderately correlated with HSOPS management response to error. Reducing healthcare worker exposure to contributing factors of negative behavior may result in increased perceptions of teamwork within a hospital unit, while addressing use of staff aggression and fear of retaliation potentially positively influences management response to error.

Negative behaviours in health care: Prevalence and strategies.

AIM: To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre. BACKGROUND: Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes. METHODS: A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours. RESULTS: The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ2  = 5.65, p < 0.017), observation of LA and VA (χ2  = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ2  = 9.03, p < 0.003) were identified. CONCLUSIONS: Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression. IMPLICATIONS FOR NURSING MANAGEMENT: Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required.

Lateral Violence in Nursing Survey: Instrument Development and Validation.

An examination of the psychometric properties of the Lateral Violence in Nursing Survey (LVNS), an instrument previously developed to measure the perceived incidence and severity of lateral violence (LV) in the nursing workplace, was carried out. Conceptual clustering and principal components analysis were used with survey responses from 663 registered nurses and ancillary nursing staff in a southeastern tertiary care medical center. Where appropriate, Cronbach's alpha (α) evaluated internal consistency. The prevalence/severity of lateral violence items constitute two distinct subscales (LV by self and others) with Cronbach's alpha of 0.74 and 0.86, respectively. The items asking about potential causes of LV are unidimensional and internally consistent (alpha = 0.77) but there is no conceptually coherent theme underlying the various causes. Respondents rating a potential LV cause as "major" scored higher on both prevalence/severity subscales than those rating it a "minor" cause or not a cause. Subsets of items on the LVNS are internally reliable, supporting construct validity. Revisions of the original LVNS instrument will improve its use in future work.