Struggling in the dehumanized world of COVID-An exploratory mixed-methods study of frontline healthcare workers' experiences.

AIM: To explore healthcare workers' experiences of the changed caring reality during the COVID-19 pandemic in Sweden. DESIGN: An online fully mixed-methods design. METHODS: A web-based self-reported questionnaire with fixed and open-ended answers collected data from March to April 2021, analysed in three steps. First, free-text questions were analysed by qualitative content analysis. Then quantitative linear regression analyses using models covering stress and coping mechanisms were conducted. Finally, a meta-inference of qualitative and quantitative data emerged a new comprehensive understanding. The COREQ guidelines were used for reporting. RESULTS: Meta-inferenced results of quantitative and qualitative findings show the pandemic was a traumatic experience for healthcare workers. Main theme; When work became a frightening experience in a dehumanized reality, comprised four themes: Entering unprepared into a frightful, incomprehensible world; Sacrificing moral values and harbouring dilemmas in isolation; Lack of clear management; and Reorient in togetherness and find meaning in a changed reality. Qualitative results comprised four categories; Working in a dehumanized world; Living in betrayal of ones' own conscience; Lack of structure in a chaotic time and Regaining vitality together. Subdimensions comprehensibility and meaningfulness were associated significantly with post-traumatic stress disorder in multiple regression analysis. In multiple regression analysis, sense of coherence was the most prominent coping strategy. CONCLUSIONS: Forcing oneself to perform beyond one's limit, sacrificing moral values and lacking management was a traumatic experience to healthcare workers during the pandemic. Reorienting as a way of coping was possible in togetherness with colleagues. There is an urgency of interventions to meet the needs among healthcare workers who took on a frontline role during the COVID-19 pandemic and to prevent mental health illness in future crisis. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. SUMMARY: The pandemic outbreak exposed frontline healthcare workers to unparallelled stress shown as negative for their mental health in several meta-analyses and systematic reviews. In-depth understanding on experiences and how symptoms of post-traumatic stress disorder relate to coping mechanisms have been scarcely explored. This study contributes to understanding on healthcare workers' experiences and the relation between lower sense of coherence and increased risk of developing symptoms of post-traumatic stress disorder. IMPLICATIONS FOR PRACTICE/POLICY: This study might guide how to prepare for resilience in future emergencies.

Nurses' experiences of informal coercion on adult psychiatric wards.

BACKGROUND: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as 'a necessary evil', confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients' dignity and autonomy. AIM: To describe nurses' experiences of being involved in informal coercion in adult psychiatric inpatient care. RESEARCH DESIGN: The study has a qualitative, inductive design. PARTICIPANTS AND RESEARCH CONTEXT: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. ETHICAL CONSIDERATIONS: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. FINDINGS: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one's actions and learning together. DISCUSSION: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and 'house rules' in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients' dignity and autonomy. CONCLUSION: If there is a need for coercion, that is, if the coercion is found to be an 'unpleasant good', rather than 'necessary evil' considering the consequences for the patient, it should be subject to reflecting and learning together with the patient.

Being Mindful as a Phenomenological Attitude.

PURPOSE: The purpose of this article is to reflect on being mindful as a phenomenological attitude rather than on describing mindfulness as a therapeutic intervention. I will also explore the possibilities that being mindful might open up in relation to nursing research and holistic nursing. DESIGN AND METHOD: I will describe and interpret mindfulness as a state of being by means of van Manen's phenomenological method, using the language of phenomenology rather than the language of reductionist science. Thus, this article can be considered a reflective narrative, describing both the process of orienting to the phenomenon, making preunderstandings-including own experiences of mindfulness-visible, and a thematic analysis of nine scientific articles describing the phenomenon. FINDINGS: Being mindful as a phenomenological attitude can be described as a deliberate intentionality, where the person is present in the moment and open to what is going on, bridling personal values and accepting the unfamiliar, thus achieving a sense of being peacefully situated in the world, and able to apprehend one's being-in-the-world. CONCLUSIONS: Being mindful as a phenomenological attitude can contribute not only to phenomenological nursing research but also support nurses' presence and awareness.