'Powering through': A qualitative descriptive study of nurses working while in pain.

AIMS AND OBJECTIVES: To describe the experience of nurses working while in pain and the potential impact on work performance. Pain is described more broadly and inclusive of musculoskeletal injuries, psychological and emotional pain. BACKGROUND: Nurse have been recognised as developing pain and injuries; however, the experience of nurses working while in pain and its impact is not well-described. DESIGN: A qualitative descriptive analysis of interviews from an explanatory mixed methods study. METHODS: Twenty direct care nurses who experienced pain in the past week participated in the semi-structured interviews. Transcripts were analysed using content analysis. Guidelines for reporting following the COREQ checklist. RESULTS: Categories identified: (1) pain provocation, quality of pain, refers, severity, and time (PQRST); (2) Avoiding pain at work; (3) Hiding pain's impact; (4) Tools at Work; (5) Pain recovery at home; (6) Career consequences; and (7) 'Supernurse' culture; (8) Stigma and its impact on pain management; and (9) Dream work environment. CONCLUSIONS: Pain was described as part of nursing and impacted nurses' career plans and performance. Nurses described minimising the direct impact on their patient care but admitted that there was an impact on teamwork and thinking which have been linked to negative patient outcomes. RELEVANCE TO CLINICAL PRACTICE: Clinical practice was an aggravating factor for all nurses in the study and impacted their performance and career trajectory. Workplace tools to decrease nurse injury and pain exist; however, tools were not used often due to lack of resources and training. The culture of nursing that accepts pain as part of the job needs to be addressed.

Clinical Nurses' Identification of a Wearable Universal Serial Bus Used for Pediatric Oncology Clinical Trial Participant Safety Management.

The expanded access to clinical trials has provided more patients the opportunity to participate in novel therapeutics research. There is an increased likelihood of a patient, as a pediatric oncology clinical trial participant, to present for clinical care outside the research site, such as at an emergency room or urgent care center. A novel wearable universal serial bus device is a proposed technology to bridge potential communication gaps, pertaining to critical information such as side effects and permitted therapies, between research teams and clinical teams where investigational agents may be contraindicated to standard treatments. Fifty-five emergency and urgent care nurses across the United States were presented, via online survey without priming to the context of clinical trials or the device, a picture of a pediatric patient wearing the novel wearable device prompted to identify significant, environmental cues important for patient care. Of the 40 nurses observing the patient photo, three identified the wearable device within Situational Awareness Global Assessment Tool formatted narrative response fields. Analysis of the narrative nurse-participant responses of significant clinical findings upon initial assessment of the pediatric patient photo is described, as well as the implications for subsequent prototyping of the novel universal serial bus prototype.

Developing a Preclinical Nurse-Nurse Communication Framework for Clinical Trial Patient-Related Safety Information.

Clinical trial trials have become increasingly complex in their design and implementation. Investigational safety profiles are not easily accessed by clinical nurses and providers when trial participants present for clinical care, such as in emergency or urgent care. Wearable devices are now commonly used as bridging technologies to obtain participant data and house investigational product safety information. Clinical nurse identification and communication of safety information are critical to dissuade adverse events, patient injury, and trial withdrawal, which may occur when clinical care is misaligned to a research protocol. Based on a feasibility study and follow-up wearable device prototype study, this preclinical nurse-nurse communication framework guides clinical nurse verbal and nonverbal communication of safety-related trial information to direct patient care activities in the clinical setting. Communication and information theories are incorporated with Carrington's Nurse-to-Nurse Communication Framework to encompass key components of a clinical nurse's management of a trial participant safety event when a clinical trial wearable device is encountered during initial assessment. Use of the preclinical nurse-nurse communication framework may support clinical nurse awareness of trial-related wearable devices. The framework may further emphasize the importance of engaging with research nurses, patients, and caregivers to acquire trial safety details impacting clinical care decision-making.

Selecting a theoretical framework to guide research on the COVID-19 pandemic impacts on nursing care delivery and the critical care work system (using Reed's Intermodern approach to theory critique).

Understanding the impact of COVID-19 on nursing care delivery in critical care work systems is urgently needed. Theoretical frameworks guide understanding of phenomena in research. In this paper, we critique four theoretical frameworks (Donabedian's Quality Model, the Quality Health Outcomes Model, the Systems Research Organizing Model, and the Systems Engineering (SEIPS) 2.0 Model) using (blinded) (2018) Intermodern philosophical perspective of nursing science. (blinded) (2018) Intermodern approach to theory critique was selected for its pragmatic perspective and focus on personal and professional health and wellbeing. The SEIPS 2.0 Model was ultimately selected to guide the study of the impact of the COVID-19 Pandemic on nursing care delivery in the critical care work systems.

Relying on myself: The lived experience of being at risk for falling in the hospital among older adults.

Inpatient fall rates have not significantly decreased the last decade. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to understand the lived experiences of being at risk for falling in the hospital among older adults. Nine participants (N=9) aged 65 years and older (female=55%) were interviewed twice using online video-conferencing after hospital discharge, and interview data was analyzed using van Manen's interpretive phenomenological method. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. Additional fall prevention interventions supporting hospitalized older adults' self-management of fall risk are needed.

Risky Business: A Mediated Model of Antecedents and Consequences of Presenteeism in Nursing.

BACKGROUND: Nurses are a high-risk group for presenteeism: When one is present at work but not fully engaged. Presenteeism can occur because of multiple work, personal, and event factors and is linked to negative nurse, patient, and organizational outcomes. A model that accounts for the multiple antecedents that lead to presenteeism, as well as its consequences, is needed. OBJECTIVE: The aim of this study was to evaluate our proposed presenteeism in nursing model among registered nurses in the United States by examining the fit of the data with the model. METHODS: Four hundred forty-seven registered nurses who provide direct patient care completed a cross-sectional survey on presenteeism, its antecedents and consequences, and demographics. Structural equation modeling was used to test relationships in the proposed model and overall model fit. RESULTS: The presenteeism in nursing model holistically accounted for significant presenteeism antecedents and consequences. There were significant relationships between work environment, perceived stress and work-life balance, and presenteeism. There were also significant relationships between presenteeism and missed care, and burnout. DISCUSSION: These relationships align with prior research and identify antecedents and consequences of presenteeism. This model can be used by practitioners and researchers to develop interventions addressing presenteeism to improve health system, nurse, and patient outcomes.

Recruiting Nurses Via Social Media for Survey Studies.

BACKGROUND: Nurses are a difficult population to recruit for research. Barriers to recruitment of nurses include survey fatigue, hospital structures and institutional review boards as gatekeepers to accessing participants, and limited generalizability of findings. Social media present innovative opportunities to recruit participants for survey research. However, there is limited information about best practices for recruiting nurses through social media. OBJECTIVES: The aim of this report was to examine the advantages and disadvantages of and determine the best practices for recruiting nurses for survey studies via social media. METHODS: We examined recruitment strategies of three survey studies involving nurse participants. Each study used social exchange theory and leverage-saliency theory to guide recruitment. The studies included were (a) the Travel Nurse Onboarding Study, which recruited participants from a single closed group on Facebook; (b) the Presenteeism and Nursing Study where participants were recruited using association listservs, healthcare organizations, and paid ads and postings on social media; and (c) the Pain and Nursing Study in which participants were recruited through social media, association listservs, and in person at conferences. RESULTS: Social media offer accessible, low-cost, high-yield approaches to recruitment of nurses for survey studies. DISCUSSION: Useful strategies for crafting effective recruitment via social media are presented, including how, where, when, and how often to post. The generalizability of social media research is also discussed. Suggestions are provided for researchers using social media as well as guidelines for institutional review boards to address gray areas of social media research. Data integrity protection techniques are proposed to ensure social media survey data are not corrupted by malicious bots. This report outlines best practices for the recruitment of nurses for survey studies using social media.

A Qualitative Study Describing Nurses' Experiences With Presenteeism.

OBJECTIVE: The aim of this study was to understand nurse awareness of coping and decision making regarding presenteeism and the consequences thereof. BACKGROUND: Nurses report high levels of presenteeism or not being able to fully function in the workplace, but we currently lack understanding of nurse perceptions of presenteeism and its consequences. METHODS: A qualitative descriptive method was used to evaluate the perceptions of nurses from medical surgical units at 2 different hospitals. FINDINGS: For purposes of the study, presenteeism was defined as being present at work when not fully engaged. Most respondents experienced presenteeism in the month before data collection. Five categories of themes were identified: 1) factors leading to presenteeism, 2) awareness and symptoms of presenteeism, 3) coping with presenteeism on and off shift, 4) decision making regarding presenteeism, and 5) consequences of presenteeism. CONCLUSIONS: Both personal and work factors contribute to presenteeism. To decrease presenteeism, healthcare leaders and systems should consider reviewing and changing sick/leave polices, unit cultures, and a lack of resources that contribute to and encourage an awareness of presenteeism, thereby decreasing nurse fatigue.

Transition to practice experiences of first- and second-career nurses: A mixed-methods study.

AIMS AND OBJECTIVES: To explore the transition to nursing practice experiences of first- and second-career nursing students. BACKGROUND: To address the nursing shortage, alternative educational programmes have been increasingly developed and implemented with to help individuals with prior career experiences transition into a career in nursing (second-career nurses). However, we know little about the transition to practice experiences of second-career nurses. DESIGN: This mixed-methods study utilised qualitative interviews with nurses who had completed a year of practice and a longitudinal survey of nurses' perceptions of stress, coping and burnout throughout their first year of nursing practice. METHODS: Qualitative data (n = 15) were analysed using latent thematic analysis and following COREQ guidelines. Descriptive and effect size analysis of quantitative data (n = 122) was conducted in order to assess for significant differences across time points. RESULTS: The thematic analysis identified three themes: Stressors and Coping, Prevalence of Burnout and Presenteeism, and Difficulty Describing Nursing's Role. The quantitative findings showed that participants' self-compassion decreased over their first year of practice. Levels of stress, presenteeism and burnout increased by the year mark. These increases were meaningfully significant between time points. CONCLUSIONS: Differences in the stressors and coping of first- and second-career nurses should be considered in developing transition to practice programmes for new nurses. Increasing rates of stress, burnout and presenteeism highlight the ongoing need to address these issues. Improving the nurse work environment may aid in the transition to nursing practice of both first- and second-career nurses. RELEVANCE TO CLINICAL PRACTICE: First- and second-career nurses have increasing rates of stress, burnout and presenteeism that need to be addressed. However, there are differences in stressors and coping between first- and second-career nurses.

Presenteeism: Nurse perceptions and consequences.

AIMS: To describe factors leading to and consequences of nurse presenteeism. BACKGROUND: Presenteeism is more prevalent among nurses than other occupational groups. Existing literatures focuses on prevalence and consequences of presenteeism for patients, health care organizations, and nurses. However, we lack understanding of nurse perceptions of factors leading to and consequences of presenteeism. METHODS: A total of 295 free responses to a cross-sectional survey were analysed using conventional content analysis. RESULTS: Nurses consider multiple factors in deciding how to respond when presentee. These include illness, staffing, availability of leave time, patients, financial constraints and guilt. Consequences of presenteeism identified were decreased mental acuity and attitude leading to lessened communication both in-person and in documentation, transmission of illness, and decline in unit culture, patient care, and nurse health and well-being. CONCLUSIONS: Multiple factors lead to nurse presenteeism and there are negative consequences to nurses' health, work environment and patient care outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: This study leads to key discoveries to the reasons for and consequences of nurse presenteeism. Many of the factors leading to presenteeism can be addressed through culture and policy changes within organizations. The consequences to patient care outcomes and the work environment emphasize the importance of addressing presenteeism.

Addressing Occupational Fatigue in Nurses: Current State of Fatigue Risk Management in Hospitals, Part 1.

OBJECTIVE: The aim of this study was to describe the current state of fatigue risk management systems (FRMS) to address nurse fatigue in hospitals. BACKGROUND: Although multiple studies have examined sources and consequences of fatigue, little is known about the current state of FRMS. METHODS: This study used a sequential exploratory mixed-method design including a survey of nurse leaders from across the United States. FINDINGS: Although healthcare organizations have implemented strategies to address fatigue, most participants' organizations did not have a formal FRMS in place. Monitoring individual nurses' levels of fatigue and using tools to predict fatigue risk were rare. CONCLUSIONS: Significant opportunities exist to implement formal FRMS in healthcare. Nursing leaders, in partnership with other organizational leaders, should develop a formal plan to monitor fatigue and implement multiple levels of interventions to prevent fatigue and mitigate its consequences.

Addressing Occupational Fatigue in Nurses: Current State of Fatigue Risk Management in Hospitals, Part 2.

OBJECTIVE: The aim of this article is to describe the current state of fatigue risk management systems (FRMSs) to address nurse fatigue in hospitals. BACKGROUND: Little is known about the current state of FRMS implementation and adoption of national recommendations in nursing work systems. METHODS: This study used a sequential exploratory mixed-methods design including a survey of nurse leaders from across the United States. RESULTS: Adoption of evidence-based policies to address fatigue is both limited and variable depending on the policy. Nurse leaders indicate that while nurse fatigue is an important issue and has negative consequences, the social norms of fatigue have not allowed the elevation of this topic to trigger sweeping organizational change. CONCLUSIONS: This study provides a framework for implementation of FRMSs as an innovation, highlighting the critical role of nurse leaders in adoption and dissemination. Raising the visibility of fatigue across the organization is a critical 1st step.

Presenteeism in nursing: An evolutionary concept analysis.

BACKGROUND: Presenteeism is an emerging concept in nursing that has been linked to increased health care costs, patient medication errors and falls, and negative nurse well-being. However, prior work has utilized various definitions and antecedents. Clarity on the significance, development, and consequences of presenteeism in nursing is needed. PURPOSE: This concept analysis seeks to understand the application of presenteeism within nursing workforce literature and in the broader workforce context. METHOD: Rodgers' evolutionary concept analysis method was used. DISCUSSION: The proposed definition of presenteeism as the act of being physically present at work with reduced performance can be attributed to multiple antecedents. These include nurse health, professional identity, work-life balance, and work environment. The prevalence of these antecedents with high rates of presenteeism among nurses and consequences point to the need for interventions. CONCLUSION: These findings can guide development of future interventions and policies that address the broader context of factors leading to presenteeism.

National nursing science priorities: Creating a shared vision.

BACKGROUND: Nursing science is essential to advance population health through contributions at all phases of scientific inquiry. Multiple scientific initiatives important to nursing science overlap in aims and population focus. PURPOSE: This article focused on providing the American Academy of Nursing and nurse scientists in the Unites States with a blueprint of nursing science priorities to inform a shared vision for future collaborations, areas of scientific inquiry, and resource allocation. METHODS: The Science Committee convened four times and using Delphi methods identified priorities with empirical evidence and expert opinion for prioritization, state of the science, expert interest, and potential target stakeholders. DISCUSSION: Nursing science priorities for 2017 were categorized into four themes including: (a) precision science, (b) big data and data analytics, (c) determinants of health, and (d) global health. CONCLUSION: Nurse scientists can generate new knowledge in priority areas that advances the health of the world's populations.

Exploring nurse leader fatigue: a mixed methods study.

AIM: To describe hospital nurse leaders' experiences of fatigue. BACKGROUND: Fatigue is a critical challenge in nursing. Existing literature focuses on staff nurse fatigue, yet nurse leaders are exposed to high demands that may contribute to fatigue and associated risks to patient, nurse and organisational outcomes. METHODS: A mixed method approach comprising semi-structured interviews and the Occupational Fatigue Exhaustion Recovery scale with 21 nurse administrators (10 nurse managers and 11 nurse executives) from hospitals in a Midwestern state. RESULTS: Most nurse leaders experience fatigue; nurse managers reported higher levels of chronic fatigue. Participants identified multiple sources of fatigue including 24 h accountability and intensity of role expectations, and used a combination of wellness, restorative, social support and boundary setting strategies to cope with fatigue. The consequences of nurse leader fatigue include an impact on decision-making, work-life balance and turnover intent. CONCLUSIONS: The high prevalence of nurse leader fatigue could impact the turnover intent of nurse administrators and quality of care. IMPLICATIONS FOR NURSING MANAGEMENT: This study highlights the significance and consequences of nurse leader fatigue. As health care organisations continue to raise awareness and establish systems to reduce nurse fatigue, policies and programmes must be adapted to address nurse leader fatigue.

A pilot resiliency course for Doctor of Nursing Practice (DNP) students: Lessons learned.

Graduate nursing students can face varied and significant stressors during their programs of study. The need for interventions to promote nursing student resiliency has been reported in the literature, by accrediting bodies, and in previous research conducted with students at the same university. Thus, the purpose of this project was to pilot a resilience course for Doctor of Nursing Practice (DNP) students. The theoretical frameworks guiding the design and implementation of the resiliency pilot program were andragogy (the science of adult learning) and rapid cycle quality improvement. The course included eleven monthly modules addressing resiliency content with written material, original videos, and online discussions and meetings. The first module overviewed the resiliency skills (Belief, Persistence, Trust, Strength, and Adaptability), five modules were dedicated to a specific resiliency skill, two modules addressed recent and anticipated challenges, two modules concentrated on the application (clinical and academic) of the resiliency skills, and the last module focused on reflection. Results of this pilot program indicate that DNP students can benefit from receiving resiliency content during their studies, especially from faculty involvement and increased peer support; however, future resiliency content may be more accepted and effective if embedded into nursing program curriculum and activities.

Work-Related Health Conditions Among American Nurses: A Scoping Review.

Background: Working in the nursing profession is hazardous, and nurses report poor health. Risk factors associated with poor health outcomes have been documented. However, the extent of literature exploring the prevalence of health conditions among American nurses that may be attributable to their work has not been examined. Method: A scoping review following the Joanna Briggs Institute recommendations was conducted of peer-reviewed quantitative studies to answer the question: What are health conditions experienced by American nurses that may be attributable to their work as nurses? Results: Thirty articles met the inclusion criteria. Due to the methods used in many articles, studies of the prevalence of health conditions among the nursing population were lacking. Health conditions studied broke into six categories: (a) work-related injuries and hazards; (b) unhealthy lifestyles; (c) mental health conditions; (d) burnout; (e) fatigue, sleep, and migraines; and (f) reproductive health. The role of work in the health conditions studied varied from an immediate impact on health (e.g., a needlestick or injury) to a cumulative impact (e.g., scheduling or workplace demands). Within the work demands, the physical environment; physical, emotional, and cognitive demands of work; and shiftwork were all frequently identified as antecedents that could be further explored and addressed to improve nurse health. Conclusions: Healthcare systems should seek to address the hazards and exposures that may be linked to health conditions in the nursing workforce. Understanding and mitigating the impact of the pandemic and nursing work on the workforce's health is crucial to the solvency of the workforce. Occupational health practitioners should assess for workplace hazards and exposures.

A Qualitative Description of Direct Care Workers of Lesbian, Gay, Bisexual, Transgender Older Adults.

Purpose: The aim of the study was to examine direct care worker (DCW) perceptions of lesbian, gay, bisexual, transgender (LGBT) older adults living in long-term care, assisted living, and home health settings. DCWs provide the closest interaction with LGBT older adults in these settings. The perceptions DCWs have toward LGBT older adults is important because the quality of care can be influenced by negative attitudes. Methodology: Qualitative description was used to synthesize what is known about DCWs' perceptions toward LGBT older adults. Results: The overarching theme, "Care is Different, but Not my Care," was supported by the categories Cues of Stereotyping, Cues of Prejudice, and DCWs' Social System and Reported Care. Application: Specific implications for practice (i.e., training, recruitment, retention strategies) and policy (i.e., mandated staffing ratios, pay) are explicated to guide future interventions to ensure equitable, quality care in health care.

A qualitative descriptive study of the COVID-19 pandemic: Impacts on nursing care delivery in the critical care work system.

The COVID-19 pandemic drastically changed the delivery of nursing care in U.S. critical care settings. The purpose of this study was to describe nurses' perceptions of the critical care work system during the COVID-19 pandemic in the U.S. We conducted interviews with experienced critical care nurses who worked during the pandemic and analyzed these data using deductive content analysis framed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. Concepts include the critical care work system structures, nursing care processes, outcomes, and adaptations during the pandemic. Our findings revealed a description of the critical care work system framed by the SEIPS 2.0 model. We suggest how human factors engineers can utilize a human factors and engineering approach to maximize the adaptations critical care nurses made to their work system during the pandemic.

Nurses' experiences of working while pregnant: A qualitative descriptive study.

BACKGROUND: Healthcare work environments are fraught with occupational hazards that can impact nurse health as well as patient care. However, little is known about how these hazards impact nurse health during pregnancy, and the experiences of nurses in the work environment during pregnancy and upon their return postpartum. OBJECTIVE: To describe registered nurses' (RNs') experiences of working while pregnant and returning to work postpartum. Specifically, their experiences related to the work environment and work-related hazards. DESIGN: A qualitative descriptive design was utilized to describe nurse experiences at work, occupational hazards during pregnancy, and experiences of returning to work after pregnancy. PARTICIPANTS AND SETTING: A convenience sample of twenty nurses working in direct patient care roles across the United States were recruited for virtual semi-structured interviews. METHOD: Participants were interviewed using a semi-structured question guide to explore nurse experiences, specifically occupational hazards at work during pregnancy and upon returning to work. Interview transcripts were analyzed using deductive and inductive content analysis. RESULTS: Deductive findings for occupational hazards and risks during pregnancy and postpartum included exposure to infectious diseases, imaging, physical tasks (e.g., lifting and performing CPR), cleaning products, patient violence, and medication administration. Inductive thematic findings included: support needed avoid occupational hazards and make necessary modifications; desire to be 'supernurses' and put the patient first even when it meant taking risks for our health and that of their child; and fear of the consequences of occupational hazards and exposures. CONCLUSIONS: Occupational hazards experienced by nurses during pregnancy that may impact their health and that of their baby were broader than previously studied. Pregnant nurses should receive education from their healthcare providers early in their pregnancies about the occupational hazards themselves and the potential modifications they should seek. Managers, occupational health and other health system leaders, and policymakers should be aware of occupational hazards for nurses, including pregnant nurses, and support workplace modifications. Future research should focus on assessing the prevalence of these hazards, the longitudinal impact of exposures that can lead to negative consequences for nurse and fetal health, and reducing the risk of exposure to these hazards for pregnant nurses. TWEETABLE ABSTRACT: RNs described a variety of occupational hazards of working while pregnant and postpartum. Inconsistent ability to modify work to protect self and baby leads to completing work demands known to be hazardous.