The Impact of Moral Injury on Self-reported Work Performance in Hospital Nurses Following the Global Pandemic Surge.

OBJECTIVE: The aim of this study was to determine relationships between moral injury (MI) and self-reported nurse work performance (NWP) among hospital nurses after the COVID-19 pandemic surges. BACKGROUND: Previously studied in the military, nurse MI became evident due to the pandemic. No previous studies have examined the impact of MI on NWP. Few studies have attended to how MI in nurses can be addressed by nursing leadership. METHODS: A convenience sample of 191 nurses from 7 hospitals in Southern California participated in a multisite correlational survey-design study. RESULTS: Significant levels of MI occurred in 57% (n = 114) of participants. Increased levels of MI were a significant predictor of decreased levels of self-reported NWP. Younger and less experienced nurses reported greater levels of MI. CONCLUSIONS: This study relates MI in nurses to NWP. There is a need for further research to assist nursing administrators in ameliorating MI in nurses and in preparing for the impact of MI on the nursing workforce in future emergent situations.

Role Delineation of the Code Blue Team: A Quasi-Experimental Study During COVID-19.

INTRODUCTION: The purpose of this study was to assess if implementing a code role delineation intervention in an emergency department would improve the times to defibrillation and medication administration and improve the nurse perception of teamwork. METHODS: A quantitative quasi-experimental study used a retrospective chart review to gather data. A pre- and post-test measured nurse perception of teamwork in a code using the Mayo High Performance Teamwork Scale (MHPTS) after a code role delineation intervention using a paired samples t-test. Pearson r correlations were used to determine relationships between nurse participant (N = 30) demographics and results of the MHPTS scores. RESULTS: A significant increase in teamwork was noted in 5 of the 16 items on the MHPTS regarding improved communication and identified roles in a code: the team leader assures maintenance of an appropriate balance between command authority and team member participation (t = -5.607, P < .001), team members demonstrated a clear understanding of roles (t = -5.415, P < .001), team members repeat back instructions and clarifications to indicate that they heard them correctly (t = -2.400, P = .029), all members of the team are appropriately involved and participate in the activity (t = -2.236, P = .041), and conflicts among team members are addressed without a loss of situation awareness (t = -2.704, P = .016). There was significance between total pre- and post-test scores (t = -3.938, P = .001). DISCUSSION: Implementation of code role delineation identifiers is an effective method of improving teamwork in a code in an emergency department setting.

An effective in-hospital chaplaincy-led care program for nurses: Tea for the soul a qualitative investigation.

Tea for the Soul (TFS) is an understudied care model, addressing bereavement and other emotional needs of nurses related to impactful patient care experiences. Nurses are at high risk for compassion fatigue, moral distress, and burnout. Facilitated by a Chaplain, the TFS program provides participants a venue to express their feelings and explore ways of adapting effectively with the death of a patient, and other traumatic workplace experiences. In this qualitative grounded theory study, hospital nurses (N = 7) who participated in TFS were interviewed. IRB approval was obtained. Questions were constructed within the context of the medical center research council and asked if TFS: (a) was personally beneficial, (b) helped nurses feel better about their work, and (c) affected job satisfaction. Four core themes emerged: (a) Nurses' Self-Care, (b) Professional Practice, (c) Community, and (d) Improved Patient Care Outcomes. The Roy Adaptation Model, Group Identity Mode was applied to the content analysis. Overarching themes were Compassionate Service, Ministry of Presence, Reflective Practice, and Sacred Encounters. Nurses reported that TFS facilitated a spiritual respite and a sense of enhanced community and was a source of strength and coping, thus may aid in the promotion of nurse well-being and the amelioration of moral distress, compassion fatigue, and burnout.

Bereavement Needs of Critical Care Nurses: A Qualitative Study.

BACKGROUND/INTRODUCTION: Bereavement and grief in critical care nurses remain an understudied phenomenon. As a way of self-protection, nurses may compartmentalize their own feelings and need assistance and support in processing feelings of bereavement. Nurses spend much of their time caring for patients and their family members, while guiding them through the dying process; however, they may not take adequate time to address their own bereavement needs. OBJECTIVE/AIMS: The aims of this study were to explore the bereavement needs of critical care nurses after experiencing the expected or unexpected death of a patient and, from their lived experiences, gain insight as to how nurses perceive, process, and cope with the death of a patient. METHODOLOGY: A qualitative, phenomenological focus group was conducted with critical care nurses (N = 10) after gaining institutional review board approval. The group discussion was audio-recorded and transcribed. Content analysis was performed to identify common themes. RESULTS: Seven themes emerged: (a) emotional distress, leading to compassion fatigue, burnout, and moral distress, (b) empathy, (c) resurfacing personal loss leading to secondary traumatic stress in the workplace, (d) unrealistic expectations placed on the nurse, (e) detachment leading to compartmentalization, (f) lack of formal education, and (g) self-care and available resources. DISCUSSION/CONCLUSION: More education for nurses in undergraduate and continuing education programs is needed to assist nurses in the bereavement process. More interventional studies are needed to explore programs of nurses' self-care both in the workplace and in nurses' personal lives to more effectively support their emotional needs.

Application of the Roy Adaptation Theory to a care program for nurses.

Theory-guided nursing practice is foundational in providing the framework for the development of excellent nursing care. There is a need for effective care programs for nurses, whereby they are adequately supported within their workplace infrastructures as a professional group whose work is essential to the provision of healthcare worldwide. Likewise, there is a need for care programs for nurses to be theory-guided. In the current global pandemic climate, the well-being of nurses continues to become compromised evidenced by increasing moral distress, compassion fatigue, and burnout. Theory-based supportive programs are vital to the overall wellbeing, morale, and retention of nurses. The Roy Adaptation Theory may serve as a guide in the development and evaluation of a hospital-based program designed to support the needs of the healthcare team. This discussion will explore the application of the Roy Adaptation Theory-Group Identity Mode to the Tea for the Soul Care Model for nurses.