Nurse Reports of Moral Distress During the COVID-19 Pandemic.

Background: COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering. Objective: The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes. Methods: This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19. Results: Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic. Conclusions: The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.

Nursing and Medical Students' Responses About End-of-Life Communication Reveal Educational Opportunities for Spiritual Care.

BACKGROUND: The need for improved spiritual care education is a national directive, prompting many nursing and medical education programs to respond with spiritual curriculum. This article reports on research that tested an educational intervention to enhance nursing and medical students' understanding of end-of-life communication with families. METHOD: This mixed-methods study included three reflection questions to ascertain students' attitudes about their own death and dying. RESULTS: Many of the students' responses were spiritual in nature. Findings revealed two important misconceptions about death and one educational strategy that can be used to help students identify potential sources of spiritual discomfort in clinical situations. CONCLUSION: The findings offer a glimpse into the attitudes and beliefs of nursing and medical students that could influence how they view and deliver spiritual care, contributing to the evidence base for spiritual care education and curriculum. [J Nurs Educ. 2023;62(11):601-605.].

Measuring spiritual uncertainty for hospice and palliative care providers.

BACKGROUND: Spiritual uncertainty is a new construct for end-of-life care that focuses on the questions, worries and doubts people have with end-of-life spirituality. Spiritual uncertainty can contribute to spiritual distress for patients and families dealing with the end of life, as well as lead healthcare providers to avoid spiritual care methods. AIMS: This article reports on the item construction of a new survey design to measure the spiritual uncertainty of healthcare providers. METHODS: Items were constructed from qualitative data gathered from five focus groups (with a total of 23 interdisciplinary hospice and palliative care providers being surveyed). Data were developed through three rounds of item construction, selection/refinement and assessment. FINDINGS: A final pool of 42 items was constructed to measure the spiritual uncertainty of healthcare providers. Expert validity was obtained by 16 interdisciplinary hospice and palliative care providers. CONCLUSION: This survey is the first to measure spiritual uncertainty of healthcare providers. Additional research is needed to assess the psychometric properties of survey items.

Reflective Journaling as Preparation for Spiritual Care of Patients.

Death is a human experience; however, an understanding of dying, grief, and loss continues to elude many cultures, even more elusive is the understanding of complicated grief for families and burnout for providers caring for the dying patient and their families. To prepare students taking care of dying patients and their families, the Catalyzing Relationships at the End of Life program included addressing perceptions of one's own death through journal reflection. The Catalyzing Relationships at the End of Life program utilized journals to ascertain student understanding of issues surrounding family communication at the end of life. Journal reflections were embedded in an online learning management system and utilized structured prompts as the journaling method. These prompts addressed what students desire for their own family relationships during their own death. Results from the qualitative descriptive analysis included 4 themes: meaning, beliefs, connections, and good death. Reflections about their own death were a powerful experience for student participants. Although questions about spirituality were not specifically asked, themes relating to spirituality emerged from the data.

The State of Spirituality Scale as a Screening Tool for Spiritual Distress.

Patients and families facing serious and life- threatening illnesses are at risk for spiritual distress. Screening for spiritual distress is an efficient way of identifying issues. The State of Spirituality scale takes a uniq.

Strategies for recruiting the dependent children of patients with a life-limiting illness as research participants.

BACKGROUND: The voices of children and adolescents have historically been substituted by the perspective of adults. There is growing recognition that children (<18 years old) are able to participate in research and appreciate the opportunity to participate in studies. AIM: To share the strategies employed by two research teams from USA and UK, who have successfully recruited children living with parental life-limiting illness as research participants. FINDINGS: The researchers overcame common challenges when negotiating ethics committees by anticipating the IRB/REC concerns, providing the committees with detailed applications including distress protocols, and offering resources to their ethics committee to learn about conducting research with this population. The researchers navigated recruitment and gatekeeping by clinicians and parents by partnering with clinical agencies and nurturing relationships with practitioners who are supportive of the research, offering to present the findings of the study with continuing education credits, and developing children's, adolescents' and parents' project advisory groups to support recruitment, data collection and analysis. CONCLUSIONS: Simple strategies can be used to overcome barriers to recruitment, providing opportunities for children to be research participants and for their unique perspectives to be heard in palliative care research.

Telling Adolescents That a Parent Has Died.

The aim of this study was to explicate ways in which parents tell their adolescents about a parent's death. This study used a descriptive, qualitative design. From a large hospice in northeastern Ohio, nine adolescent children and six surviving spouses of recently deceased hospice patients were recruited. Participants completed a demographic questionnaire and a semistructured individual interview. Thematic content analysis techniques were used to analyze the data. Surviving parents tell adolescents about the parent's death in ways that are intended to inform and ease the adolescents' distress. They engage in the process of disclosure in one of three ways: measured telling, matter-of-fact telling, and inconsistent telling. Findings from the current study are consistent with the ways parents told their children about an ill parent's life-threatening illness and imminent death. The findings support a framework that describes the processes of disclosure of a parent's illness, imminent death, and death to their adolescent children. Predeath findings about telling foreshadowed the postdeath findings. These results can be used to inform the development of interventions in which nurses and other health care professionals assist families with disclosure before and after death by tailoring strategies according to the family's communication style.

Spiritual Uncertainty Among Hospice Providers: "There Were Tensions".

How providers of end-of-life care perceive spirituality both within themselves and for others can directly impact their ability to provide spiritual care to patients and families. Uncertainty about spirituality can contribute to the awkwardness of spiritual care. Spiritual uncertainty includes the questions, worries, and doubts people have about the meaning, beliefs, connections, self-transcendence, and value that comprise spirituality. This article reports qualitative findings from a mixed-methods study that sought to understand spiritual uncertainty among hospice providers. Data were collected from 28 hospice team members (nurses, physicians, social workers, and expressive therapist) using focus groups, reflective journals, and one-on-one interviews. An overarching theme emerged that described the tensions perceived by providers caring for hospice patients. Those tensions were further categorized as being interpersonal, intrapersonal, and transpersonal in nature. The identification of tension as a source of strain for providers delivering spiritual care is necessary to the development of future interventions that can assist providers and patients navigating end-of-life spirituality.

Family caregiver recruitment via social media: challenges, opportunities and lessons.

BACKGROUND: Illness blogs are a way seriously ill people communicate publicly about their illness journey. As communication about serious illness increases on social media, it is important to evaluate how this affects the family caregiver. However, identifying and accessing family caregivers remains challenging, especially via social media. PURPOSE: The aim of this article is to report the opportunities, challenges and lessons learned from using social media to recruit family caregivers. METHODS: Recruitment methods included posting study invitations on illness blogs, advertising through Facebook and placing study fliers in the community. RESULTS: Using social media to recruit was inexpensive and provided a wide geographical reach. One important finding was discovering the importance of using language in the recruitment materials that family caregivers could identify with to help deem themselves as eligible to participate in the study.

Support for using five attributes to describe spirituality among families with a parent in hospice.

OBJECTIVE: The importance of spirituality in the dying process is well documented. However, what spirituality means in these situations is hard to discern because few people (patients, families, researchers, or caregivers) will view spirituality in the same way. The present research supports the use of a spiritual framework consisting of five common attributes (meaning, beliefs, connections, self-transcendence, and value) as a mechanism for viewing spirituality for people nearing the end of life. Using qualitative interviews from two related studies, our study aims to describe the prevalence of spirituality and its nature according to these five spiritual attributes. METHODS: Data from two previous studies were analyzed. The first employed the methods of grounded theory to understand the strategies adolescents used to manage the impending death of a parent. Some 61 participants from 26 families were interviewed, including ill parents/patients, well parents/caregivers, and adolescents. The second study consisted of 15 interviews with the surviving parent and adolescents from 6 of these families after the death of the parent. RESULTS: The original research from which these data were drawn did not seek to describe spirituality. However, spiritual themes were prevalent in the stories of many participants and included each of the five spiritual attributes. SIGNIFICANCE OF RESULTS: Our findings demonstrate the prevalence of spirituality in the everyday lives of these families and supports the use of the spiritual framework according to the five common attributes to describe spirituality.

Uncertainties experienced by family members when one parent is dying.

PURPOSE: This research examined uncertainty as a salient theme for families in which a parent was dying while receiving hospice care. METHODS: Interviews were conducted with 61 participants from 26 families in the parent study to explore the strategies used by adolescents with a parent in a hospice. Second interviews were conducted with 15 original participants after the death of their parent. Conventional content analysis was used to analyse data. RESULTS: Uncertainty was a prevalent and salient theme in the participants' stories revealing patterns about the causes, barriers, effects and strategies used to manage uncertainty. CONCLUSION: Uncertainties associated with the end of life can be problematic for some people, requiring attention by health professionals.

Describing Spirituality at the End of Life.

Spirituality is salient to persons nearing the end of life (EOL). Unfortunately, researchers have not been able to agree on a universal definition of spirituality reducing the effectiveness of spiritual research. To advance spiritual knowledge and build an evidence base, researchers must develop creative ways to describe spirituality as it cannot be explicitly defined. A literature review was conducted to determine the common attributes that comprise the essence of spirituality, thereby creating a common ground on which to base spiritual research. Forty original research articles (2002 to 2012) focusing on EOL and including spiritual definitions/descriptions were reviewed. Analysis identified five attributes that most commonly described the essence of spirituality, including meaning, beliefs, connecting, self-transcendence, and value.

Racial and Ethnic Diversity in Grounded Theory Research.

National initiatives in the United States call for health research that addresses racial/ethnic disparities. Although grounded theory (GT) research has the potential to contribute much to the understanding of the health experiences of people of color, the extent to which it has contributed to health disparities research is unclear. In this article we describe a project in which we reviewed 44 GT studies published in Qualitative Health Research within the last five years. Using a framework proposed by Green, Creswell, Shope, and Clark (2007), we categorized the studies at one of four levels based on the status and significance afforded racial/ethnic diversity. Our results indicate that racial/ethnic diversity played a primary role in five studies, a complementary role in one study, a peripheral role in five studies, and an absent role in 33 studies. We suggest that GT research could contribute more to health disparities research if techniques were developed to better analyze the influence of race/ethnicity on health-related phenomena.

Spirituality and uncertainty at the end of life.

PURPOSE/OBJECTIVES: To examine the theoretical congruency between uncertainty and spirituality at the end of life (EOL). DATA SOURCES: Relevant empirical and theoretical articles using the key words spirituality, uncertainty, terminal illness, and similar derivatives were drawn from the databases of CINAHL®, MEDLINE®, PsycINFO, and SocINDEX. DATA SYNTHESIS: Spirituality and uncertainty were compared for theoretical congruency based on five general categories: prevalence, temporality, interpretation, quality, and directionality. The categories were drawn from the uncertainty literature and looked at the ability of spirituality and uncertainty to contribute to or detract from health. CONCLUSIONS: This article presents an innovative way of viewing how spirituality is experienced at the EOL. The likelihood that uncertainty and spirituality can coexist as a simultaneous and even blended construct that influences the EOL is supported and warrants additional exploration. IMPLICATIONS FOR NURSING: Health professionals must recognize the prevalence of spiritual uncertainty in the lives of their patients and understand the need to frequently assess for spiritual uncertainty. Specific recommendations are provided to guide professionals in addressing spiritual uncertainty with patients.

Peer involvement in adolescent dating violence.

This study investigated the ways in which peers are involved in adolescent dating violence. Eighty-eight young adults aged 18-21 were interviewed and asked to reflect on aggressive dating relationships they experienced as teens. The researchers used grounded theory to analyze the data. Findings showed that male and female peers were involved in adolescent dating violence in unique ways. Male peers were involved in dating violence by participating in the aggression, agitating the aggression, being the competition, trivializing the aggression, and keeping tabs on the recipient. Female peers were involved in dating violence by deserting the recipient, cheating with the boyfriend, being the audience, needling the male dating partner, and helping the recipient. Male and female peers were involved similarly in adolescent dating violence by confronting the partner. School nurses working with adolescents are uniquely positioned to approach adolescents about dating violence. Interventions aimed at promoting discussions with adolescents are discussed.

Ambiguity and violence in adolescent dating relationships.

PROBLEM: Little is known about dyadic processes that lead to adolescent dating violence. The purpose of this study was to examine the phenomenon of relationship ambiguity in adolescent dating relationships to better understand how ambiguity contributes to violence and aggression between dating partners. METHODS: Data were drawn from 88 narratives of young adults who had participated in a study on adolescent dating violence. Interpretive phenomenology was used to produce an in-depth description of the phenomenon of relationship ambiguity. FINDINGS: Relationship ambiguity results in differing expectations between partners regarding closeness and intimacy, fidelity, and obligation. These differences lead to conflicts that set the stage for violence and aggression in adolescent dating relationships. CONCLUSIONS: A series of recommendations for clinicians working with adolescents are presented.

Adolescent dating violence and Peplau's dimensions of the self.

BACKGROUND: Adolescent dating violence (ADV) is a significant public health problem. Despite an association between ADV and lowered self-esteem, little research has examined identity issues in persons who have experienced ADV. OBJECTIVES: To use Peplau's model of the dimensions of the self to describe identity concerns in those who experienced ADV. DESIGN: Verbatim comments that met Peplau's definitions of self-statements were extracted from the narratives of 50 young adults who had taken part in an ongoing qualitative study on ADV. The statements were coded into Peplau's dimensions using content analysis. RESULTS: 175 verbatim sentences were extracted from the narratives. The statements addressed 16 different personal characteristics, including strength, sociability, and aggressiveness. CONCLUSIONS: Individuals who have experienced ADV have a number of concerns related to self-concept. Recommendations are made regarding how these concerns may be addressed with investigative counseling, as described by Peplau.

Speculum 'self-insertion': a pilot study.

AIM: This paper reports phase II of a pilot study that aimed to determine whether self-insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure. BACKGROUND: Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain. DESIGN: The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self-insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self-Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques. PARTICIPANTS: A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty-three women agreed to self-insert their own speculum. RESULTS: The study demonstrated that speculum self-insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self-insertion and would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion. CONCLUSIONS: The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self-insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost-neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages. RELEVANCE TO CLINICAL PRACTICE: Speculum self-insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.