AACN Advanced Critical Care, Год журнала: 2024, Номер 35(4), С. 366 - 373
Опубликована: Дек. 6, 2024
Язык: Английский
Nurse Leader, Год журнала: 2025, Номер unknown
Опубликована: Янв. 1, 2025
Язык: Английский
Процитировано
0
Nursing Management, Год журнала: 2025, Номер unknown
Опубликована: Фев. 11, 2025
FigureThe COVID-19 pandemic hit many healthcare systems incredibly hard. Many direct care nurses, especially those working in critical (CC) and EDs, were particularly challenged by their experiences. Since the height of pandemic, nursing are rebounding, but, like recovering from virus itself, recovery workforce has been uneven. Experiences with patients impacted but difficult experiences involving coworkers, management, leadership may be even slower to heal.1 Nurses have expressed a loss trust employers, which linked organizational betrayal poor communication.2,3 Organizational describes actions, or lack an organization that disregards health safety its employees, violating terms relationship.2-4 Inadequate actions can contribute negative feelings about work and, potentially, impacts on mental physical well-being.2 require active support organizations fulfill duties, so they're vulnerable betrayals inadequate provision protective equipment, ineffective hostile diminishing concerns after events.2 In addition supporting leaders need provide transparent effective communication. Ineffective communication skills transparency diminish trust, is vital successful, sustainable relationships.3 Building within mutual act, taken weaken break entire organization. Lack give rise resentment, as employees feel despondent skeptical.2,4-6 Research finds nurses CC ED continued express toward waned.4,7 What exactly causes these distrust still unknown. The purpose this study was explore nurses' perceptions, answer following questions: 1) For RNs, what mistrust betrayal? 2) How did restore "personal self?" Findings will guide efforts better staff, times uncertainty. THEORETICAL FRAMEWORK Reina Trust Betrayal Model, focuses interpersonal relationships exhibited emotions, guided study. This model how essential aspect relationship between individuals organizations, grown, maintained, damaged. It asserts acquired gradually through reciprocity interactions consists three dimensions: Communication, Character, Capability.8 Communication demonstrated openness regarding reception information, including feedback mistakes. Character reflects clear expectations, fulfilling promises, consistency. Capability signifies confidence another's ability perform tasks, interact others, learn new skills, make decisions. These lay foundation for respect behaviorally focused framework assessing where built broken, practices bolster positive environment.8,9 authors selected sensemaking theory recommendations addressing themes would emerge Sensemaking initial step larger proposed Ancona create more changing world.10 It's dynamic process using open-minded inquiry, setting aside entrenched ideas problems solutions, categorize available data.11 categorization into guides future enabling translate unidentified, chaotic, complex coherent phenomenon understood, explained, worked collaboratively improve environment. METHODS Design uses secondary data collected during 2021-2022 two nursing-focused intervention research studies. See Box 1 brief descriptions studies, inclusion/exclusion criteria. Prior observation comparison analysis, reviewed approved organization's institutional review board. All participants provided informed consent before participating original A qualitative descriptive approach used, allowing exploration events related primary topics.12 Sample Data included responses 29 RNs employed Magnet®-designated, acute care, academic hospitals located Pennsylvania Missouri. Qualitative analysis used templating, flexible thematic use both priori drawn directly organize coding.14 template developed utilizing Model Researchers independently participants' deidentified referenced studies coded content themes. modified include subsequent codes identified analysis. Codes further refined inductive Formal discussion emerging themes, facilitated another researcher group, followed centered coding similarities differences. Discussion until consensus saturation reached. RESULTS demonstrate perceive ongoing betrayal. contributing factors feelings: inconsistent response uncertainty constraints, financial human resource challenges, persistent residue perceived (see Table 1). Direct also conveyed enhanced emotional self-awareness self-appreciation reflected distinct theme: professional growth gratitude challenging situation. TABLE 1: - Themes, illustrative quotes, connections models, Theme Inconsistent constraints (Definition: Nurses' reciprocal administrators/managers resulted administration wasn't worthy anymore.) Subtheme(s) Quotes Link Potential adaptative responses/Sensemaking interventions Missteps "Whether it's trusting information she's bringing back us, not at all. I know that's huge dissatisfier right now just kind there [sic] expecting wanting more..." "These management over again continuously fall deaf ears." "But there's no one answer. No action. So, you know... like, what's next then hearing." trust—Trust Disclosure Be receptive information. Involve others (including staff themselves) discussions decisions affect micro-, meso-, macrosystem employed. Not feeling valued "Very little done things prevent similar situations occurring, coworkers resigning every day... defeating." "To people labeled 'essential worker' being forced show up shift take dying than overwhelming. There nights my had put 5+ body bags fill rooms same type patients. while having limited resources, minimal worrying myself loved ones dying, hatred felt towards who claimed COVID real got 'work home' laughed moving computer mouse couple hours actually working." "The overwhelming sadness loneliness only living person comfort dying. Standing pillar when left we get raise money other facilities paying travelers twice our wages." Contractual Listen encourage forthcoming share As result, respected, valued, heard. Acknowledge reward contribution(s). Abandonment "I don't I'm getting need." "There several hung out dry support, charge nurse nothing. worst part last few years. Nor they me patient help safe. They watched it all happen nothing." "As preceptor facilitator, am expected do certain completed time. complete tasks because job expected. However, education teams here nowhere found." Recognize speak louder words. visible, available, approachable. Identify revise hazardous processes macrosystem. 2: Challenges resources stressed stability organizations. vacated inpatient rate outpacing replacements.) Impact preparing clinical environment "My facility found way cut orientation time limit process. seen numerous come go ... stable place work." "I've prepared job, workload heavy, much such resources. expect continue want remain bedside training/education, enforced nurse-to-patient ratio rules, stressful environment?" preceptors gone team educators listed topics believe improved tools properly educate with, never delivered." innovative onboarding delivery environments constraints. Create structures adaptable work. self-aware realize impact your own behavior creating you're leader. Threats values responsibility outcomes understand hospital cannot function without proper income reimbursements; disheartening constantly watch suffer afford necessary items/positions." "During experience, always seems guilt. wish something else could knowledge situation." unable enough able oral frequently turn them off bottom pressure ulcers enough, giving medicine, drawing labs, blood, calling providers, family, day deserved. hard accept nurse. excellent safe deserve." Competence Improvise adapt. Support facing moral ethical dilemmas. Breaches relational integrity "It makes sad. We team. helped each other. well-oiled machine. didn't beg someone routine tasks. People knew jobs them." experience affected personally professionally. showed people's thereof well-being." entitlement, laziness, arrogant stupidity fear healthcare. thing concerning rampant laziness apathy disassociation management." Engage professional, meaningful way. 3: Persistent lingering betrayal.) Misgivings doubt forgiven absence some friends comments scariest moments career." have. firmly best interests mind, look ourselves 'it fine' asked was. if ever change." "Now agitated, stressed, truly questioning why do. complain this? say unsafe is? raising brick wall." Act intent. Communicate present versus image, targeting effect interpret confront. 4: Professional situation capacity clinicians partly dependent personal coping mechanisms/skills awareness (sense) situation.) Acknowledgment "Looking grown. become confident patients, physicians collaboration prior together. see pandemic. grateful time." back, grew physically, emotionally, spiritually. taught great deal, professionally." "This definitely changed me. very proud sure dark spot nursing, reaffirmed others." N/A validate words indirect staff. Demonstrate concern. Optimism, acceptance, hope "Thinking experiences, reminded sadness, well encouragement others. encouraging kept going fact together." "COVID days most witness defeat coworkers' eyes. offer everyone, hopes making bit better." "A wise old once told me, 'You born heartbeats, time.' tend crutch question why. trying rationalize things, sometimes everything perfectly inevitable happens. overly myself, permission think failed." Reestablish chaotic revised, orderly frameworks Personal chip away unpleasant memories let heat soften edges memories. somewhat selective memory. chose store positives... After all, storage prefer keep neutral, positive, funny journal helps shave preserve matter now." clean, wipe, fluff, puff, his needs met. talk him letting sun shining, open shades allow sunlight room. tell 'No tanning though he's naked under sheets' — hoping understands joking around. Respiratory, RN, PCA room giggling. Just everyone less tense ease." telling work, book. wrote lot anger book." Offer means, methods, opportunities self-reflection self-restoration. diminished leadership. experienced leaders' inconsistency evolving transparency. One stated: stupid things. failed plan. gather PPE stocked units long remember. shelves full masks, paper, N95 sizes. An shelf hand sanitizer, bouffant caps, face shields. came despondent. looked raided storeroom. Nothing left. Nothing. Administration denied pulled supplies." contributions sacrifices; ultimately, broken led actual abandonment based behaviors. spoke "staff overworked, underpaid, underappreciated, beyond exhausted. supported departments upper Poor simultaneously compounded among neglected deserted consistently visible welfare themselves risk. "She [patient] screaming level noise unit hear it. Including intervene. correct attempt fix Failing breached implicit explicit promises key behaviors associated Character. cared experiencing shortages material which, turn, excessive workloads stress. Participants reported waves exited bedside, resulting specialty vacancies often expensive replace. shortage negatively preparation novice sample anger, frustration, training Capability, Communication. acknowledged newer themselves, providing substandard accountable nurse-sensitive regret as: deserved, threats core quality failure promise. Even waned, persisted. frustration behavior, inability render foster employee well-being. how: "anger...is short-fused handled things." haven't fully diminished. common consequence pattern beginning second-guess judgment. Some questioned career choice overall meaning profession. Additional breaches caregivers (colleagues peers) contributed described concern "What happened simply orders? Who thinking? concerned." saw hadn't ended stretched future. emphasized navigating system faced. self, exhibiting possible. talked how, despite challenges: "Because COVID, My forward garner deserve community, administration, colleagues." Despite acknowledgment self peers family. seeing challenges ahead, optimism healthy strategies manage self-acceptance, faith, closure, gallows humor, attention, reduce discomfort experiencing. summed perspective "Going forward, plan focus independent event night conglomerate; easier large number events. hopeful year." DISCUSSION examined spoken written narratives researchers contributors' General findings uncertainty, fear, isolation, shared decision-making mistrust. These, along crisis, impacted, impact, Importantly, weren't passive recipients actively engaged variety activities survive profession's current state. Our corroborate demonstrating workers due pandemic.15 example, 2022 report 45% act good faith whereas 23% behave manner employees.16 American Association's state amid revealed deep resilience fundamentally responsible extent harm.17 expand results nuanced leading connect specific practices. study, dimensions compromised. minimal, lacking unclear, contradictory, address experienced. Consequently, couldn't leaders. eroded absent. abandoned, either remotely secure office space. Perceived inequities risk allocation fueled unclear boundaries agreements. deteriorated handle acuity assigned willing capable concerns. exacerbated attitudes, convey "time move on."3 Decisions made hires, safety, cornerstone Code Ethics.18 Although since ended, emotions linger upon challenging, traumatic allows arrangement concrete policy change.11 Leaders unfamiliar unknown, understanding, test evaluate policies, developing understanding.10 indicates perceptions highly must trust. First, study's indicate and/or rebuilt bidirectional, synergistic process, building requires parties together engage healing occurred cocreate addresses individual systematic trust.8 component rebuilding understanding embarking path healing. regard, acknowledge ways necessary, contribution.6 Open decision-making, valuing well-being, features character.19 aftermath apparent observe well-being.20 By demonstrates desire improve, build Focusing offers promising road map strategies.9,21Table approach. aspects Reina's model, experience. disclosure, honesty, proactive planning, shared, constructive feedback. communicate clear, concise, straightforward manner, identify appropriate avenues communication, impart vision cultivate maintain trust.19 Similarly, consistency policy, direction align vision. consistent times, realistic clarify boundaries, everyone's challenges.8 Finally, sustained attention practice, sufficient mechanisms needed safely enact roles, acknowledging capabilities self-knowledge discern well. can't roles (for patients) won't capability possible broad, lead changes particular setting. LIMITATIONS, STRENGTHS, AND IMPLICATIONS important implications limitations. Themes generalizable contain biases, memory recall bias. second limitation data, questions Researchers' ask follow-up probes narrative means depth interview, quite expressive nonetheless. third involves attribution causation perspective. adds aides concepts, thereby facilitating causative identified. Further strengths consider. identification implemented utilized survival, cases growth, clinically environments. finding suggests already resilient possess amplified. Understanding provides facilitate implementation additional aren't promote well-being integrity. Identification positively presently contemplating leaving Identifying adopted restoring preserving crisis situations. Recommendations Based findings, should regain simultaneous application theory, known reinstill team(s). Exploration authentic, collaborative day-to-day operations. RESTORE TRUST WELL-BEING result communicated sense gratitude. Leadership augment investing systemic solutions amplify dismantle patterns degrade era reliant accordingly. seek required rebuild potential team(s); however, unique Through devise meaningful, informative, interpersonal. Inclusion decision-makers facilitates involvement, promotes consensus, acknowledges expertise. familiar teams, appreciate teams' uniqueness, adversity appropriately. Study "Impact Narrative Expressive Writing (NEW) Improving Resilience Working Critical Care Emergency Departments" sought compare writing control condition improving resilience. prompts Inclusion/exclusion: nonagency least 20 per week hospitals. series asking faced Schwartz Rounds Emotional Well-being Nurses" studied Rounds, dialogue sessions experiences.13 offered monthly multidisciplinary forum discuss social, issues arising care. Attendees participated peer-represented panel expressing perspectives. attended offering. 30-minute, semistructured interviews conducted
Язык: Английский
Процитировано
0
Oxford University Press eBooks, Год журнала: 2024, Номер unknown, С. 162 - 192
Опубликована: Сен. 19, 2024
Abstract Understanding moral resilience, the ability of an individual to preserve or restore integrity in response adversity, benefits from targeted scholarship broader concept resilience other contexts. Building on definitions literature and qualitative analysis clinicians’ this chapter outlines key attributes resilience. The foundation is personal relational integrity. self-regulation self-awareness—including mindfulness, buoyancy, efficacy, self-stewardship—support preservation restoration These are defined illustrated with quotes interprofessional clinicians. Taken together, these constitute a conceptual basis for
Язык: Английский
Процитировано
1
Oxford University Press eBooks, Год журнала: 2024, Номер unknown, С. 100 - 132
Опубликована: Сен. 19, 2024
Abstract Integrity or moral wholeness is the foundation of resilience. arises when intentions, words, thoughts, and actions align there fidelity in adherence to ethical commitments, norms, conscience. It includes a robust notion agency that considerations congruence character, choices, behavior, as well responsibility for them. requires well-honed conscience; sensitivity, perception, imagination; self-regulatory capacities; ongoing reflection evaluate one’s motivations, actions; cognitive judgement; ability devise reasonable solutions internal conflicts; steadfast commitment responsibly enact considered decisions. clinicians have dual obligations those served themselves. Personal relational integrity are fundamental clinicians. This dynamic interplay attunement issues personal at play clinical practice including relationships with patients, families, colleagues, leaders, organizations broader society.
Язык: Английский
Процитировано
0
Oxford University Press eBooks, Год журнала: 2024, Номер unknown, С. 256 - 270
Опубликована: Сен. 19, 2024
Abstract The concept of moral resilience has gained increased interest. It been included in various studies which most the researchers examined among a health-oriented caregiving population. Without valid and reliable measure resilience, it would neither be possible to gauge existing level healthcare professionals nor effectiveness interventions designed enhance this need an empirically sound manner led development Rushton Moral Resilience Scale (RMRS). This chapter reviews RMRS scale, examines evidence derived from using it, proposes future directions.
Язык: Английский
Процитировано
0
AACN Advanced Critical Care, Год журнала: 2024, Номер 35(4), С. 366 - 373
Опубликована: Дек. 6, 2024
Язык: Английский
Процитировано
0