Secondary Qualitative Analysis of Moral Injury in Obstetric and Neonatal Nurses

ObjectiveTo investigate the presence of symptoms of moral injury in obstetric and neonatal nurses.DesignA secondary qualitative analysis using an analytic expansion of three primary studies.SettingPostal mail and electronic surveys.ParticipantsI used three primary studies: participants in the first consisted of 78 labor and delivery nurses, participants in the second consisted of 75 nurse-midwives, and participants in the third consisted of 22 NICU nurses.MethodsI used Krippendorff’s content analysis method for qualitative data to reanalyze the three primary data sets. The categories I used in this analysis were the 10 symptoms of moral injury that are assessed by the Moral Injury Symptoms Scale–Health Professionals Version.ResultsWhen combining the three types of obstetric and neonatal participants, the top three most frequently cited symptoms of moral injury were moral concern, guilt, and self-condemnation. For participants in labor and delivery units and NICUs, moral concern was the most often described symptom, whereas for participants in midwifery it was guilt. None of the participants reported loss of meaning in their lives, loss of faith, or religious struggle. Participants who worked in NICUs did not describe any symptoms of shame or difficulty forgiving.ConclusionIn addition to the primary symptoms of moral injury, reported secondary consequences of moral injury can include depression, anxiety, anger, self-harm, and social problems. Interventions such as acceptance and commitment therapy are needed to help nurses address the potential for moral injury and repair its effects. Since the COVID-19 pandemic, now more than ever, moral injury needs to be recognized in obstetric and neonatal nurses and not just in the military population.     

Moral Distress and Burnout in NICU Nurses

The objectives of this study were to factor analyze the Moral Distress Scale–Revised (MDS-R) in NICU nurses and to evaluate the relationships among dimensions of the MDS-R and the demoralization, exhaustion, and loss of motive dimensions of the Burnout Measure (BM). A total of 142 NICU nurses completed modified pen-and-paper versions of the MDS-R and BM. Exploratory and confirmatory factor analyses showed that the MDS-R-14 was a relatively good fit for the data. The compromised care dimension predicted BM demoralization (β = 0.24) and exhaustion (β = 0.22), the futile care dimension predicted BM exhaustion (β = 0.18), and the untruthful care dimension predicted BM demoralization (β = .25). Strategies to mitigate moral distress and resulting burnout in NICU nurses should address futile care, compromised care, and untruthful care.     

神经外科住院患者人文关怀感知与护士关怀实践的对比研究

目的了解神经外科住院患者及护士对护士人文关怀的感知与评价差异,为更好地实施人文关怀护理服务提供参考。方法选取86例神经外科住院患者及92名神经外科护士作为研究对象,分别使用关怀行为量表进行问卷调查。结果患者与护士对护士人文关怀的总体评分分别为4.77±0.84、4.86±0.60,无统计学差异(P>0.05),双方均在“尊重患者”及“联系患者”2个维度评分较低。在“支持和保证”维度,患者对护士人文关怀的感知水平显著低于护士自评结果(P<0.01)。结论护患双方均对护士关怀行为的评价较好且双方在对护士关怀行为的整体认知上存在较高的一致度,但护士对患者心理层面的关怀相对不足,患者对护士在“支持和保证”相关关怀行为方面具有较高的期待。护士需要进一步改进与提升人文关怀质量。     

The effectiveness of humanoid diagram teaching strategy on care capacity and retention in novice nurses

AimTo examine the effectiveness of a Humanoid Diagram Teaching Strategy (HDTS) on care capabilities and retention of novice nurses.BackgroundGuiding novice nurses in clinical practice is a matter of concern and the use of diagrams in assisting the learning process and to promote learning efficiency has been acknowledged.DesignThis is a quasi-experimental study with asynchronous repeated measurements for the experimental and control groups.MethodsThe study was conducted in a medical centre in southern Taiwan with 24 novice nurses. The intervention, Humanoid Diagrams Teaching Strategy, contained three parts: the head and neck; trunk; and limbs. The HDTS was applied three time weekly. Each session lasted approximately 30 min and the training lasted 4 weeks. The effectiveness of HDTS was measured using Mini-CEX, CbD and retention rates in the 3rd and 6th months of novice nurses’ experience.ResultsAfter the HDTS, although increases in mini-CEX and CbD scores in the experimental group were greater than the control group, these differences were not statistically significant after considering the time interaction. But the 3rd month and 6th month novice nurses’ retention rates were statistically significantly different by comparing the differences under the time interaction effects in both groups.ConclusionsThe Humanoid Diagram Teaching Strategy is an effective tool for preceptors to use in assisting novice nurses in learning, improving their nursing care knowledge and technical skills and to increase their retention rate.     

新冠肺炎“动态清零”常态化下应急梯队护士体验的质性研究

目的 研究新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验。提出针对性改善护士的心理状况的方法和建议。方法 于2021年10月选取上海市静安区闸北中心医院应急梯队的护士11名为研究对象，对其进行半结构式面对面谈话，并采用Colaizzi七步分析法进行资料分析。结果 进入应急梯队的护士普遍存在着紧张焦虑，情绪低落，身心疲惫等心理问题。而执行完应急任务后的成就感，社会的认同，多方的理解支持，有利缓解心理压力。结论 通过对新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验的了解，护士普遍存在各种心理问题，需要给予针对性的干预措施，提高应急梯队成员的心理素质和应急能力。     

Validity and Reliability of the Modified Attitudes About Drug Use in Pregnancy Scale

ObjectiveTo contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses.DesignCross-sectional survey.SettingFour hospitals in the Midwestern United States.ParticipantsRegistered nurses who worked in perinatal units (N = 440).MethodsWe collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal–newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach’s alpha. We tested for differences between units using analysis of variance and Tukey’s post hoc honest significant difference test of pairwise differences.ResultsThe final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88?.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant.ConclusionsThe Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.