Pilot Testing a Novel Tool to Assess Resilience among Nurses Delivering Direct Patient Care in Teams in the Hospital Setting
Tiara Benson, Ma Fe Chase, and Amanda Miles
Background: With the appearance of the COVID-19 pandemic, nurse emotional well-being has suffered, with burnout being highly reported. Team resilience may mitigate feelings of burnout, and is defined as homeostasis among the healthcare team while experiencing continuous change. Strategies for enhancing resilience of individuals are prevalent, yet nurses often deliver care in a team setting. While some literature offers insight on nurse team resilience, no valid and reliable tools currently exist to measure this concept. Purpose: To develop and pilot test a tool to measure team resilience among nurses delivering direct patient care in an acute care hospital in the Pacific Northwest. Methods: Nurse leaders and direct patient caregivers at one large, urban hospital partnered to conduct a comprehensive review of the literature to develop a team resilience questionnaire. Using concepts from Gesalt theory, action change methodology, and incorporating components of the health care environment, the final tool consists of five domains. They are: 1) maintenance, defined as planned, scheduled cycles of process improvement; 2) community, defined as spirit of collaboration and engagement; 3) atmosphere, defined as department culture and behaviors; 4) structure, defined as shared views of workflow, expectations, roles and accountability; and 5) foundation, defined as behaviors and attitudes that underpin the unit. Each domain is measured with six questions (30 questions total) measured on a Likert like scale ranging from Never (0) to Always (4). Raw scores are summed to calculate a total for each domain (possible range: 0-24) and cumulatively for all domains (possible range 0-120). Higher scores indicate greater team resilience. To evaluate acceptability and feasibility of the assessment tool, a small pilot test was conducted on nurses working on a 20-bed post-anesthesia unit (PACU) from November 2019 to November 2020. Results: Twenty-four PACU nurses completed the initial assessment. At repeat assessments three, six, and nine months later, a total of nine, 17, and seven nurses participated, respectively. Responses analyzed using Chronbach’s Alpha supporting an internal reliability greater than 0.66 for each cycle. Informal assessments of nurses who completed our questionnaire revealed that they felt it provided them with a structure to work together as a team to address departmental concerns and that using it helped them achieve their goals. Discussion: A total of 24 nurses responded to our questionnaire and over a one-year span, between 29 and 71 percent of this cohort participated in repeat assessments. Next steps include administration of the tool among nurses across multiple specialties in the hospital to increase the sample size for validity and reliability testing. Implications: With rapid changes in healthcare, processes for assessing and supporting resilience among nurses delivering direct patient care in a team setting are necessary to support nurse emotional well-being and prevent negative outcomes such as turnover. Structured, validated tools such as the one developed by our project team may help measure and improve team resilience over time.
Shelly Johnson and Alice E. Dupler
Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide direct patient care with increased volumes during the pandemic, non-licensed surgery schedulers were tasked with calling patients to cancel cases without ability to assess patient conditions or provide guidance on when the case might be rescheduled. As a consequence, children and their families who were impacted by cancellations experienced uncertainty and fear that, if left untreated and unevaluated, the underlying condition might worsen and lead to an emergency situation. Nurses in this pediatric surgery center therefore conducted a deep dive into the literature to identify best practices to inform when and how to resume elective surgeries in this vulnerable population.
Purpose/aims: To investigate the role of pediatric nurses following unexpected surgery cancellation for at-risk children.
Methods/Approach: An integrative literature review was conducted. The Cochrane Library, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and OVID databases were searched using the key words “pediatric surgeries”, “delayed”, “COVID-19”, and “nursing assessment”. Retrieved evidence was limited to peer-reviewed publications, government websites and reputable healthcare organizations published between January 2018 and September 2020. Results: A total of 25 articles and government-sponsored websites met search criteria. Evidence supported that the following criteria merit high priority for rescheduling surgeries for patients: risk for loss of life, limb, organ function, delayed breastfeeding, and developmental delay. Furthermore, nurses are uniquely trained to prevent illness, facilitate healing, and alleviate suffering, and are recommended to assess ongoing individualized care needs that could drive prioritization of surgery rescheduling following unexpected cancellation.
Conclusion: In pediatric patients awaiting non-emergent, elective surgery during the COVID-19 pandemic, literature supports that pediatric surgery nurses must provide ongoing assessment and care of each child affected by cancellation of an elective surgery. Appropriate and timely assessment of evolving family and child needs related to the cancelled surgery can reduce the likelihood of harm during the pre- and post-operative periods.
Implications for practice: Pediatric surgery nurses are uniquely positioned to minimize the impact of cancelled elective surgeries by advocating for rescheduling procedures based on assessment of evolving pediatric patients’ need for care. Moving forward, pediatric surgery nurses should collaborate with interdisciplinary teams to write specific institutional policies to guide decisions regarding how and when to resume and prioritize pediatric surgeries if elective procedures need to be delayed.
Shelly Johnson, Alice E. Dupler, and Deanna J. Koepke
Background: Relationships exist between improved patient outcomes and Registered Nurse (RN) caregivers with an earned Bachelor’s degree or higher compared to those with an associate’s or diploma in nursing. However, nurses who are working and attending a bridge program to obtain a Bachelor of Science in Nursing (BSN) report high levels of stress which may increase risk for withdrawing from the program or quitting work. Furthermore, providing direct patient care during the COVID-19 pandemic may significantly increase stress among those who are concurrently finishing a nursing advanced degree. Little is known about how front-line caregivers perceive the experience of working at least three days per week during a pandemic such as COVID while also completing a full-time RN-BSN program.
Purpose/aims: To explore the lived experience of final-semester RN-BSN students working at least 0.6 full-time-equivalent in the healthcare setting during a global pandemic. Methods/Approach: A qualitative study using thematic content analysis was conducted to explore perceptions of working and going to school during the COVID-19 pandemic among graduating RN to BSN students working between 0.6-1.0 FTE concurrently during the program. Two weeks prior to graduation from the program, students from one cohort were required to write and submit a reflection with the following prompt, “Tell your story about working and going to school during the COVID-19 pandemic”. Analysis of the narratives was undertaken with automated content and thematic analysis by Leximancer software, an automated textual analysis technology, to identify and characterize emerging themes and concepts described in the narratives. The software produces a visual representation of the frequency of concepts reported in qualitative data, and draws lines to demonstrate how often certain terms are used in conjunction with others. The study received IRB approval from the primary investigator’s institution.
Results: A total of 42 students were part of the cohort and 35 submitted a reflection. All 35 were analyzed by the software with names and identifiers were removed. Based on the qualitative software output and validation of generated themes by two independent nurse scholars, three separate concepts arose: COVID-19, time, and family. Many students reported COVID being a major disruptor to all aspects of life during their experience in the program. For instance one student said, “It is like, sucking the life out of me.”
Conclusion: Participants in the study made distinctions between COVID-19, time and family in written assignments discussing their lived experiences of working and going to school during the pandemic. For our participants, work and social environments may play an important role in stress levels for working RN-BSN students which is intensified in the context of the pandemic.
Implications for Practice: College and healthcare leaders should partner to support the RN to BSN workforce to reduce stress and optimize individual capacity to provide effective care to patients and family. Nurses who are working full-time during the current pandemic should carefully consider the pros and cons to returning to school and create a plan for self-care to enhance success and maintain a worklife balance.