Phillips Natasha, Hughes Luke, Vindrola-Padros Cecilia, Petrella Anika, Fern Lorna A, Panel-Coates Flo, Taylor Rachel M
NHSX, National Health Service England, London, UK.
Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Lead. 2023 Mar;7(1):21-27. doi: 10.1136/leader-2021-000588. Epub 2022 May 13.
The aim was to determine how the learning about protective factors from previous pandemics was implemented and the impact of this on nurses' experience.
Secondary data analysis of semistructured interview transcripts exploring the barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions in wave 1 of the pandemic. Participants represented three-levels of leadership: whole hospital (n=17), division (n=7), ward/department-level (n=8) and individual nurses (n=16). Interviews were analysed using framework analysis.
Key changes that were implemented in wave 1 reported at whole hospital level included: a new acute staffing level, redeploying nurses, increasing the visibility of nursing leadership, new staff well-being initiatives, new roles created to support families and various training initiatives. Two main themes emerged from the interviews at division, ward/department and individual nurse level: impact of leadership and impact on the delivery of nursing care.
Leadership through a crisis is essential for the protective effect of nurses' emotional well-being. While nursing leadership was made more visible during wave 1 of the pandemic and processes were in place to increase communication, system-level challenges resulting in negative experiences existed. By identifying these challenges, it has been possible to overcome them during wave 2 by employing different leadership styles to support nurse's well-being. Challenges and distress that nurses experience when making moral decisions requires support beyond the pandemic for nurse's well-being. Learning from the pandemic about the impact of leadership in a crisis is important to facilitate recovery and lessen the impact in further outbreaks.
目的是确定从以往大流行中汲取的关于保护因素的经验是如何实施的，以及这对护士体验的影响。
对半结构化访谈记录进行二次数据分析，探讨在大流行第一波期间为支持与新冠病毒相关住院人数激增而实施的变革的障碍和促进因素。参与者代表三个领导层级：全院（n = 17）、科室（n = 7）、病房/部门层级（n = 8）以及个体护士（n = 16）。采用框架分析法对访谈进行分析。
全院层面报告的在第一波实施的关键变革包括：新的急症人员配置水平、重新调配护士、提高护理领导力的可见度、新的员工福祉举措、设立支持家庭的新角色以及各种培训举措。在科室、病房/部门和个体护士层面的访谈中出现了两个主要主题：领导力的影响和对护理服务提供的影响。
危机期间的领导力对于护士情绪健康的保护作用至关重要。虽然在大流行第一波期间护理领导力的可见度有所提高，且建立了加强沟通的流程，但仍存在导致负面体验的系统层面挑战。通过识别这些挑战，在第二波期间有可能通过采用不同的领导风格来支持护士的福祉从而克服它们。护士在做出道德决策时所经历的挑战和困扰需要在大流行之外为护士的福祉提供支持。从大流行中汲取关于危机中领导力影响的经验教训，对于促进恢复和减轻未来疫情爆发的影响很重要。
