Can restorative supervision positively impact the emotional wellbeing of HEI lecturers in healthcare?

Staff wellbeing is crucial to providing a high standard of education for students. Restorative Supervision has been shown to have positive impacts on staff wellbeing including feeling 'valued', reductions in stress and burnout, increased job satisfaction and improved retention. It enables staff to reflect on the emotional and psychological impact of their work and explore and understand the challenges and rewards that are intrinsic to providing high quality teaching. Aim To explore whether restorative supervision can be used to support health care professionals working in a higher education setting. Methods 1. Monthly restorative supervision sessions over six months with 15 multidisciplinary health professional academic staff 2. Focus groups exploring the implications of restorative supervision on perceived and experienced stress and wellbeing Findings Participants identified numerous sources of compassion and emotional burden including self, colleagues, students, and families. Restorative supervision allowed participants to feel supported in their roles and able to reflect on the emotional and psychological impact of their multifaceted working. In particular, the challenges of moving from a clinician to an academic role were explored by several of the participants who felt that they had embarked on a second and completely different career with little support

Toxic Absence: Why Leader Presence Matters in Times of Crisis

Aims. This study examines the importance of senior-leader presence on the “frontline” in times of crisis. Background. The COVID-19 pandemic placed unprecedented demands on nurses charged with delivering critical care. Extant research suggests that the active presence of ward-level leaders has an important role to play in supporting frontline staff and mediating the negative impacts of stress and burnout. There is little evidence on the impact of senior leader presence or absence on the experience of frontline critical care nurses, particularly at times of crisis. Methods. A three-phase qualitative interview study of critical care nurses in the UK and Ireland. A total of 107 semistructured interviews with 54 nurses representing 38 different healthcare units. Results. Senior-leader presence at the time of crisis serves as an important symbol of organisational support. Where senior leaders are not meaningfully present, they risk allowing the necessary pain of difficult work situations to become toxic. Toxicity is manifested with increased staff stress, emotional ills, absence, and turnover. Conclusions. Senior leaders must balance their responsibilities for strategy and structures with the frontline presence required to shape a positive emotional climate. Implications for Nursing Management. Senior managers should consider supplementing their strategic focus with punctuated returns to the floor. Symbolically, leaders who get their hands dirty embody a sense of mutual struggle and practical support. Managerially, time on the floor increases the opportunities for collecting primary data to improve decision-making and support

ViPER - Introducing a service to deliver restorative supervision for nursing students, to improve retention and raise the quality of student experiences.

Abstract ID 239:Introduction:Restorative Supervision (RS) is increasingly being delivered to post qualified healthcare staff, via the growth of the PNA role (NHS England,2023). The benefits of delivering this to pre-registration students in education have been previously documented. The potential of RS to support student personal and professional development has been demonstrated (Stacey et al, 2017: Stacey et al, 2020). The restorative function of supervision is most valued when facilitated in an environment where humanistic principles are present (Sheppard et al, 2018). This approach may be suitable for nursing students, who manage significant emotional demands in clinical practice, alongside additional challenges resulting from their academic studies.The aim of this project was to support student’s health and wellbeing skills and coping strategies. A dedicated ‘Nursing Student Advocate Support (NSAS) Lead’ was appointed to deliver different modes of RS to nursing students (including group sessions, individual 1-1’s and telephone contacts).To sustain the project in the long term, RS training was developed and offered to HEI staff.Methods:The impact of the service was evaluated over the timeline of the project. Qualitative feedback from student mentimeter surveys was used to collect anonymous data. This type of data collection can provide valuable insights into student experiences of educational programmes (Mohyn et al., 2022).Results:Qualitative data from students demonstrated that RS was a positive experience for all those who engaged in it. Five common themes emerged (anxiety, communication, competing priorities, employment, family commitments). Results suggest that RS supports a nurturing educational environment which develops student professional practice. Facilitating RS in a safe environment enables increased self-awareness and time out for student reflection.Conclusion:RS was found to support growth in students’ self-efficacy, self-esteem and problem-solving skills

‘Running Towards the Bullets’: Moral Injury in Critical Care Nursing in the COVID-19 Pandemic

The COVID-19 pandemic placed unprecedented strain on healthcare professionals around the globe, particularly those working in intensive care units. It was reported that instances of moral injury – a betrayal of what is ethically right by those in positions of power – were widespread in these organizational settings. In this paper, we explore these emerging findings to ask: What are the experiences and implications of moral injury in critical care nursing during the pandemic? Drawing on 103 interviews with 54 critical care nurses, we offer insights into the experience of moral injury in a workplace experiencing crisis, focusing on (i) unsafe staffing levels, (ii) inadequate equipment, and (iii) inability to provide patients with a dignified death. We provide accounts of the implications of moral injury ranging from debilitating anxiety to post-traumatic stress disorder and sectioning, as well as widespread feelings of anger and guilt leading to an intention to leave the profession

‘Doing the best we can’: Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19

Aims: To explore registered nurses' experiences of patient safety in intensive care during COVID-19. Design: A qualitative interview study informed by constructivism. Method: Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. Results: Two key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. Conclusion: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness. Impact: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals

'Doing the best we can': Registered nurses' experiences and perceptions of patient safety in intensive care during COVID-19

Aims: To explore registered nurses' experiences of patient safety in intensive care during COVID-19.Design: A qualitative interview study informed by constructivism. Method: Semi-    structured interviews were conducted and audio- recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. Results: Two key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short-  and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer  Support. Conclusion: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an under-standing of the holistic and long-term impacts on patient safety and recovery from critical illness. Impact: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing work-force modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals

Emotional Labor: Concept and Practical Categorizations in Light of COVID Critical Care Nursing

This chapter considers the changing nature and recognition of emotional labor as a category of work. Over 40 years of scholarship have tracked and conceptualized emotion at work; marking those features that link or delineate one occupation from another according to task, performance and context. Utilizing research with Critical Care Nurses in the UK, this chapter illuminates the changing face of emotional labor. We show how and why emotional labor has come to be recognized, the different forms that it takes, its relation to reason and its impact on workers. We pay particular attention to the ways in which emotional labor is altered by contextual factors such as the site of enactment, temporality and embodied verses virtual encounters. In terms of its affects, we consider the ways in which emotional labor can act as a source of professional pride and occupational virtue, while also carrying the threat of dissonance, burnout and alienation. These affects draw attention to the obligations that might attend such categories of work. We conclude by noting that responsibilities for these affects are likely diffused, touching upon individuals, educators, occupational bodies and, perhaps most importantly, the managers, leaders and systems that constitute employers

Fallen angels and forgotten heroes: A descriptive qualitative study exploring the impact of the angel and hero narrative on critical care nurses

Background: During the COVID-19 pandemic, the use of the labels ‘heroes’ and ‘angels’ to describe nurses (and especially critical care nurses) became prevalent. While often well intentioned, the use of these labels may not be the most positive image of nurses and the nursing profession. Critical care nurses have not previously been given the opportunity to provide their perceptions of the angel/hero narrative and the impact this may have on their practice and working environments. Objectives: The objectives of this study were to explore the perspectives of critical care nurses and discover their perceptions about the angel/hero narrative and its impact on their clinical practice, safe working environments, and professional development during the COVID-19 pandemic. Methods: A semistructured qualitative virtual interview study was conducted with critical care nurses from the United Kingdom, Australia, and North America. Digital audio data were transcribed verbatim. Thematic analysis of the transcribed data was performed. The COREQ guidelines were used to report the study. Findings: Twenty-three critical care nurses located in the United Kingdom, Australia, and North America participated. Four themes were synthesised: history repeating, gender stereotypes, political pawns, and forgotten heroes. Conclusions: Critical care nurses did not perceive the hero and angel labels positively. Participants were concerned about unrealistic expectations, potential safety workplace risks, and poor remuneration related to these narratives. Participants perceived that context and intention were important in the interpretation of these narratives; they spoke with pride about their work and called for improved representations of their role, recognition, and work conditions

Fallen angels and forgotten heroes: A descriptive qualitative study exploring the impact of the angel and hero narrative on critical care nurses

BACKGROUND: During the COVID-19 pandemic, the use of the labels ‘heroes’ and ‘angels’ to describe nurses (and especially critical care nurses) became prevalent. While often well intentioned, the use of these labels may not be the most positive image of nurses and the nursing profession. Critical care nurses have not previously been given the opportunity to provide their perceptions of the angel/hero narrative and the impact this may have on their practice and working environments. OBJECTIVES: The objectives of this study were to explore the perspectives of critical care nurses and discover their perceptions about the angel/hero narrative and its impact on their clinical practice, safe working environments, and professional development during the COVID-19 pandemic. METHODS: A semistructured qualitative virtual interview study was conducted with critical care nurses from the United Kingdom, Australia, and North America. Digital audio data were transcribed verbatim. Thematic analysis of the transcribed data was performed. The COREQ guidelines were used to report the study. FINDINGS: Twenty-three critical care nurses located in the United Kingdom, Australia, and North America participated. Four themes were synthesised: history repeating, gender stereotypes, political pawns, and forgotten heroes. CONCLUSIONS: Critical care nurses did not perceive the hero and angel labels positively. Participants were concerned about unrealistic expectations, potential safety workplace risks, and poor remuneration related to these narratives. Participants perceived that context and intention were important in the interpretation of these narratives; they spoke with pride about their work and called for improved representations of their role, recognition, and work conditions