Globally nurses and midwives are working hard to detect cases of COVID‐19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop ...the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS‐CoV‐2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.
Purpose
The purpose of this study was to investigate the effect of nurse burnout on nurse‐reported quality of care and patient adverse events and outcomes in Thai hospitals.
Methods
Cross‐sectional ...analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes.
Findings
Thirty‐two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection.
Conclusions
Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals.
Clinical Relevance
Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care.
Around the world, nurses are working under enormous pressure providing care to sick and dying patients during the pandemic. Many are faced with increased stress, and other negative effects on their ...mental health. They are also faced with the possibility of infection and death from COVID‐19. Before the pandemic there was a global shortage of nurses, but this is likely to be exacerbated by the increased demands of caring during COVID‐19 as well as the usual care of non‐COVID patients. One serious concern is that the pandemic and multitudinous effects on the nursing profession will exacerbate nursing attrition and their poor mental health into the future. Another serious concern is whether the profession will be able to attract sufficient numbers of nurses to care for populations into the future. Governments and health policymakers everywhere need to invest in nursing and health care and pay attention to the needs of health systems to ensure a healthy population. It is argued that without this, economies will not recover and prosper, and health systems will not be able to provide quality care.
Little is known about nurses' direct experiences of ethical preparedness for dealing with catastrophic public health emergencies and healthcare disasters or the ethical quandaries that may arise ...during such events. A systematic literature review was undertaken to explore and synthesize qualitative research literature reporting nurses' direct experiences of being prepared for and managing the ethical challenges posed by catastrophic public health emergencies and healthcare disasters. Twenty‐six research studies were retrieved for detailed examination and assessed by two independent reviewers for methodological validity prior to inclusion in the review. Of these, 12 studies published between 1973 and 2011 were deemed to meet the inclusion criteria and were critically appraised. The review confirmed there is a significant gap in the literature on nurses' experiences of ethical preparedness for managing public health emergencies and healthcare disasters, and the ethical quandaries they encounter during such events. This finding highlights the need for ethical considerations in emergency planning, preparedness, and response by nurses to be given more focused attention in the interests of better informing the ethical basis of emergency disaster management.
Many changes in practice and education have occurred in the last 40 years in nursing. Turale comments on challenges in practice and education that need to be overcome to ensure nurses are better ...prepared for practice.
The impressive work of nurses, midwives and other health and emergency workers is far from over in the COVID‐19 pandemic. But opportunities to learn from adversity are being explored and enacted in ...many settings and locations. Many ideas, opinions, research findings, innovations in practice, and policy recommendations are described in this Special Issue of International Nursing Review, The Official Journal of the International Council of Nurses in Switzerland. The contents will help inform educators, policymakers, health reformers, researchers, governments, leaders and practitioners about nursing’s future. On International Nurses Day 2021, we dedicate this issue to the memory of the yet unknown number of nurses and midwives around the world who have died during this pandemic.
Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: FG serves on the executive committee for the UK Health Alliance on ...Climate Change and is a Trustee of the Eden Project. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades 1. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality 5,6.
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