Abstract

Background
Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nursing home environments are often frail, have reduced quality of life, higher rates of rehospitalisation and mortality, and greater complications in heart failure management. Further, nursing home staff often lack the knowledge and skills required to provide the necessary care for those living with heart failure. Interventions for improving heart failure management in nursing homes have proven effective, yet there is a lack of understanding regarding interventions for optimising care provision. The aim of this review was to synthesise the current evidence on educational interventions to optimise care provided to people with heart failure in nursing homes.

Methods
A scoping review with four databases searched: Medline, CINAHL, Web of Science, and EMBASE. Relevant reference lists were searched manually for additional records. Studies of nursing home staff or resident outcomes associated with changes in care provision (i.e., resident quality of life, staff knowledge of heart failure) were included. Results from the charting data process were collated into themes: intervention outcomes, changes to practice, and implementation and process evaluation.

Results
Seven papers were deemed eligible for inclusion. Most studies (n=6) were comprised of nursing home staff only, with one comprised only of residents. Study aims were to improve heart failure knowledge, interprofessional communication, heart failure assessment and management. Positive changes in staff outcomes were observed, with improvements in knowledge, self-efficacy, and confidence in providing care reported. No difference was reported concerning nursing home resident outcomes. Interprofessional communication and staff ability to conduct heart failure assessments improved post-intervention. Changes to practice were mixed, with issues around sustainability reported. Nursing home staff highlighted their appreciation towards receiving education, recommending that videos, images, and humour could improve the intervention content.

Conclusions
There is a paucity of evidence around educational interventions to support residents living with heart failure in nursing homes. However, available evidence suggests that educational interventions in nursing homes may improve care through improving staff self-efficacy and confidence in providing care, heart failure knowledge and interprofessional communication. The complexity of implementing educational interventions in the nursing home setting must be considered during the development process to improve implementation, effectiveness, and sustainability.

Background

Heart failure, defined as a clinical syndrome characterised by structural and/or functional changes to the heart (Bozkurt et al., 2021), has an estimated prevalence of 64.3 million cases worldwide (Savarese et al., 2022). People living with heart failure often present with three or more comorbidities, such as hypertension, diabetes mellitus and chronic kidney disease, which increases the severity of heart failure symptoms and negatively impacts quality of life and prognosis (Groenewegen et al., 2020). The presence of multi-comorbidities increases the complexity to effectively manage patients with heart failure (Conrad et al., 2018). Consequently, difficulties in management have resulted in higher rates of rehospitalisation (Groenewegen et al., 2020, Komajda, 2015, Wachter and Rommel, 2022), placing a significant demand on hospital facilities and personnel, and incurring substantial healthcare costs (Cleland et al., 2019, Conrad et al., 2018, Lesyuk et al., 2018, Urbich et al., 2020).

Due to an ageing population, improvements in diagnostic testing, and greater survival rates following a cardiovascular event, the incidence of heart failure is expected to continue to rise (Lippi and Sanchis-Gomar, 2020, Savarese et al., 2022). The prevalence of heart failure increases with age, from 1% for those <55 years to 10% for those aged >70 years (McDonagh et al., 2021). In the USA between 2001 and 2014, of the 14.6 million individuals hospitalised due to heart failure, 75.3% were classified as older people (>65 years) (Akintoye et al., 2017). The mean age of this population is 75.2 years (Norhammar et al., 2023).

Conclusions

The findings from this review highlight the potential of interventions implemented in nursing homes for improving care provision to residents with heart failure. However, outcomes reported across the included studies were mostly focused on nursing home staff. Thus, future research is needed to determine whether such interventions are effective in improving outcomes associated with nursing home residents. Also, future research should aim to determine whether such interventions can produce long-term effects and sustainability. Education was a common intervention component employed across the studies, provided face-to-face to nursing home staff. Participant feedback, although limited, indicated that education was well-received and beneficial, improving heart failure knowledge of staff. However, this study reported poor participant attendance at the sessions, with the intervention facilitator indicating that this approach was burdensome. The delivery of a digital intervention may provide greater success, reducing the burden on staff and the need for an intervention facilitator. A digital approach also provides participants with the ability to access the intervention at a time that suits them, potentially improving intervention acceptability, user engagement, and likelihood of success.

Abstract

Background
Perceived organizational politics is a common phenomenon in almost every organization and is associated with undesirable employee outcomes. Despite numerous studies on this important topic, studies describing the influence of perceived organizational politics on nurses’ outcomes (job satisfaction and stress) remain underinvestigated. This study examined the impact of perceived organizational politics on job satisfaction and job stress among nurses.

Methods
A quantitative cross-sectional design was used in this study. Two hundred and thirteen (213) nurses participated. Three standardized instruments were utilized: Perception of Organizational Politics, Job Satisfaction Scale, and Job Stress Scale. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression analyses.

Findings
Nurses perceived a high level of organizational politics. We identified a significant correlation between perceived organizational politics, job stress, and job satisfaction in nursing. The results showed nurses’ perception of organizational politics had a positive relationship with job stress and a negative relationship with job satisfaction.

Managerial implication
Hospital management should reconsider the organizational, group, and individual situations that create perceived organizational politics to prevent any unnecessary political behaviors in the hospital. Also, strategies to enhance nursing management and healthcare provision should be directed at reducing the use of politics to promote self-interest.

Originality/value
Our study provides a novel insight into the unexplored nature and impact of perceived organizational politics on nurses’ job satisfaction and stress in Ghana. It is the first research to investigate organizational politics using nursing population in the Ghanaian context and makes significant contributions to theory and practice.

Background

Organizations are made up of people with diverse values, attitudes, ideas, beliefs, values, and these differences affect the way these people interpret issues in the organization (Delle, 2013, Khan et al., 2020, Rughoobur-Seetah, 2022). These differences project how people’s subjective interpretation is linked with organizational problems such as politics (Asrar-ul-Haq et al., 2019). Hence, scholars have described organizations as political arenas (Rughoobur-Seetah, 2022). Organizations where politics are widespread provide an unfavorable work environment for people, which is not conducive to fostering positive work-related behaviors.

Perceived organizational politics (POP) has been defined as social influence attempts directed at those who can provide rewards that will help promote or protect the self-interests of the actor (Takeuchi, Yu, & Lin, 2022). Labrague et al. (2017) described POP as purposeful actions by individuals aimed at realizing one’s self-interest while ignoring the well-being of others or their organization. Such behaviors are mostly hidden and not consistent with the organizational rules and regulations but directly or indirectly affect the organization’s bureaucracies (Landells & Albrecht, 2019). In every organization, politics exist in different ways and is used to achieve individual goals and benefits, improve one’s professional career and gain resources or advantages from the organization (Landells and Albrecht, 2019, Zibenberg, 2021). Employees often get involved in organizational politicking to enhance their position at the expense of others, such as their colleagues.

Conclusion

We investigated the nature of POP and how it impacts nurses’ job satisfaction and stress. Based on the findings of this study, it can be concluded that organizational politics is a determinant of high levels of job stress and low level of job satisfaction among nurses. Since POP negatively affects individual nurses and the organization’s productivity, investigating strategies to reduce the effect of political behavior presents a big challenge to hospital managers. This call for a well-structured measure that will enhance both horizontal and vertical interactions among nurses is eminent. Thus, hospital managers should discourage and defuse political behaviors/activities by introducing transparency and accountability in nursing management, which holds promise for enhancing nurse satisfaction. Given this, nurses should be given equal opportunities to develop in their professions.

This study has examined the impact of POP on nurse job stress and job satisfaction. The study found that POP negatively affects job stress and satisfaction in nurses. The findings strengthened the contention that the prevalence of POP within the healthcare environment can trigger a negative reaction from the staff. Increased job stress and decreased job satisfaction in nurses can halt performance and productivity resulting in poor quality and efficiency of care. Therefore, hospital management should establish precautionary procedures and policies to tackle and eliminate political behaviors within healthcare organizations. These policies should include organization-directed and person-directed measures such as continued professional development, the adequate orientation of new staff, improving the work environment, use of clinical ladders for promotions, and enhanced salary.

Abstract

Background

    The current pandemic has led to unprecedented scenarios worldwide. In this context, educational institutions had to move abruptly from in-person to online classes, having to be flexible and innovative, one of the main concerns being the semester-end examinations in practical modules.

Objective

     This study aimed to explore nursing students’ perceptions of the use of a serious game-like model in their final online objective structured clinical examination (OSCE).

Design

     An exploratory phenomenological study was conducted during the COVID-19 pandemic, in particular during June 2020.

Settings

     This study took place at the University of Almeria with nursing students enrolled in a clinical placement module.

Participants

Eighty-nine fourth-year nursing students took part in this study.

Methods

     Following the educational principles of the OSCE, a virtual OSCE was designed, using the Genially platform, an online platform for creating interactive content, to set up an assessment as a story-telling game-like model. A total of 5 focus groups (FGs) were conducted afterwards via the GoogleMeet platform. In addition, 30 semi-structured interviews were performed via the same platform. The data was analysed using a content analysis approach and supported by the ATLAS.ti 8.4 software.

Results

     Our finding revealed 2 main themes and 4 sub-themes. The two main themes were (i) generating emotions and feelings in times of virtuality; including emotions and feelings experienced by students during their online assessment process, and (ii) online assessment: a potential alternative to educational barriers; describing the variability of traditional modality, its implications for learning and the acquisition of competences.

Conclusions

      Serious game-like models, such as the story-telling game proposed, as part of their online OSCE assessment appear to be an appropriate alternative assessment method for face-to-face approaches. This paper adds new evidence on the use of innovative and state-of-art resources as part of nursing OSCE assessments in a new reality for most students and teachers. Serious game-like models in online OSCE may empower students and help them to remove perceived barriers in face-to-face assessments.

Introduction

     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread, which began in December 2019, has produced an unprecedented global scenario (Choi et al., 2020). Not only did the pandemic pose a challenge to all healthcare systems worldwide, but also to other key sectors, such as economics and education (Ceylan et al., 2020). In this sense, educational institutions had to move abruptly from in-person to online classes, affecting more than 1.5 billion students in 191 countries (World Health Organization, 2020). As in other countries, all educational institutions were closed down and all clinical practices were suspended as a preventive measure for health students when Spain officially decreed lockdown on 15th March (Ministry of the Presidency, 2020).

      In this manner, universities have had to be innovative, flexible and agile in a short period of time to decide how to continue their students’ education. Although online training is not a novel method of delivery for many universities, it raised a number of concerns related to the semester-end final examinations (Jones et al., 2020). This transition has therefore been particularly challenging for some health-related degrees, such as medicine and nursing, which include some practical modules that have been traditionally assessed by the Objective Structured Clinical Examination (OSCE) approach (Prior et al., 2020). This approach measures clinical competence through different scenarios and, consequently, its challenge was to creatively restructure them in order to reduce the disruption of the curriculum (Kakadia et al., 2020).

Conclusion

     Serious game-like models, such as the story-telling game proposed, as part of their online OSCE assessment appear to be an appropriate alternative assessment method for face-to-face approaches. Serious game-like models in online OSCE could be seen as a realistic assessment environment that allows students to handle all patient details at their own pace and helps them to get rid of nervousness related to the feeling of being observed like in face-to-face assessments, revamping their clinical-decision making skills. Similarly, online OSCE using storytelling game-like models seems to strongly favour learning and reflection, aspects that the participants do not perceive as such in face-to-face approaches. In this sense, the participants consider this state-of-the-art approach to be more objective and equal, since the inter-evaluator variability does not influence their assessment.

Abstract

1. Introduction

2. Method

3. Results

4. Discussion

5. Conclusions

References

Abstract

     We aim to present the use and viability of mental health indicators at a Brazilian reference psychiatric hospital. We elaborated a Business Process Model and Notation based model of the patients’ hospitalization process based on semi-structured interviews with managers and professionals of the hospital. We analyzed the model and selected a set of 6 mental health indicators, based on evidence-based practice from other countries, using information from several Health Information Systems regarding hospitalizations from 2013 to 2017. In Brazil, there is a lack of methods for the manager to measure the actions carried out in mental health. Thus, the method proposed in this article can be used as metrics to assess the impact of public policy implementation and to assist planning and decision-making based on evidence in mental health.

Introduction

     The 66th World Health Assembly, composed of 194 Member States, adopted the Comprehensive Mental Health Action Plan of the World Health Organization (WHO) for the period from 2013 to 2020. One of the main objectives presented in this plan was to strengthen Health Information Systems (HIS) evidence and research in mental health. More specifically, this objective proposed that the basic concept in the creation of a HIS was the use of quality indicators that could provide relevant information to estimate improvements in mental health management [1].

One of the ways to carry out such management is mapping and modeling of business processes within hospital services, to identify points, along a process, where raw data can be collected for the subsequent generation of indicators. Business Process Model and Notation (BPMN) is a technique used to illustrate procedure models in a simple and easily understandable way that visually represents the sequence of tasks completed to achieve the organization’s goal [2].

Psychiatric hospitalization remains an indispensable therapeutic resource for many patients, especially for those with more severe conditions [3]. In particular, the hospital sector must manage activities of high operational complexity, in which it is necessary to concentrate trained human resources, the latest technology and diversified processes [4]. The use of indicators that contemplate the processes involved in this environment can be of great use for the management of hospital organizations and their stakeholders. These indicators, when addressing both the financial perspective and the clinical evolution of patients, and their flow within the process, can support efficient and effective management, in addition to assisting the development of strategic public policies [5].

Conclusions

     In this article, we presented the results of a BPM-based method to collect data for mental health indicators in a reference hospital in Brazil. The method includes modeling a hospitalization process using BPMN, pointing out the places and the HIS that support this collecting, and describing the results obtained for selected mental health indicators. These show important information that can be used to improve decision-making, not only from the clinical perspective, but also from the management, organizational and technological ones. Results and discussion already provide some valuable insights on the collected data, and point out possible areas of improvement. The method proposed can be applied to other health indicators, to comply with practices long observed in developed countries. Mapping these indicators to existing processes and HIS proven also to be a non-intrusive way of collecting these relevant data.

 Abstract

Keywords

1. Introduction

2. Methods

3. Results

4. Discussion

5. Conclusions

Funding statement

CRediT authorship contribution statement

Declaration of competing interest

Acknowledgments

References

Abstract

Background
To use advanced medical technologies (AMTs) correctly and safely requires both specialist knowledge and skills, and an awareness of risks and how those can be minimized. Reporting safety concerns about AMTs in home care can contribute to an improved quality of care. The extent to which a health care organization has integrated the reporting, evaluation and learning from incidents is a key element of that organization’s patient safety culture.

Objectives
To explore nurses’ experiences regarding the education followed in the use of AMTs in the home setting, and their organizations’ systems of reporting.

1. Introduction

Developments in and the increased use of advanced medical technologies (AMTs) in the setting of the home have led to various and increasingly complex educational challenges within the nursing domain (McGrath and Higgins, 2006; Shin et al., 2006). To use AMTs correctly and safely requires both specialist knowledge and skills, and an awareness of risks and how those can be minimized. This can be achieved through educational interventions tailored to the device, education about the risks and how to deal with them (Fex et al., 2012; Porte et al., 2018). For the purpose of this study, we use the definition of AMTs as ‘devices that are life-supporting or life-sustaining in their application, or their use is of substantial importance in preventing impairment of human health, or their use prevents a potential unreasonable risk of illness or injury’ (APSF, 2016).

Several studies have shown that educational interventions in learning how to use medical devices properly and safely are both essential and effective (Keller et al., 2017; Shukla and Muthal, 2017). Although educational interventions are effective, at least in the short-term, continual systematic training, periodical intervention reinforcement and assessment are necessary after formal education has been completed (Ewertsson et al., 2015; Forsberg and Engström, 2018). Medical devices are continually developing and therefore an approach of lifelong learning is essential among professionals who use such technologies (Keller, 2010). In nursing, learning also relates to active reflection about existing situations and concrete actions have to be taken to generalize knowledge and skills. Experiential learning, according to Kolb’s learning cycle, applies to a process of having a concrete experience grounded in practice, reflective observation about the experience, learning from the experience through abstract conceptualisation and active experimentation of what has been learned (Kolb, 1984).

From the 1990s, frequently identified methods of learning how to use a medical device were trial and error (self taught), learning by watching a video or slide tapes, training on-the-job or receiving instruction from another staff nurse (McConnell and Hilbig, 2000). Other forms of learning used over time include instructions by manufacturers, user manuals, and simulations (Fu et al., 2012; Gaba, 2004). New technologies to improve and extend learning in healthcare include web-based instruction, apps and social media (Bullock and Webb, 2015). An emerging educational technology in training in the use of medical devices is that of virtual reality simulation (Lino et al., 2016). The benefits of virtual simulation are, for example, that it offers a cost-effective approach to providing students with sufficient preparatory information to improve their knowledge and skills, and allowing practice in dealing with incidents in a safe environment, including allowing the trainee to make mistakes (Foronda et al., 2017; Kay et al., 2018).

Abstract

Keywords

Background

Methods

Findings

Discussion

Conclusion

Author Contribution

Acknowledgment

Supplementary materials

References

Article Info

Tables

Abstract

Background
Roles and responsibilities of nurses are crucial in the battle of Coronavirus disease 2019 (COVID-19), but nursing duties also put them at risk for infections.

Purpose
The purpose of this study was to explore the lived experience of nurses in combatting COVID-19 in Belitung, Indonesia.

Methods
This study employed a phenomenological study design. Online interviews and chatting were conducted among 17 clinical nurses who were purposively selected from March to June 2020. Data were audio-recorded, transcribed, and validated among researchers. The thematic approach was used for data analysis.

Findings
Seven themes emerged (1) feeling “nano-nano”, (2) lack of N95 masks, (3) we are just pawns, (4) being rejected, (5) please do not spread our identity, (6) we miss home, and (7) feeling betrayed by regulation.

Discussion
Findings of this study should be used by government agencies, nurses, and the general population in combatting COVID-19.

Background
Coronavirus disease 2019 (COVID-19), detected in Wuhan, China, was first reported to the WHO Country Office in China on December 31, 2019. It has been spread through 218 countries and territories around the world and two international conveyances (Worldometers, 2020). As of January 8, 2021, there are 216 countries and areas involved, with 88,499,863 confirmed cases. This includes 1,906,693 deaths and 63,610,686 recovered patients (World Health Organization, 2020). Indonesia is one of the affected countries, and as of January 8, 2021, there are 797,723 confirmed cases. There are 659,437 recovered patients and 23,520 confirmed deaths (Ministry of Health of Indonesia, 2020).

The biggest challenge is the excessive number of cases, and our health care systems are being challenged. Lack of hospital capacity, insufficient numbers of facial masks and personal protective equipment, lack of ventilators, caregiver fatigue, and challenges with rapid and diagnostic tests have become the issues among the affected countries (Djalante et al., 2020; Gunawan et al., 2020; Tanne et al., 2020). Leaders’ are dealing with complexity, ambiguity, and uncertainty in decision making (Djalante et al., 2020)—due to the rapidly evolving situation, lack of expert knowledge of the evolving novel disease and the constant additional information that is made available locally and globally as it is discovered.

Abstract

Keywords

1. Introduction

2. Method

3. Results

4. Discussion

CRediT author statement

Ethical approval

Conflict of interest

Funding

References

Abstract
Background
Previous studies on the effects of providing feedback about quality improvement measures to nurses show mixed results and the factors explaining the variance in effects are not yet well-understood. One of the factors that could explain the variance in outcomes is how nurses perceive the feedback. It is not the feedback per se that influences nurses, and consequently their performance, but rather the way the feedback is perceived.

Objectives
This article aims to enhance our understanding of Human Resource attributions and employee engagement and burnout in a feedback environment. An in-depth study of nurses’ attributions about the ‘why’ of feedback on quality measurements, and its relation to engagement and burnout, was performed.

Design and Methods
A convergent mixed-methods, multiple case study design was used. Evidence was drawn from four comparable surgical wards within three teaching hospitals in the Netherlands that volunteered to participate in this study. Nurses on each ward were provided with oral and written feedback on quality measurements every two weeks, over a four month period. After this period, an online survey was distributed to all the nurses (n = 184) on the four participating wards. Data were collected from 91 nurses. Parallel to the survey, individual, semi-structured face-to-face interviews were conducted with eight nurses and their ward manager in each ward, resulting in interview data from 32 nurses and four ward managers.

Results
Results show that nurses – both as a group and individually – make varying attributions about their managers’ purpose in providing feedback on quality measurements. The feedback environment is associated to nurses’ attributions and these attributions are related to nurses’ burnout.

Conclusions
By showing that feedback on quality measurements can be attributed differently by nurses and that the feedback environment plays a role in this, the study provides an interesting mechanism for explaining how feedback is related to performance. Implications for theory, practice and future research are discussed.

1- Introduction

1-1 Background

Providing feedback to nursing teams is an important and frequently used strategy for improving clinical performance after quality measurements in hospital care (De Vos et al., 2009). Feedback on performance is generally used to draw healthcare workers attention to gaps between desired and actual practice in patient care, and can be defined as “delivering information about clinical performance provided to patient populations over a specified period of time to professionals, practices or institutions, for the purpose of improving the team’s or clinician’s insight into the quality of care they provide and improving it when possible” (Ivers et al., 2020). The mechanisms of how providing feedback on performance would lead to improved performance are too often ignored in the literature on healthcare quality improvement (Tuti et al., 2017). However, from behaviour change literature we know that feedback is a basic change method that relates to several theories on learning and goal setting (Kok et al., 2016), with the most likely mechanisms being: 1) that feedback on performance triggers positive change through creating awareness of suboptimal performance; and 2) that positive feedback in case of improved performance over time can be rewarding and thus stimulate further improvement.

Abstract

Creating the Pledge

The Pledge in Practice

References

Vitae

Abstract
Last year, the Organization of Nurse Leaders (ONL), which represents nurse leaders in Massachusetts, Rhode Island, New Hampshire, Connecticut, and Vermont, worked with the New England Regional Black Nurses Association (NERBNA) to create the Nurse’s Pledge to Champion Diversity, Equity, and Inclusivity. This article details the development of the pledge.

Following the death of George Floyd in May 2020 and the national spotlight on social injustice, ONL felt compelled to act, but was challenged by the lack of diversity around our board table and within our organization. Before acting, we wanted to listen and understand. We reached out to our colleagues at NERBNA to begin a dialogue about actions nurse leaders and organizations could set in motion to address social injustice and persistent disparities. The dialogue reminded us that “the racial status quo is comfortable for white people, and we will not move forward in race relations if we remain comfortable.”1

The year 2020 revealed deep and significant racial and ethnic injustice in the United States as evidenced by disproportionately higher COVID-19 death rates in nonwhite communities, and a tragic number of high-profile police shootings of black and brown people. The confluence of these circumstances struck a chord with nurse leaders who were continuously trying to support nursing and care teams to cope with—and better understand—these long-standing inequities.

The US Department of Health and Human Services describes these disparities as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”2 According to the Centers for Disease Control and Prevention, COVID-19 cases, hospitalizations, and deaths were more than 2 to 4 times higher in vulnerable populations. The color of a person’s skin, a person’s ethnicity, as well as where they live, work, and worship, are social determinants of health that can exacerbate health challenges and, ultimately, keep a population at substantial risk.3 The COVID-19 pandemic forced the health care system and nurses to rise and meet the challenge of serving all those needing care.

Abstract

Keywords

1. Introduction

2. Background

3. Methods

4. Results

5. Discussion

6. Conclusion

Funding

Ethical approval

CRediT authorship contribution statement

Declaration of competing interest

Acknowledgements

References

Abstract

Background
A nurse educator has an important role in promoting students’ learning and professional development as well as in offering high quality nursing education.

Objectives
To describe the competence of nurse educators and explore its connection with the self-evaluated competence of graduating nurse students.

Design
A cross-sectional survey design was used.

Participants
A total of 1796 graduating nurse students in Finland, Germany, Iceland, Ireland, Lithuania and Spain participated in this study.

Methods
The data were collected with structured electronic or paper-and-pencil questionnaires. Graduating nurse students evaluated the nurse educators’ competence using six items derived from the Tool for Evaluation of Requirements of Nurse Teacher (ERNT) and in addition, the students evaluated their own generic professional competence using the Nursing Competence Scale (NCS). The data were analysed statistically.

Results
On average, graduating nurse students evaluated the competence of nurse educators to be rather high. Icelandic and Irish students evaluated nurse educators’ competence the highest. German and Finnish students were the most critical. The students also evaluated the level of their own professional competence as good. The higher graduating nurse students evaluated their own competence, the higher they also evaluated their nurse educators’ competence.

Conclusions
Students’ evaluations of their educators’ competence and their own competence seem to be aligned. However, educators’ competence and its connection with students’ competence warrants further studies.

Abstract

Keywords

1. Background

2. Theoretical framework

3. Methods

4. Data analysis

5. Results

6. Discussion

7. Strengths and limitations

8. Implications to nursing and conclusion

CRediT authorship contribution statement

Declaration of Competing Interest

Acknowledgements

Funding sources

References

Abstract

Background
Nurses have been labelled “heroes” by politicians, the mass media, and the general public to describe their commitment to providing front-line care to people with COVID-19, despite the risks of exposure and lack of clinical resources. Few studies have examined the implications of the hero discourse to nurses’ professional, social, and political identities.

Objective
To critically examine the effects of the hero discourse on nurses who are contending with the ongoing COVID-19 crisis and to consider the political, social, cultural, and professional impact of this discourse on nursing work.

Methods
A poststructural discourse analysis, employing the theoretical ideas of truth, power, knowledge, subjectivity, and normalization, was conducted to explore the mass media’s constructions of nurse as hero in the contexts of COVID-19. Media electronic databases were searched between March 1, 2020 to August 1, 2020 to locate newspaper and magazine articles, corporate advertisements, videos, social media postings, and institutional/corporate websites.

Setting
Data sources included English language media accounts that originated from Canada, the USA, and the UK.

Results
Three main elements of the hero discourse include: 1. Nurses as a “necessary sacrifice” – portraying nurses as selfless, sacrificing, and outstanding moral subjects for practicing on the front-line without adequate protective gear and other clinical resources; 2. Nurses as “model citizens” – positioning nurses as compliant, hardworking, and obedient subjects in contrast to harmful individuals and groups that ignore or resist COVID-19 public health measures. 3. Heroism itself as the reward for nurses – characterizing hero worship as a fitting reward for nurses who were unappreciated pre-pandemic, as opposed to supporting long-term policy change, and highlighting how heroism reconfigures nursing work from the mundane and ordinary to the exciting and impactful.

Conclusions

The hero discourse is not a neutral expression of appreciation and sentimentality, but rather a tool employed to accomplish multiple aims such as the normalization of nurses’ exposure to risk, the enforcement of model citizenship, and the preservation of existing power relationships that limit the ability of front-line nurses to determine the conditions of their work. Our study has implications for approaching the collective political response of nursing in the ongoing COVID-19 crisis and formalizing the ongoing emotional, psychological, ethical, and practice supports of nurses as the pandemic continues.