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Purpose: The purpose of this study was to assess the associations between demographic, professional and other personal nurse characteristics, social support factors and comfort in conducting research with nurses' level of active participation in clinical research. Design: A prospective, cross‐sectional, correlational design was used. Methods: Clinical nurses working in a multihospital healthcare system were recruited by email to complete an anonymous survey that used multiple valid and reliable scales to assess demographic and professional work characteristics, curiosity, grit, locus of control, perceived social support (for research activities), comfort in conducting research, and level of being research‐active. Univariate and multivariable analyses were completed. Results: Of 310 participants, 274 (88.4%) were female and mean (SD) age was 42.9 (13.1) years. After condensing 11 levels of research activity to four categories, 179 (57.7%) were not research‐active, and 91 (29.4%), 26 (8.3%) and 14 (4.5%) were engaged at low, moderate, and high levels, respectively. Of 78 factors, 69 (88.5%) were associated with being research‐active in univariate analyses. In multivariable analysis that adjusted for age, personal experience as a patient, years as a nurse and hours in direct patient care, professionalism characteristics, higher curiosity, internal locus of control, grit perseverance, support of a nurse scientist and nurse friends, and comfort in conducting research remained associated with higher levels of being research‐active (all p < 0.01). Conclusion: Research‐active nurses were more likely to be engaged professionally in hospital‐based activities beyond their work roles and displayed higher levels of positive psychological characteristics and mentorship that supported research capacity. Clinical Relevance: Research‐active nurses were more likely to have internal factors and external resources that promoted higher levels of being research‐active. A strong professional governance model may enhance clinical nurses research activities. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition that beyond frontline workers' ability to speak up, their feeling heard is also vital, both for improving work processes and reducing burnout. However, little is known about the conditions under which frontline workers feel heard. Purpose: This inductive qualitative study identifies barriers and facilitators to feeling heard among nurses in hospitals. Methodology: We conducted in-depth semistructured interviews with registered nurses, nurse managers, and nurse practitioners across four hospitals (N = 24) in a U.S. health system between July 2021 and March 2022. We coded with the aim of developing new theory, generating initial codes by studying fragments of data (lines and segments), examining and refining codes across transcripts, and finally engaging in focused coding across all data collected. Findings: Frontline nurses who spoke up confronted two types of challenges that prevented feeling heard: (a) walls, which describe organizational barriers that lead ideas to be rejected outright (e.g., empty solicitation), and (b) voids, which describe organizational gaps that lead ideas to be lost in the system (e.g., structural mazes). We identified categories of responsive practices that promoted feeling heard over walls (boundary framing, unscripting, priority enhancing) and voids (procedural transparency, identifying a navigator). These practices appeared more effective when conducted collectively over time. Conclusion: Both walls and voids can prevent frontline workers from feeling heard, and these barriers may call for distinct managerial practices to address them. Future efforts to measure responsive practices and explore them in broader samples are needed. Practice Implications: Encouraging responsive practices may help ensure that frontline health care workers feel heard. [ABSTRACT FROM AUTHOR]

Background: There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard "narrow" definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims: To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design: A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants: Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations: IRB approval was obtained. Results: 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by "other" distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions: Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. [ABSTRACT FROM AUTHOR]

Aims: To identify and understand ethical challenges arising during COVID‐19 in intensive care and nurses' perceptions of how they made "good" decisions and provided "good" care when faced with ethical challenges and use of moral resilience. Background: Little is known about the ethical challenges that nurses faced during the COVID‐19 pandemic and ways they responded. Design: Qualitative, descriptive free‐text surveys and semi‐structured interviews, underpinned by appreciative inquiry. Methods: Nurses working in intensive care in one academic quaternary care centre and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free‐text surveys, and seven participants completed interviews. Data were analysed using content analysis. Results: Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision‐making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem‐solving, teamwork and peer support and resources. Conclusions: Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities. Implications for Nursing Management: Nurse managers would benefit from greater ethics training to support their nursing teams. [ABSTRACT FROM AUTHOR]

Background: Purposeful hourly rounding and information on whiteboards in patients' rooms have been known to reduce use of call lights. Problem: Call light activation was higher than desired. Methods: This continuous improvement initiative used retrospective data collection (pre-, early- and maintenance postintervention) to assess call light responsiveness. Intervention: A bundled purposeful hourly rounding approach was used. Results: Call light frequency was higher in the early postintervention period than in the preintervention; however, there was no change in the frequency of call lights that extended beyond 5 minutes. In the maintenance postintervention period, compared with the pre- and early postintervention periods, call lights per patient/unit day and call lights extending beyond 5 minutes per patient/unit day decreased (all P < .001). Conclusions: Activation of a bundled purposeful hourly rounding approach was associated with a decrease in all call lights and call lights extending beyond 5 minutes per patient/unit day. [ABSTRACT FROM AUTHOR]