The Integration of Care Ethics and Nursing Workload: A Qualitative Systematic Review

Overview

Journal J Nurs Manag

Specialty Nursing

Date 2022 Jun 15

PMID 35704019

Authors

Denise Waterfield

Susan Barnason

Affiliations

Soon will be listed here.

Abstract

Aim: The aim of this review was to explore literature from January 2017 to December 2021 for specific aspects of care ethics related to nursing workload in the acute care setting.

Background: High nursing workload is associated with adverse outcomes for nurses as well as patients. Nursing workload goes beyond patient-to-nurse ratios and encompasses patient, nurse and organizational factors.

Evaluation: This qualitative systematic review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The four features of care ethics related to nursing workload guided the review of qualitative studies in MEDLINE, CINAHL and PsycINFO, and synthesized findings were presented in the four phases of caring.

Key Issues: Key issues include ethical dilemmas, time pressure, shared moral burden and managerial support.

Conclusion: To reduce nursing workload, a care ethics perspective can provide solutions through fortifying interprofessional relationships and enhancing empathetic actions.

Implications For Nursing Management: Situational, individual and team approaches to management allows for incorporation of personal values and ethics of care to support patient-centred care. Leadership initiating conversations and being proactive about workload can lead to an improved work environment for both the nurse and the nurse manager.

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References

Chua W, Legido-Quigley H, Ng P, McKenna L, Hassan N, Liaw S . Seeing the whole picture in enrolled and registered nurses' experiences in recognizing clinical deterioration in general ward patients: A qualitative study. Int J Nurs Stud. 2019; 95:56-64. DOI: 10.1016/j.ijnurstu.2019.04.012. View

Berlinger N . Workarounds Are Routinely Used by Nurses-But Are They Ethical?. Am J Nurs. 2017; 117(10):53-55. DOI: 10.1097/01.NAJ.0000525875.82101.b7. View

Martin P, Bouchard L . Constraints, Normative Ideal, and Actions to Foster Change in the Practice of Nursing: A Qualitative Study. ANS Adv Nurs Sci. 2020; 43(4):306-321. DOI: 10.1097/ANS.0000000000000322. View

Jam R, Mesquida J, Hernandez O, Sandalinas I, Turegano C, Carrillo E . Nursing workload and compliance with non-pharmacological measures to prevent ventilator-associated pneumonia: a multicentre study. Nurs Crit Care. 2018; 23(6):291-298. DOI: 10.1111/nicc.12380. View

Assaye A, Wiechula R, Schultz T, Feo R . Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review. JBI Evid Synth. 2020; 19(4):751-793. DOI: 10.11124/JBISRIR-D-19-00426. View

Bujacz A, Rudman A, Gustavsson P, Dahlgren A, Tucker P . Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis. J Nurs Manag. 2021; 29(8):2603-2610. DOI: 10.1111/jonm.13430. View

Moore V, Allen L, Nash M, Buck J, Chipps E . Exploring Nurses' Perception of Dynamic Patient Events. J Nurs Adm. 2016; 46(2):57-60. DOI: 10.1097/NNA.0000000000000295. View

Maslach C, Leiter M . Early predictors of job burnout and engagement. J Appl Psychol. 2008; 93(3):498-512. DOI: 10.1037/0021-9010.93.3.498. View

Aiken L, Clarke S, Sloane D, Sochalski J, Busse R, Clarke H . Nurses' reports on hospital care in five countries. Health Aff (Millwood). 2001; 20(3):43-53. DOI: 10.1377/hlthaff.20.3.43. View

10.

Womack D, Vuckovic N, Steege L, Eldredge D, Hribar M, Gorman P . Subtle cues: Qualitative elicitation of signs of capacity strain in the hospital workplace. Appl Ergon. 2019; 81:102893. PMC: 6834115. DOI: 10.1016/j.apergo.2019.102893. View

11.

Charette M, Goudreau J, Bourbonnais A . Factors influencing the practice of new graduate nurses: A focused ethnography of acute care settings. J Clin Nurs. 2019; 28(19-20):3618-3631. DOI: 10.1111/jocn.14959. View

12.

Harvey C, Thompson S, Otis E, Willis E . Nurses' views on workload, care rationing and work environments. J Nurs Manag. 2020; 28(4):912-918. DOI: 10.1111/jonm.13019. View

13.

Markey K, Moloney M, Doody O, Robinson S . Time to re-envisage integrity among nurse leaders. J Nurs Manag. 2022; 30(7):2236-2240. PMC: 10078655. DOI: 10.1111/jonm.13557. View

14.

Lebet R, Hasbani N, Sisko M, Agus M, Nadkarni V, Wypij D . Nurses' Perceptions of Workload Burden in Pediatric Critical Care. Am J Crit Care. 2021; 30(1):27-35. DOI: 10.4037/ajcc2021725. View

15.

Bishop A, Macdonald M . Patient Involvement in Patient Safety: A Qualitative Study of Nursing Staff and Patient Perceptions. J Patient Saf. 2014; 13(2):82-87. DOI: 10.1097/PTS.0000000000000123. View

16.

Bryant R, Chaar B, Schneider C . Differing clinical pharmacy service models: Quantitative and qualitative analysis of nurse perceptions of support from pharmacists. Int J Nurs Stud. 2018; 86:90-98. DOI: 10.1016/j.ijnurstu.2018.04.003. View

17.

Tamata A, Mohammadnezhad M, Tamani L . Registered nurses' perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study. PLoS One. 2021; 16(5):e0251890. PMC: 8136713. DOI: 10.1371/journal.pone.0251890. View

18.

Fast O, Rankin J . Rationing nurses: Realities, practicalities, and nursing leadership theories. Nurs Inq. 2017; 25(2):e12227. DOI: 10.1111/nin.12227. View

19.

Myny D, Van Hecke A, De Bacquer D, Verhaeghe S, Gobert M, Defloor T . Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: a cross-sectional study. Int J Nurs Stud. 2011; 49(4):427-36. DOI: 10.1016/j.ijnurstu.2011.10.005. View

20.

Waltz L, Munoz L, Weber Johnson H, Rodriguez T . Exploring job satisfaction and workplace engagement in millennial nurses. J Nurs Manag. 2020; 28(3):673-681. DOI: 10.1111/jonm.12981. View