Nurses’experiences in providing antenatal care during COVID-19 lockdown in Ghana

Background:The coronavirus disease 2019(COVID-19)pandemic posed a major global health threat,leading to the disruption and strain of numerous health systems globally.The situation deprived essential routine healthcare services,including antenatal care,of the needed attention,significantly affecting facility workers.This study therefore aimed to explore the lived experiences and challenges faced by nurses providing antenatal care during the COVID-19 pandemic.Methods:Data were collected through in-depth interviews with seven antenatal care nurses.The interviews were transcribed and analyzed using thematic analysis to identify recurring themes.Four main themes emerged:(1)Knowledge capital,which refers to the essential knowledge and skills required;(2)Interventions,highlighting the measures taken to adapt care;(3)Antenatal care challenges,detailing the specific obstacles faced;and(4)Coping strategies,outlining the methods used by nurses to manage stress and maintain care quality.Results:The results highlight the emotional and economic toll of the pandemic on antenatal care nurses and the importance of effective collaboration and coping strategies.The findings also underscore the crucial role of teamwork,dedication,quick adjustment,and the role of information communication technology in maneuvering through pandemics to provide continuous essential care.Conclusion:These insights are crucial for health agencies and organizations to develop supportive strategies that ensure the continuity of healthcare delivery and safeguard the well-being of healthcare workers during crises.

Nurses’ knowledge regarding triage in Al-Najaf City: a cross-sectional study

Background:Triage remains a cornerstone of emergency care,both in the context of large-scale disasters and within everyday hospital emergency departments.It is a process of sorting and prioritizing patients based on their illness or injury severity.This prioritization ensures that those in most critical need receive timely medical intervention,potentially saving lives and improving their overall prognosis.Therefore,we assessed the nurses’knowledge regarding triage to identify the level of required ongoing training and education to ensure accurate assessments and optimal patient outcomes in hospital care.Methods:A descriptive,cross-sectional study with a convenience sampling method was conducted in three main teaching hospitals in Al-Najaf city from December 2023 till April 2024.A specially prepared questionnaire was used to collect the required data from 70 nurses working in those hospitals.Results:findings showed that(62.9%)were females.Along with this(60%)of the total do not have training courses on triage.In concern knowledge,nurses exhibited poor knowledge(47.14%)and moderate knowledge(50%)about triage.Furthermore,the overall nurses’knowledge concerning triage was not associated with nurses'demographic data(P>0.05).Conclusion:The study concluded that the majority of nurses had overall poor to moderate knowledge of triage,which is a poor finding,and there was a high association between nurses’knowledge and training courses on triage.

A cross-sectional study on the nurses’attitude towards rapid response system activation for clinically deteriorated patients

Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical deterioration is still largely negative.This is because most RRSs rely on ward nurses to recognise clinical deterioration and manually alert responders through phone calls,hospital communication systems,or face-to-face communication.

Operating Room Nurses’ Role in Multidisciplinary Surgical Coordination for a Patient with a Large Abdominal Tumor and Multiple Pelvic Fractures

In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.

Nurses’ Knowledge, Attitude and Practice of Oral Care for Intensive Care Unit Patients

The aim of this study was to describe the intensive care unit (ICU) nurses’ knowledge, attitude, and practice of mouth care for their patients. This is a cross sectional hospital based study. A total of 154 ICU nurses were randomly selected from seven governmental hospitals in Khartoum state and were invited to take part in this study. 97.4% of ICU nurses had high knowledge of the importance of mouth care for ICU patients and similarly for the priority of mouth care. However, only 20% of nurses were found to apply good practice. 64.5% of the nurses received training in mouth care provision, and (81%) indicated that further training would be beneficial. The oral care practice of ICU nurses ranged between average among 57% and poor among 23%. The study highlighted the need for setting of ICU protocols and adoption of advanced training for ICU nurses.

A qualitative study of nurses’experiences of self-care counseling in migrant patients with heart failure

Objectives:This study aims to enhance researchers’and nurses’understanding of how to best support migrant patients with heart failure in self-care management.Previous research on self-care in heart failure patients has highlighted its importance,particularly among migrant populations.Nurses play an important role in informing and engaging patients with chronic conditions like heart failure to support their active participation in self-care.However,nurses’experiences of providing self-care counseling to migrant populations with heart failure have not been studied.Methods:A qualitative study was conducted.Nurses working with migrant patients with HF(n?13)from different types of facility in Western Sweden were interviewed between October and December 2020.Data were collected using semi-structured interviews and analyzed using inductive thematic analysis.Results:The main theme that emerged from the interviews was the difficulty for nurses“to find balance”in self-care counseling.The nurses during self-care counseling had:“to accept challenges,”“to use creative strategies,”faced“problems related to health literacy,”and“to work according to their(the nurses’)obligations.”It was evident that nurses faced several challenges in counseling migrants in self-care,including language and cultural barriers,time resource constraints,low levels of health literacy,and experienced disharmony between the law and their professional norms.They perceived building caring relationships with their patients to be crucial to fostering health-promoting self-care processes.Conclusions:To increase self-care adherence,nurses must become more sensitive to cultural differences and adapt self-care counseling to patients’health literacy.The findings of this research support and challenge nurses in providing the best counsel to migrant patients with heart failure living in Sweden’s multi-ethnic society.Policymakers in the health care organization should act to facilitate mutual cultural understanding between all involved partners for patient-safe self-care counseling.

Nurses’ Role in Birth Preparedness and Complication Readiness among Pregnant Women in University of Calabar Teaching Hospital, Calabar

Background: Birth preparedness and complication readiness (BPCR) promotes timely information and utilization of skilled health attendance/services to pregnant women to prevent complications due to 3 delays that lead to maternal deaths. Objective: To determine nurses’ role in birth preparedness and complication readiness among pregnant women in University of Calabar Teaching Hospital Calabar. Methods: This study adopted a survey research design. Simple random sampling technique was used to select a sample size of 80 participants working in antenatal clinic, antenatal ward, gynecological ward, labour ward, postnatal ward, and Family planning unit. Data were collected using self-administered structured questionnaires. Data were analyzed using frequency, percentage and Pearson Moment Product Correlation Coefficient statistical methods of data analysis. Results: Findings of the study revealed that 53 (66.3%) of the respondents acknowledged nurse/midwives responsibility for the health education of mothers on dangers of pregnancy while 42 (52.5%) strongly agreed that nurses/midwives carry out discussion on plan for delivery with mothers. The study hypothesized that there is no significant relationship between the role of nurse/midwives and the practice of BPCR among pregnant women. The correlational analysis result that there is no revealed (r-cal = 0.67, r-crit = 0.58, df = 79, P > 0.05) thus rejecting the hypothesis statement as r-calculated was greater than r-critical. This implies that the role of nurse/midwives have very strong positive relationship with the practice of BPCR among pregnant women. Conclusion: Positive pregnancy outcome depends on nurse/midwives independent and interdependent roles to prevent delays, emergencies, have access to skilled care.

Diversity and Scope of Senior Nurses’ Informal and Formal Experiences of Patient and Public Involvement in England

Patient and public involvement (PPI) has been recognized internationally. In England, NHS policies have increasingly emphasized the importance of patient-centered services, but limited evidence exists about the implementation of PPI policies and strategies within organizations. Few studies have explored health professionals’ perceptions of PPI and comparatively little is known about the experience of senior nurses. A national consultation utilising three focus groups aimed to explore senior nurses’ PPI experience. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Sixteen categories emerged within five sub-themes of PPI experience: provision of information and raising awareness (1 category), informal generic PPI-activities not perceived as PPI (3 categories), formal generic PPI (3 categories), involvement of specific groups (5 categories) and PPI in commissioning and strategy (4 categories). Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. Nurses performed PPI in a pragmatic sense, by virtue of the nature of nursing, but they did not recognise or label these activities as such. However, a plethora and variety of innovative activities formally recognised as patient and public involvement were undertaken, together with specific networks and groups’ involvement, and involvement linked to commissioning and strategy. Enhancing awareness of nurses through education, together with monitoring and feedback mechanisms could support the PPI implementation and effectiveness at organisations.

Jordanian Nurses’ Knowledge of Preventing Surgical Site Infections in Acute Care Settings

Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, its account for up to 16% of all healthcare-associated infections worldwide. The SSIs can contribute to post-operative morbidity, prolonged recovery, delayed discharge and increasing cost. Nurses’ knowledge of the evidence-based recommendations is necessary to provide high-quality nursing care. Aims: To assess the level of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs, to describe the relationship between nurses’ knowledge and selected sociodemographics, to examine the differences in nurses’ knowledge with respect to selected dichotomized variables, and to identify the most significant predictors of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs. Design: Cross-sectional design. Sample: Two hundred registered nurses at four targeted hospitals were recruited conveniently. Results: The mean of the total knowledge scores of the sample was 3.28 out of nine (SD = 1.72, range = 0 - 7), the median was 3 out of nine. There were a statistically significant correlation between all tested continuous sociodemographics variables and the total knowledge score (p > 0.05). There is a significant difference in nurses’ knowledge between those who are attending to special surgical related training course and who are not. The most significant predictors of Jordanian nurses’ knowledge were: the number of credit hours attended by nurses for surgical-related training courses and the total years of work experience in nursing. These variables explained 16.7% of variance. Conclusion: The results of this study shed light on the obstacles that hampers the Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs in acute care settings. However, the successful implementation of infection control measures, particularly SSIs prevention measures, and well-structured continuing education programs are considered as a substantial element that would improve nurses’ knowledge.

Nurses’ Care Approach (NCAp): Connecting Differences to Islamic Believer Patients in the Arab World

Background: Nursing care approaches may vary from one patient to another. In the nursing profession, nurses are imbibed with the attributes of multicultural care competencies that would empower the nurses to be adaptive and mindful of how they provide and go with their carative nursing managements. This would entail that the non-Muslim nurses must be aware and be sensitive enough in their approaches and communicative exchanges with their Muslim patients. Objective: The study aims to identify the care approaches given by non-Muslim nurses working in the Arab world and how they elicit and provide a universal approach in caring Muslim patients. Methods: The study utilized a mixed methodology, specifically the explanatory sequential design, which involved a descriptive-comparative quantitative research design and eidetic qualitative research design. Results: Based on the result with the highest mean 3.63%, the respondents strongly agree that the non-Muslim nurse is aware of her own culture, 3.60% strongly agree that the non-Muslim Nurse does not discriminate the decisions of the patients regardless of gender, race, culture or belief and 3.58% still strongly agree that the non-Muslim nurse encourages patients to communicate as need arises. Here are three themes emerged from the study: understanding and respect of cultures, caring across borders, and caring calmness. In connecting the differences, non-Muslim nurses must be aware of their own culture, must not discriminate the decisions of the patients regardless of gender, race, culture or belief and must encourages patients to communicate as need arises. Conclusion: Knowing and understanding the scope of nursing practice with a high regard of respect to patients without discrimination will promote and provide holistic, safe and high-quality nursing care.

Nurses’ Role and Experiences as Group-Leaders in a Group Intervention for Women after Gynecological Cancer

Aim: The aim of this study is to provide insight into nurses’ role and their experiences of leading an education and counselling group intervention for women after gynecological cancer. Methods: A qualitative study, based on focus group interview and logs from nurses who led the intervention, was conducted. Findings: The group leaders were touched by the women’s community and were given a deeper understanding of lived experiences after cancer. These insights raised the group-leaders’ understanding of nursing and influenced them to sharpen focus on patient care and priorities in cancer care and follow-up. Being a group-leader meant creating a trusting and secure atmosphere in which the individual woman’s own coping resources was strengthened and empowered. Equally important, the nurses worked continuously and substantially on themselves to build strength and endurance related to situations that called for competent leadership. Conclusion: Being competent in group leadership and having knowledge in the field of cancer are important qualifications for group leaders. Practice Implications: The study shows that nurses gain valuable insight and knowledge about women’s lived experiences of going through gynecological cancer, cancer treatment and rehabilitation. As such, this intervention seems to be educational for nurses, as well as for participants.

Effect of Supportive Measures Guidelines on Nurses’ Practices during Labor

Objectives: To investigate the effect of supportive measures guidelines on nurses’ practices during labor. Methods: A quasi-experimental design (an interventional pre and post-test study). Setting: The study was conducted at obstetric wards and intrapartum units at Nasser Institute Hospital. Sample: All nurses provide guided direct care, there were 40 nurses included in the study. Tools: Three tools were used to collect data named self-administered questionnaire sheet, labor supportive measures’ observational checklists, and nurses’ satisfaction sheet. Results: There was a highly significant improvement in total knowledge and total practical skills among the studied sample pre-intervention compared to immediate post and follow-up intervention (p ≤ 0.01). Additionally, 95% of the studied sample was satisfied with the advanced knowledge included in the guidelines. Conclusion: The supportive measures guidelines had an efficient improving nurses’ knowledge and practices post-intervention. Also, the majority of the studied sample was satisfied with the implemented guidelines. Recommendations: Implementation of labor supportive measure guidelines in different childbirth units to improve nurses’ practice. Further research is required to investigate parturient woman’s satisfaction with the childbirth process after implementing labor supportive measures and the effect of labor supportive measures on childbirth process outcome.

Nurses’ Experiences in Service Provision a COVID-19 Dedicated Tertiary Public Hospital

Objectives: To assess the nurses’ experiences in service provision a COVID-19 dedicated tertiary public hospital. Materials and Methods: This descriptive cross-sectional study was conducted in one tertiary level public hospital namely Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from January to December 2021. Data were collected through face-to-face interview using a structured questionnaire containing demographic details and experiences faced by the nurses in service provision during COVID-19. Data was analysed by using SPSS (Statistical Package for Social Science) software version 23. Results: The findings revealed that the mean age of the respondents was 32.35 ± 7.248 years, the minimum age was 23 years and maximum age was 58 years. About half of the respondents 52.1% were in 21 - 30 years. The majorities 89% were female. More than half of the respondents 72.6% were Muslim and 63.83% of respondents have completed Diploma in nursing. About 32.2% respondents were living with senior citizen, 33% respondents were infected by COVID-19, 24.23% respondent mentioned nurse-Patient ratio in general ward was 1:7 and 71.08% mentioned nurse-patient ratio in I.C.U/C.C.U. was 1:3 (December 2021). PPE were available among 88.0% respondents and N95 mask were available among 84.0% respondent. About 34.8% respondents got COVID-19 guideline training and 32.4% got donning and doffing training. More than half of the respondents 76% stated that equipment is adequate, 56.38% respondents mention that insufficient of nurses and 53.7% were mentioned insufficient of subordinate staff. About 22.6% respondents faced social stigma and majorities 96.5% respondents mentioned they got proper family support. There was a significant association found between Professional educational qualification and satisfaction of current designation (p value = 0.001 Conclusion: The most important findings of this study was lack of training, insufficient of manpower especially nurses and subordinate staff, high nurse-patient ratio and fear about personal and family safety. The findings of the study will be helpful for the authority in planning for future course of action.

Nurses’perception on competency requirement and training demand for intensive care nurses

Objectives Various authors have explored the combination of competencies necessary for ensuring safe and quality care carried out by nurses in Intensive Care Units(ICUs).Nurses’perception of training is an element that must be studied in order to adopt appropriate educational measures.This study aimed to evaluate nurses’perception of the importance of intensive care training in Spain.Methods A descriptive,cross-sectional,multicentre study was conducted on a national level in Spain.Totally 85 ICUs took part in the study.The questionnaire used was developed using the Delphi method and had 66 items to investigate nurses’perception on competency requirements and training needs.The evaluation was conducted by a 10-point Likert scale.Results The sample was 568 Spanish nurses.Significant differences were found on an academic level,in terms of gender and hospital type,and in the professional experience of the nurse when it comes to evaluating the different training items;the differences in overall questionnaire scores among these groups were statistically significant(P<0.05).The nurses analyzed believe that previous training and professional experience in other care services are necessary before starting work in an ICU.Conclusion Implementation of training programs tailored to the needs of critical nurses had benefits for nurses and the health system.Nurses benefited from training focused on the skills and knowledge of each moment of their working life.Nurses have a different evaluation of their training needs throughout their professional cycle.Therefore,their training must be adapted to the professional stage of each nurse.

Nurses’ stories about their interactions with patients at the Holy Family Hospital, Techiman, Ghana

Factors, which induced positive nurse-client interac-tions and barriers to positive nurse-client interactions from the perspective of nurses at Holy Family Hos-pital, were explored. In all, twelve State Registered Nurses participated in semi-structured interviews. Factors which induced positive nurse-client interac-tion included availability of adequate time, showing empathy, giving prompt care, considering nursing as a call (spiritual interpretation) and rendering holistic care. Factors which induced negative nurse-client interaction included differences in beliefs between the nurse and the client, perceptions of unfair treatment, payment requirement and processes, issues with clients’ relatives, client issues, miscommunications and misunderstandings about treatment needs, coer-cion, forced dependence, human resource issues, professional nursing issues, issues with work envi-ronment, nurse issues, lack of communication and good interaction, and dropping of professional ethics. Suggestions for nursing education, practice and ad-ministration have been outlined. Among them is the need to use role-play as a major teaching method for nursing students to develop empathic behaviours so that they can put themselves in clients’ situations. This understanding will allow them to practise quality nursing after completing their educational programs. There is also the need for policy makers in nursing to institute measures to hold nurses accountable if they abuse clients or clients’ relatives. Lastly, as an important tool, nurses and other health care workers can make use of reflective practice to evaluate their professional interactions with clients and their relatives. This will foster positive nurse-client interaction in future.

Clothing Colour Preferences in A Hospital Environment in Hong Kong:Part Ⅱ-Paediatric Nurses’Preferences of Colour on Their Uniform

The present study investigated nurses’colour prefer-ences on their uniform in paediatric wards.Results ofthe study provided guidelines for the selecting of ap-propriate colours for nurses’uniforms for paediatricwards,and the comparison of nurses’preferences ofcolours on their uniform and child patients’colourpreferences of nurses’uniform was drawn.

Development and Evaluation of Korean Nurses’ Core Competency Scale (KNCCS)

Purpose: The purpose of this study was to develop and evaluate a Korean Nurses’ Core Competency Scale (KNCCS). Methods: This methodological research was conducted over two major steps. The first step involved developing a preliminary 70-item KNCCS based on an extensive literature review and the standards and criteria proposed by the Korean Accreditation of Nursing. The second step involved evaluating validity and reliability of the KNCCS. 528 newly graduated nurses recently employed in nine major hospitals were participated in this research for validation. Results: The final KNCCS consisted of 70 items. The exploratory factor analysis identified five subscales under which each item could be categorized: 1) human understanding and communication skills;2) professional attitudes;3) critical thinking and evaluation;4) general clinical performance;and 5) specific clinical performance. Conclusion: The KNCCS shows good reliability and validity. However, the test of both criterion and construct validity were recommended further.

Nurses’experiences of caring for preterm infants in pain:A metaethnography

Objective:Preterm infants are subjected to numerous painful procedures during their neonatal intensive care unit(NICU)hospitalization.Despite advancements in pain alleviation,nurses remain challenged to provide timely and effective pain management for preterm infants.Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population.The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’experiences of taking care of preterm infants in pain.Methods:An extensive literature search in PubMed,CINAHL,PsycINFO,Scopus,BIOSIS and ProQuest Dissertation and Theses Database was conducted,including studies within the past 10 years.Two nursing researchers conducted data extraction and analysis independently.Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants.Studies published in a language other than English,articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’experiences were excluded.Critical Appraisal Skills Programme was used for literature quality evaluation.Results:Eight studies remained after further screening according to inclusion and exclusion criteria.These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran,Canada,the United States,Finland,Sweden,Switzerland,and Australia.Five themes emerged on the nurses’perspectives of taking care of preterm infants in pain:1)They sense the neonatal pain;2)Adverse consequences of unrelieved pain;3)Barriers of managing pain;4)Concerns of available approaches for pain relief;5)Failure to work with parents.Conclusions:This meta-ethnography identified nurses’understanding of pain in preterm infants that can be assessed,and they acknowledged that unrelieved pain could cause developmental deficits in infants.The barriers are lack of training and support on pain assessment and intervention in preterm infants.Optimizing workload and environment,developing age-specified pain assessment and intervention,receiving emotional support and training,and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.

Operating room nurses’lived experiences of ethical codes:A phenomenological study in Iran

Objective:Operating room nurses,as essential members of health care teams,often face ethical challenges in the operating room.By using the ethical experiences of operating room nurses,a better understanding of ethics in the operating room can be achieved,which can lead to better nursing decisions in the face of these challenges.Therefore,this study was conducted to investigate operating room nurses’lived experiences of ethical codes.Methods:A hermeneutic phenomenological study was performed in Hamadan(Iran)from February 2019 to November 2020.Ten operating room nurses were selected as participants by purposive sampling.Data were collected through in-depth and semi-structured interviews.Data analysis was performed based on Van Manen methodology.Results:Data analysis revealed three main themes and 11 sub-themes representing the operating room nurses experience of the ethical code.The main themes were;adherence to professional commitments,preserving patient dignity,and respect to colleagues.Conclusion:The results underlined ethics and ethical values in the operating room.Due to the intense interactions between operating room nurses with the patient and surgical team,commitment to ethics by nurses can lead to improving quality of care and interactions among members of the surgical team.It is suggested that using these codes as a guideline and a framework could be developed to improve the ethical and professional performance of operating room nurses.

Self-endangering:A qualitative study on psychological mechanisms underlying nurses’burnout in long-term care

Objectives To develop a more specific understanding of psychological mechanisms in the development of burnout in long-term care as a basis for potential new intervention strategies aiming at improving nurses’mental health.Methods Two qualitative studies with thematic analysis were conducted.In Study 1,we conducted eight group interviews with 110 nurses from May–July 2019 in the context of workshops at eight nursing homes in Germany.In Study 2,we supplemented these with semi-structured interviews with 14 executives at German nursing homes in December 2019.Results The thematic analysis in Study 1 identified three main themes:causes of challenges,employees’opportunities for change,and organisational opportunities for change.Thematic analysis in Study 2 identified three main themes:job motives,reasons for filling in for others,and employee self-care.Further,our results show that the need to stand in for colleagues,in particular,is one of the greatest challenges for geriatric caregivers.In dealing with these challenges we found that self-endangering behaviour—a diminished ability to say no when asked to fill in or to do work overtime—was an important antecedent of nurses’burnout.Further,high levels of altruistic motivation and identification with the team or organisation were associated with self-endangering behaviour in the presence of adverse working conditions.Low levels of self-worth are a further risk factor for self-endangering.Conclusions Our findings are at odds with some core tenets of classic models of job demands and burnout that construe motivation and identification as resources.Our results show the need of a holistic intervention program in nursing including individual coaching,team-based interventions and organisational development processes.Employees themselves should be sensitized to this issue and supported in the long term,and politicians should create structures that do not encourage this behaviour any further.