Persistent Changes of Nurses' Practices and Working Conditions in High Acuity Settings in the Post-Pandemic Era: A Qualitative Meta-Aggregation

AimsTo explore the persistent changes in working conditions and nursing practices in high acuity settings in the post COVID-19 pandemic era.DesignA qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute.MethodsAfter screening by two authors based on the inclusion and exclusion criteria, 36 studies were included. Quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were then extracted and synthesised. Confidence of findings was assessed using the ConQual approach.Data SourcesThe electronic databases: MEDLINE, CINAHL, Embase, and Scopus were searched in November 2023. Additional searches were conducted using the preprint servers: medRxiv, Open Science Foundation, Social Science Research Network, and Journal of Medical Internet Research.ResultsSynthesised findings of 'unfavourable working conditions and changed nursing practices' and 'health concerns caused by the nursing practices' with eight categories were identified. Significant findings included increased workloads; overwhelming use and insufficient supply of personal protective equipment; decreased communication between nurses and patients, families, and other healthcare workers; lack of knowledge of the disease; and adequate support from coworkers, but inadequate support from nurse managers and physicians.ConclusionThis study synthesised existing knowledge and offered insight into the nursing practices and working conditions of high acuity nurses during the COVID-19 pandemic. Clinical nurses and managers need to actively take action on those modifiable aspects of their practices in a future similar crisis. This review did not identify any studies focusing on high acuity nurses' working conditions and practices in the post-pandemic era. This kind of research is urgently needed.ImpactNurse managers and policy makers can use the findings of this review to help construct better working conditions for their high-acuity nursing staff in a future similar crisis. Frontline high-acuity clinical staff may use the findings of this review to help better guide their nursing practices and mitigate negative effects of a future similar crisis on their practice and health.Reporting MethodThe study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.Patient or Public ContributionNo patient or public contribution.Trial RegistrationInternational Prospective Register of Systematic Reviews: CRD42023473414