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•The National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity calls for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity.•The report recommends that the systems that educate, pay and employ nurses: 1) permanently remove barriers to care; 2) value their contributions; 3) prepare nurses to tackle health equity; and 4) diversify the workforce. The need to fully support nurses is interwoven throughout the report.•All nurses should work in partnership with others to advance the nine major report recommendations. The National Academy of Medicine's long-anticipated report, The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, offers an aspirational vision: the achievement of health equity in the United States built on strengthened nursing capacity, diversity, and expertise (Wakefield, 2021Wakefield M. Federally qualified health centers and related primary care workforce issues.Jama. 2021; 325: 1145-1146Crossref PubMed Scopus (10) Google Scholar). Released in May 2021, the report arrives at a critical moment for the profession. Many nurses are burned out, exhausted, and have experienced moral injury from caring for an unrelenting stream of patients with COVID-19. The pandemic has laid bare and further exacerbated long-existing health inequities. School closings during the pandemic similarly exacerbated educational disparities, and poor treatment of Black, Indigenous, and other people of color by police spotlighted inequities in law enforcement. Collectively, these inequities have resulted in renewed calls to dismantle structural, cultural, and interpersonal racism, including within nursing. This new report provides a roadmap for how the nursing profession can contribute its expertise to create a fairer, more just and healthier world. The report is the second collaboration between the Robert Wood Johnson Foundation (RWJF) and the National Academy of Medicine (NAM) on the future of nursing. The first report, released in 2010, re-conceptualized the role of nurses in transforming the healthcare system (Shalala et al., 2011Shalala D. Bolton L.B. Bleich M.R. Brennan T. Campbell R. Devlin L. The future of nursing: Leading change, advancing health. 10. The National Academy Press, Washington DC2011: 12956https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-healthGoogle Scholar). RWJF and AARP formed The Future of Nursing: Campaign for Action, a nationwide initiative to advance the report recommendations. Over the past decade, the nursing field strengthened nursing education, advanced practice, promoted leadership, and increased workforce diversity. In doing so, the nursing field has built – and is continuing to build – its capacity to provide high-quality care to more Americans. As nursing built its capacity and as the evidence increasingly linked inequities to poorer health status, it became clear that nurses could do more to build healthier communities and advance equity. Nurses are the most trusted profession and the first point of contact for most people seeking health care. They are bridge builders and collaborators who engage and connect with people, communities, and organizations to promote health and well-being (Pittman, 2019Pittman, P. (2019,. March 12). Activating nursing to address the unmet needs of the 21st century: Background paper for the NAM Committee on Nursing 2030.Robert Wood Johnson Foundation. Available at: https://publichealth.gwu.edu/sites/default/files/downloads/HPM/Activating%20Nursing %20To%20Address%20Unmet%20Needs%20In%20The %2021st%20Century.pdfGoogle Scholar). Their expertise could be better used to combat the many shortcomings of the U.S. health system. The United States spends $3.5 trillion each year on health care (CMS, 2020) more than any other country in the world but ranks last compared with other high-income countries on equity, access to care, health care outcomes, and administrative efficiency (Schneider et al., 2021Schneider, E. et al.,(2021, August)) Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. compared to other high-income countries (Commonwealth Fund). https://doi.org/10.26099/01dv-h208.Google Scholar). Life expectancy, infant mortality and maternal mortality are worse in the United States compared with other high-income nations. Disparities in health care access and outcomes related to race, income, geography and other social and environmental factors are also common. RWJF has long believed that nurses have enormous potential for tackling the shortcomings of health and health care in the United States and in 2019 asked the NAM to form a committee tasked with charting a path for the nursing profession to create a culture of health, reduce health disparities, and improve the health and well-being of the nation. As the committee was well into the process of reviewing evidence and preparing to write the report, the pandemic took hold across the country and shined a light on the nation's rampant health inequities. The committee delayed the report to incorporate the major lessons from the pandemic: its disproportionate and devastating toll on poor and marginalized populations that could largely be attributed to persistent health disparities; the need to fully support nurses; and better prepare the workforce for future disasters. Released in May 2021, the report called for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity. The report recommends that the systems that educate, pay, and employ nurses: (1) permanently remove barriers to care; (2) value their contributions; (3) prepare nurses to tackle health equity; and (4) diversify the workforce. The report underscores that prioritizing nurse well-being is paramount to advancing the recommendations. In addition, the report calls on national nursing organizations to develop a shared agenda for addressing the social determinants of health and achieving health equity. Finally, the committee prioritized research needs to build the evidence base to support nurses in advancing health equity. Each of these areas is discussed below. Far too often in the United States, people do not see a health care provider when they need one. Nearly 30 million people are uninsured in the United States, and roughly 40 million have health plans that leave them potentially underinsured (Collins et al., August 2020Collins, Sara R., Gunja, Munira Z., & Aboulafia, Gabriella N. (2020). U.S. Health insurance coverage in 2020: A looming crisis in affordability — findings from the Commonwealth Fund Biennial Health Insurance Survey, 2020.Commonwealth Fund. https://doi.org/10.26099/6aj3-n655.Google Scholar). In addition, timely access to health care is undermined due to the inability to pay; geographic inaccessibility to services and providers, particularly in rural and underserved urban areas; lack of health literacy; and fundamental mistrust of the health care system and providers. Research demonstrates that delays in obtaining care can lead people to experience worse symptoms and disease progression (Man et al., 2018Man R.X.G. Lack D.A. Wyatt C.E. Murray V. The effect of natural disasters on cancer care: A systematic review.The Lancet Oncology. 2018; 19: e482-e499https://doi.org/10.1016/S1470-2045(18)30412-1Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar). Nurses can help to explicitly address these gaps in access to care. For example, about 70% to 80% of advanced-practice nurses work in primary care, including in pediatrics, adult practice, gerontology, and nurse midwifery. While the primary care nurse practitioner field has grown, the number of physicians entering primary care has stagnated or declined (Barnes et al., 2018Barnes H. Richards M.R. McHugh M.D. Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners.Health Affairs. 2018; 37: 908-914https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (127) Google Scholar; Barnes et al., 2018Xue Y. Ye Y. Brewer C. Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.Nursing outlook. 2016; 64: 71-85https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (117) Google Scholar). Care provided by nurse practitioners has been found to be comparable to the care provided by physicians, according to numerous studies (Perloff et al., 2019Perloff J. Clarke S. DesRoches C.M. O'Reilly-Jacob M. Buerhaus P. Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries.Medical Care Research and Review. 2019; 76: 597-626Crossref PubMed Scopus (24) Google Scholar; Yang et al., 2020Yang B.K. Johantgen M.E. Trinkoff A.M. Idzik S.R. Wince J. Tomlinson C. State Nurse Practitioner practice regulations and US health care delivery outcomes: A systematic review.Medical Care Research and Review. 2021; 78: 183-196https://doi.org/10.1177/1077558719901216Crossref PubMed Scopus (32) Google Scholar). They are less expensive to employ than physicians and are more likely to care for vulnerable populations, including those in rural areas (Perloff et al., 2016Perloff J. DesRoches C.M. Buerhaus P. Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians.Health Services Research. 2016; 51: 1407-1423Crossref PubMed Scopus (83) Google Scholar). However, the ability of nurses to expand access to care is limited by state and federal laws, institutional barriers, and restrictive health systems policies that prohibit them from working to the full extent of their education and training (Wakefield et al., 2021Wakefield M.K. Williams D.R. Le Menestrel S. Flaubert J.L. The future of nursing 2020-2030: Charting a path to health equity. National Press, Google Scholar). The report calls for and organizations to remove these and as well as restrictive policies and In during the and provided full practice to nurse is just about the effect of the to expand scope of practice during the pandemic et al., R. Impact of pandemic on from a national 2021; Full Text Full Text PDF PubMed Scopus Google Scholar; et al., 19: for nurse practitioners to healthcare and for full practice 2021; PubMed Scopus (24) Google in the found that with to from The of nurse practitioner to reduce from the and Scholar). The report calls for these restrictions on scope of practice to be This to remove practice barriers the work of the first report, but it in more the need to barriers that and nurses from to the of their education and training to access to care and help to reduce health care inequities for populations to see a provider when they need one. that the care that and nurses provide restrictions on services and policies that nurses from care. nurses to practice to the full extent of their education and training is an policy to gaps in access to care. As the report the and systems do to reduce health inequities. This has been by the has its to health equity a in policy & E. M. D. et at the for Medicare and a for the 2021; Google Scholar). health care that health equity can a in The U.S. systems the care that nurses provide and the critical role that they can play in addressing to health equity. 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The of nurses needs to be well to promote health equity and improve the health and well-being of nurses need to and the social and environmental factors that health, care for an and more engage in new new with other and health equity and to a policy and collaboration with across the health care and health systems as well as of health care with organizations on social and be paramount during the the nursing field an in preparing the as an million nurses during the by This in an May as nursing education to nurses well to on and roles and to advance the NAM report recommendations. to prepare nurses to tackle health equity related to the social determinants of health, health and health are not into and nursing that nurses are to address the social determinants of health and advance health and healthcare equity. and should be throughout including need to the extent to they provide education in that provide with and from who with an of social needs as well as with communities with the social determinants of health (Wakefield et al., 2021Wakefield M.K. 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Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? 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"I broke down and cried today. I cried of exhaustion, of defeat. Because after 4 years of being an ER nurse, I suddenly feel like I know nothing" (Sydni Lane, USA, Instagram and Facebook). (Fick , 2020) “It's an experience I would compare to a world war” Roberta Re, Italy. (Giuffrida, 2020) “we're on our knees here, and it's really difficult and we're all trying the best we can and we don't feel… we feel like we could be doing more, and I know we can't … we're staying away from our families and we're putting ourselves in danger to try and save other people's loved ones, it feels like a losing battle but it's not, we've all got hope and we're all trying to do what we can.” (Shirley Watts, UK ICU Nurse, BBC news 04 April 2020) As the coronavirus disease 2019 (COVID-19) pandemic takes hold, nurses are on the front line of health and social care in the most extreme of circumstances. We reflect during a moment in time (week three of lockdown in the UK and week 5/6 across Europe) to highlight the issues facing nurses at this unprecedented time. At the bedside 24 hr a day seven days a week, in similar outbreaks, nurses have had the highest levels of occupational stress and resulting distress compared with other groups (Cheong & Lee, 2004; Maunder et al., 2006; Nickell et al., 2004). Nurses are already a high-risk group, with the suicide rate among nurses 23% higher than the national average (ONS, 2017). Despite this, the RCN (Royal College of Nursing in the UK) has reported that nurses feel “repeatedly” ignored by their employers when they raise concerns about their mental health (Mitchell, 2019). A focus on personal responsibility for psychological health and well-being and an overemphasis on nurses being “resilient” in the face of under-staffing and often intense emotional work is consistently challenged by nurses and nurse academics (Traynor, 2018). Treating resilience as an individual trait is seen to “let organisations off the hook” (Traynor, 2018), yet has often been the focus of organisational strategies to date. This does not work at the best of times and certainly is not appropriate now in these most difficult of circumstances. Here, we discuss the stressors and challenges and present evidence-informed guidance to address the physical and psychological needs of nurses during the COVID-19 pandemic. We stress the importance of peer and team support to enable positive recovery after acutely stressful and emotionally draining experiences, and outline what managers, organisations and leaders can do to support nurses at this most critical of times. The high prevalence of COVID-19 in the general population of many countries, its novelty and highly infectious nature, and the associated morbidity and mortality rates are placing an unprecedented demand on health and social care services worldwide. In addition to the admission to hospital of high numbers of critically ill patients, care demands on nurses and care assistants have also increased in the community, in care homes and in learning disability and mental health services. These demands must be met by an already-depleted workforce (+44,000 RN vacancies in the UK pre-COVID-19) and one that is further depleted at this time due to infection, self-isolation and family responsibilities in the face of the crisis. The nature of care itself and new ways of working are potentially highly stressful for staff. Nurses are not only experiencing an increase in the volume and intensity of their work, but are having to accommodate new protocols and a very “new normal.” For instance, many mental health services have transformed almost overnight from providing face-to-face care and treatment to a predominately virtual service of telephone or video consultations. In many other areas, nurses are adjusting to providing end-of-life care more frequently and often in the face of more rapid deterioration than they are used to. Isolation rules mean the presence of family at the bedside is rarely possible. Nurses are therefore frequently standing in for family members and facilitating remote access for loved ones. Established nurse–patient ratios are under strain. In ITU in the UK, for instance, staff-patient ratios of one-to-one are changing to ratios of one ITU nurse to six or more patients, with the shortfall being made up by staff without ITU experience. To boost the nursing workforce, many countries have also fast-tracked their final-year nursing students to join the nursing register early and have encouraged retired colleagues back to practice (Jackson et al., 2020). Many nurses have been redeployed, working in new specialities or in higher acuity areas. All of these factors are likely to be adding stress for existing staff, with additional implications for the well-being of new members of the team. Evidence from studies on COVID-19 and other infectious respiratory disease outbreaks reflects high concern among nurses for personal or family health in the face of direct contact with a potentially deadly virus and the stress of balancing this concern with the ethical obligations of continuing to provide care (Jiang, 2020; Khalid, Khalid, Qabajah, Barnard, & Qushmaq, 2016; Kim & Choi, 2016; Nickell et al., 2004). Other stressors evident from research to date include concerns about shortages of staff and of personal protective equipment (PPE), navigating an unfamiliar setting or system of care and lack of organisational support (Kim, 2018; O'Boyle, Robertson, & Secor-Turner, 2006; Shih et al., 2009). Additionally psychological conflicts between healthcare workers' responsibility to care for the ill and their right to protect themselves from a potentially lethal virus were reported (Chen, Wu, Yang, & Yen, 2005). Our own anecdotal sources in the UK and Europe endorse these findings for COVID-19 as (at time of writing) we approach the peak of the pandemic, but also raise the possibility of other stressors including moral distress resulting from treatment decisions based on finite resources, the lack of access to antigen or antibody testing for most front-line staff, and the discomfort and fatigue resulting from long shifts spent wearing full PPE. On social media, nurses speak of crippling tiredness after long shifts with sore faces after so many hours in masks, as well as communication barriers with colleagues and patients when wearing full PPE; nurses often cannot hear patients, and patients can struggle too; not being able to see nurses' faces or hear what is said. Nurses also speak of the difficult ethical and moral judgements that are being taken in hospitals; care homes and the community throughout the world. They tell of experiencing stigma in the wider community, being perceived as a threat to the safety of others and as “disease-carriers.” As the number of COVID-19 patients grow, there will be increasingly stringent rules about who can be offered ventilation, with one doctor suggesting “soon many of our own staff would not meet the criteria” (Anon & The Guardian, 2020). Reflecting on the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) COVID-19 guidelines for the criteria that doctors and nurses should follow, the moral philosopher Yascha Mounk reflects: “If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?” (Mounk, 2020). Nurses are likely to experience moral and ethical conflict with the potential for stress and moral distress or moral injury (Bridges et al., 2013; Greenberg, Docherty, Gnanapragasam, & Wessely, 2020; Morley, Ives, Bradbury-Jones, & Irvine, 2019). These stressors are present across settings in health and social care, and relevant to all members of the nursing team, including care assistants and temporary members of the team drafted in from their studies or from retirement. There is also an emerging narrative of guilt and some of potential shaming among nurses and students who are unable to contribute to direct patient care due to their own high risk and vulnerability to coronavirus. Nurses and their unions are speaking up about the lack of testing for front-line staff and the variation in access to PPE. Nationally and internationally it appears there is wide variation in access to PPE and the Royal College of Nursing in the UK and its counterparts across the world have been campaigning for adequate PPE for nurses suggesting the nursing voice has been side-lined in the relevant debates (Ford, 2020). In many countries, the focus has been on acute and intensive care; however, nurses in the community and mental health and learning disability settings may also have inadequate access to PPE. The UK priorities for PPE distribution and testing are being interpreted as further discrimination against nurses who do not work in acute physical health settings, leading to further anger that some lives appear to matter less. A failure to protect nursing staff adequately is causing anger and frustration, making nurses feel unsafe at work, while they are risking their own health and fearful of transmission to their families. Unless nurses feel well supported by their organisations and governments, that anger may linger after the crisis potentially causing some to leave the profession. It would be difficult as a nurse not to have strong emotional reactions to the COVID-19 virus and its impact on one's work (fear, anger, frustration, worries). Such fear and anxieties are normal, as are the intense feelings evoked when nurses feel unable to care for patients as they would have otherwise. Nurses and healthcare or nursing assistants, in acute, community mental health and social care settings are having to make extremely difficult decisions from one moment to the next. They are having to be very creative about new ways of working with very ill patients with mental health needs or learning disabilities or dementia. Legal frameworks to support the continuation of care at times of mental health crises such as (in the UK) potential temporary amendments to the Mental Health Act 1983 and the Coronavirus Act 2020 which enforce isolation; place further strain on therapeutic relationships and the delicate balance between nursing care and restrictive practice. In situations where compliance with social distancing and isolation with COVID-19 is low on the list of priorities for people in receipt of care, nurses are having to weigh up human rights, safeguarding and infectious disease protocols all of which may potentially conflict. There are some good signs that health systems are recognising how important it is to support healthcare staff. In the UK, NHS staff have been given free access to more than 1,500 specialists, online therapy and group counselling sessions and will receive practical and financial assistance as well as specialist bereavement and psychological support. Volunteers from charities including Hospice UK, the Samaritans and Shout are staffing phone and text helplines. The NHS is also offering free access to support from Apps such as Headspace, UnMind and Big Health for healthcare staff and their families to include guided meditation and tools to battle anxiety and help with sleep problems. This is a good start, but these services rely on the individual seeking help, and this may well not be sufficient. Investment in a range of supportive measures that do not just place the onus on the individual is almost certainly necessary. Supporting nurses practically and psychologically is essential to preserving their health in the short and long term, particularly when occupational stress levels are so high. Ensuring psychological well-being requires a layered response, with different components at different times, comprising strategies aimed at prevention through to treatment, and strategies/actions at different levels, from organisational and team/ward responses to those aimed at individual self-care and peer support. Response to the specific unprecedented challenge of COVID-19 will also need a flexible strategy as needs and requirements are likely to change over the course of the pandemic response. Furthermore, nurses working outside acute hospitals, working autonomously or in dispersed teams across large geographical areas can find accessing support challenging. Having reviewed the literature and gathered intervention resources from a variety of sources, it is evident that there is much to learn from other similar crisis situations such as SARS, MERS and Ebola. The evidence base in this area is considered weak, and most research is observational or has focussed on early interventions after major incidents and once the crisis has passed (Billings et al., 2020). From a nursing perspective, few studies consider nursing outside of hospital walls. In Figure 1, we present strategies and interventions aimed at supporting nurses' psychological well-being during the COVID-19 crisis. This guidance is led by best-available evidence, underpinned by theory (see Figure 1), expert opinion and models used in the military, as well as experiences from other countries and other infectious disease outbreaks (Watson, 2020; Watson, Brymer, & Bonanno, 2011; Watson et al., 2013). Below, we highlight physiological and safety needs; peer support; team support; and the roles and needs of managers and leaders as well as long-term recovery support needs. While at work and outside of work, nurses should prioritise their own well-being as much as possible, paying attention to meeting their essential needs for drinks, food, rest and sleep, and building in rest and comfort breaks (Cole-King & Dykes, 2020). At times of crisis, human physiological and safety needs come to the forefront—adequate food, shelter, rest, sleep and safety needs for example (Kenrick, Griskevicius, Neuberg, & Schaller, 2010). Recent interviews with medical staff (including nurses) treating COVID-19 in a hospital in Hunan Province support this (Chen et al., 2020). A detailed psychological intervention package (online course to deal with psychological problems; a psychological assistance hotline; and group interventions) encountered obstacles, as staff were reluctant to participate. Staff reported not needing a psychologist at this time, as they were concerned with more immediate worries including not wanting their families to worry; more rest without protective and support and with anxiety and The psychological intervention measures were therefore to include a place to and of their work to with families to to psychological problems; and access to staff for psychological the rest areas to to staff and and provide support (Chen et al., 2020). In countries with the threat of the from the there are from nurses for adequate PPE; and access to the right for psychological support with the wider evidence base that early with more intense for example psychological can be & & Wessely, 2009). on the work of Watson (Watson, 2020; Watson et al., we know that to the healthcare work is by stress may be the to it and stigma can be an to for often do not prioritise good care of recognising it may on or they fear the team without after nurses cannot after health are to after others and not are therefore likely to need others and to to of For week a of a of for a nursing team who had not had a for more than Figure for strategies and interventions for individual and peer support. the pandemic, nurses may be working with people who are not their team therefore need to support other and find ways to help new members feel and as as (see Figure with more colleagues can help support colleagues who have from have been or are final-year students who are in the numbers or in some countries have been early et al., needs to be so that the people are not support and should be so that is not seen as an for organisations they are not providing adequate psychological or other support. All members of the and access to support during and after the In the for Care (Bridges et al., 2018), nurses and healthcare assistants the of nursing teams in to in on This other that the of for members to learning and social support for nurses difficult work with Staff in the an to meet to in on well-being the safety and other evidence at the and of shifts can also help to social support for other (see Figure In times, there is evidence that group such as can team and increase for colleagues and patients et al., 2018). to psychological safety in our that staff by members should not be staff should have had the to and a difficult or experience to protect staff from et al., 2009). as to all in the and face to may not be the at the of the pandemic. The of Care in the UK is therefore their in to in has the of but in a virtual to be in existing teams across the with by of and for a time of an with present 2020). These sessions are being in practice and in and other teams in the few and we to with our students at the of these will A from studies of members of the is that team and leaders and their is highly with mental with a reported in mental health between who perceived themselves as having a good or et al., There is therefore much managers and leaders can do to support nurses in their teams and organisations (see Figure for strategies and guidelines also and communication is as well as and access to physiological and safety needs (Billings et al., 2020; & Dykes, 2020). It is also important that nurses support for so that they have the to support others and are able to good to decisions and access to a are particularly important for where they can through the difficult decisions they are having to make in to COVID-19 They will need their healthcare and to on during the pandemic. or seeking a for peer support is therefore Evidence it is important not to what are and anxieties in such and situations and stress and that needs change over time (Billings et al., 2020). to highly or resilience and do not long-term psychological Greenberg, & Wessely, 2005). some will in most these without the need for interventions Wessely, & is evidence of staff experiencing stress after infectious disease outbreaks for example et al., that does not mean all staff will experience mental health it will be important to the psychological needs of the nursing workforce the of the pandemic, so that in teams and across organisations as well as across we can learn and make nurses have access to adequate support in the recovery to a of nurses with psychological or in the of the acute staff may be on some may have staff colleagues have or family members there has been time to and some may have or guilt (Cole-King & Dykes, 2020; et al., It is important that interventions do and are to individual at and groups should be early or detailed could an and psychological is now with A of research has the of the of as a in of long-term for a of psychological may in et al., et al., 2009). to treatment for those staff who of mental health such as therapy and and which are to be in et al., may be may be for this, and it will be important that there is of access and that this is to nurses as well as other members of the healthcare team. to this unprecedented some resilience is but nurses need their their the and the to support with and and front-line staff throughout Europe is to and some nurses at the of and of such as and other There are also of teams in and in and intensive care to but a this is not nurses also need to feel their needs are for and that they are with adequate PPE equipment in all settings where health and social care are being They need access to rest good peer and team support and leaders that will to care for well after the pandemic is As who have nurse well-being for it is to see the increased focus on healthcare staff yet that it takes a pandemic to its critical staff will need but resilience must be seen as an individual it is a and organisational Evidence from the the resilience of the team appears to be to the between team members than the psychological or of et al., The resilience is now as staff can feel it is to staff are and psychologically lack of resources or ethical and emotional challenges as in nurses can feel it is their they have not the adequately or been This is not this be an to the and emotional strain that nurses on of and not only through this crisis but after it is all health care is back to support for nurses' well-being will critically While COVID-19 particularly high stress on there is very in the guidance that not relevant to staff well-being and when the pandemic is we to the guidelines being used to support for nurses and nursing the We are to our colleagues for their support in the of this to who had the for guidance and through the different levels of while being with are also due to the colleagues who on the and for evidence and

The number of studies on trauma in psychiatric nursing is steadily increasing. An annual growth rate of 7.7% is observed in publications, and the highest number of publications is expected to be reached in 2025. This trend highlights the growing significance of trauma-related research on psychiatric nursing. This study aimed to examine the quantitative and qualitative characteristics of publications on trauma in the field of psychiatric nursing from a bibliometric perspective. The Web of Science database was used for this research. In this study, a bibliometric analysis, which is a methodological approach used to determine the scope of knowledge in a specific field and evaluate productivity, was applied. Data were collected by screening studies published up to June 2025, the study date, without time limitation, using the keyword combination "mental health nursing" OR "psychiatric nursing" AND "trauma." In this study, 523 trauma studies and reviews conducted in the field of psychiatric nursing between 1996 and 2025 were identified, and the analysis was completed using 461 studies in accordance with the exclusion criteria. The analysis revealed 1,630 authors, 383 research articles, and 78 reviews/systematic reviews, with an average of 16.5 citations per publication. A noticeable increase has been observed in the participation of psychiatric nurses in trauma research. It is recommended that nursing professionals conduct more research to examine trauma processes by considering biopsychosocial factors and developing ethically sound approaches for both patients and healthy individuals. What is already knownPsychiatric nurses work in high-stress environments and frequently work with traumatized patients.Although progress has been made in understanding and addressing trauma in psychiatric nursing, there remains a critical need for continued research.What this paper adds to existing knowledge?It is seen that the highest number of publications in the field of psychiatric nursing were made in 2023.It was determined that the most frequently used keywords were trauma, mental health and mental health nursing.It was observed that one of the journals in which the most articles were published was the Issues In Mental Health Nursıng.Implications for practice These findings indicate that although progress has been made in understanding and addressing trauma in psychiatric nursing, there remains a critical need for ongoing research, policy development, and practical interventions aimed at ensuring both nurses and patients’ safety and well-being in mental-health settings.

As the COVID-19 pandemic unfolded in the U.S., individuals with mental health disorders faced compounded challenges exacerbated by existing inequities, including racial and economic injustice. This study examined the association between having a history of a prior mental health condition and psychological distress related to COVID-19 among predominantly Black and Latino public housing residents, identifying both risk and protective factors. We used longitudinal data comprising eight time points from participants (N = 392) in a sample of 146 households of public housing residents in South Bronx, NYC. We conducted a mixed-effects multilevel logistic regression model for cross-sectional and longitudinal analysis to evaluate the association between recent psychological distress related to COVID-19 and self-reported mental health diagnosis, adjusting for sociodemographic, risk, and protective factors. Participants with prior mental health conditions (31% of the sample) faced higher likelihood of distress related to COVID-19 (AOR = 3.54, 95% CI: 1.62-7.73) and over time (AOR = 4.88, 95% CI: 2.25-10.59). Resilience was a protective factor against distress for individuals with prior mental health conditions, while middle adulthood (age 36-55) emerged as a risk factor for distress. All self-reported measures pose a potential risk of information bias. Our study highlights the significant impact of prior mental health conditions on COVID-19-related distress among public housing residents, emphasizing resilience as a protective factor. A targeted approach is critical, including screening for past mental health issues and promoting equity-centered programs tailored to the needs of Black and Latino individuals with pre-existing mental health conditions.

Bullying, harassment, and other negative workplace behaviours are unfortunately all too common in nursing. In this discursive paper, we illuminate the darker side of nursing by summarising prominent negative behaviours in nursing academia, exploring their causes, and considering the weaponisation of complaints as a covert form of bullying. Informed by published peer-reviewed literature on bullying in nursing, bullying in academia, organisational justice, workplace fairness, complaints processes, and weaponisation, as well as specific negative workplace behaviours, we report on how nursing academia shapes professional culture and patient care, yet negative workplace behaviours persist. Weaponised complaints perpetuate bullying in nursing academia, harming academics' wellbeing and reputations while undermining universities' credibility. Such practices damage organisational culture and risk graduating nurses into environments where harm is normalised, ultimately undermining the profession's commitment to safe practice. Addressing weaponised complaints is important to protect nurse wellbeing, foster collegiality and ensure nursing students inherit cultures grounded in procedural fairness, integrity and safe practice. Recognising and preventing misuse is important to safeguarding wellbeing, integrity and collegiality in nursing academia and beyond.

Children with unmet mental health needs from regional and rural settings experience compromised service access. A lack of skilled workforce is a key driver of this problem. This Australian-based two-phase mental health nurse led study aimed to co-design, develop and then trial the helpfulness of a six-week capability development training called the Lighthouse Project for supporters of rural children experiencing mental health challenges. Phase One of the study involved a co-design focus group of stakeholders (N = 20) with Phase Two being qualitative survey responses from supporter participants. Phase One group data confirmed lived experiences of restricted service access to mental health services. Core content and enabling mechanisms for the training to help mitigate that challenge were subsequently developed. Phase Two data (N = 79) reported four themes: (1) New knowledge and attitudes, (2) Practical application of learning, (3) Positive participant subjective experiences, and (4) Mechanisms supporting or hindering outcomes. Co-designed online capability training enables effective role shifting of introductory yet specialised child mental health interventions to rural parents, carers and other supporters. Mental health nurses can undertake key roles in delivering primary mental health interventions such as the Lighthouse project in the context of diminishing practice roles outside of tertiary mental health settings. This study was conducted under a small rural mental health grant from the Peregrine Centre.

The research on schizophrenia and stigma within the nursing discipline is experiencing a notable increase. This trend underscores the escalating significance of addressing schizophrenia and stigma within the nursing profession. This study aimed to examine the quantitative and qualitative characteristics of publications on schizophrenia and stigma in the field of nursing from a bibliometric perspective. The data of this bibliometric analysis. The data were retrieved using the keyword combination "schizophrenia" and "stigma," encompassing studies published up to July 2025, the date of the study, without imposing any temporal restrictions. In this study, 290 schizophrenia and stigma research articles/reviews conducted in the field of nursing between 1997 and 2025 were identified, and 274 articles were included in accordance with the exclusion criteria. The analysis revealed that there were 874 authors, 243 research articles, and 31 reviews/systematic review articles, with an average of 18.4 citations per publication. The findings indicate that, despite advancements in comprehending and addressing stigma associated with schizophrenia within the nursing profession, there remains a significant need for continued research, policy formulation, and practical interventions. It is advisable for nursing specialists to engage in further research on schizophrenia and the mechanisms of stigmatization. The findings indicate that, despite advancements in comprehending and addressing stigma associated with schizophrenia within the nursing profession, there remains a significant need for continued research, policy formulation, and practical interventions. These efforts are essential to ensure the safety and well-being of both nurses and patients in mental health care environments.

The concept of help-seeking has been widely used across health disciplines to describe individuals' efforts to access care, yet its meaning remains inconsistent, particularly in the context of domestic violence. Survivors of intimate partner violence often experience multiple barriers in seeking help, with research showing that, on average, seven attempts are made before leaving an abusive relationship. Clarifying the help-seeking journey is therefore critical to understanding survivors' vulnerability and informing supportive nursing practice. This concept analysis applied Walker and Avant method, drawing on an extensive review of the literature, to identify the defining attributes, antecedents, consequences, and empirical referents of the help-seeking journey. Findings indicate that the help-seeking journey is a dynamic and continuous process in which individuals recognize a problem, define it as requiring outside assistance, and engage in interpersonal interaction with selected sources of care, including health professionals, to enhance safety and mental well-being. By offering an operational definition of the help-seeking journey, this analysis provides a foundation for theory development, research, and practice. The clarified concept can guide psychiatric and mental health nurses in recognizing barriers, facilitating trauma-informed interventions, and shaping policies that promote timely and effective help-seeking among survivors of domestic violence.

Suicide prevention represents a critical opportunity for nursing practice, policy, and research to advance a more cohesive and proactive model of care. Many individuals who attempt or die by suicide have had recent contact with healthcare services but were not adequately assessed for suicide risk, underscoring the importance of early identification through brief, validated screening tools such as the ASQ and C-SSRS. Implementing universal screening promotes consistent assessment across clinical settings, reducing missed opportunities for intervention in emergency, inpatient, and outpatient care. However, national data reveal substantial variability in screening practices, driven by workflow constraints, limited training, and unclear policy guidance, highlighting the need for greater standardization. As the largest and most patient-facing segment of the healthcare workforce, nurses are uniquely positioned to lead suicide prevention efforts. Through strong nursing leadership, screening protocols can be integrated into routine care, documentation processes streamlined, and clear pathways for escalation and follow-up established. Standardized approaches support both clinicians and patients by supporting shared responsibility for suicide care across healthcare systems while honouring patient autonomy, lived experience, and the complex role that suicidal thoughts may play in coping with psychological pain. Aligning policy, practice, and research is essential to advancing a cohesive, preventative framework that strengthens patient safety and ensures individuals at risk are identified and supported before reaching crisis points.

This study examined how sibling dyads in families with a parent diagnosed with bipolar disorder navigate shared adversity and develop interconnected lived experience orientations toward parental mental illness. A qualitative secondary analysis of narrative inquiry data was conducted using semi-structured interviews with four sibling dyads (seven females and one male, aged 20-32). Guided by narrative inquiry principles and the SHARE framework, the analysis examined seven dimensions: life focus, emotions toward family, coping with parental mental illness, supporting family, perceived gains and losses, perceptions of siblings, and perceptions of sibling relationships. Two interrelated orientations were identified. Family-oriented experiences involved emotional closeness, caregiving engagement, and active illness management, whereas individual-oriented experiences emphasized autonomy, self-protection, and career development, often expressed through financial or practical support. Across families, siblings assumed complementary roles and dynamically negotiated closeness and distance to sustain family balance and personal adaptation, reflecting an interplay between emotional connection and independence. These findings underscore the importance of assessing sibling dynamics in psychiatric settings, particularly how differentiated orientations shape caregiving roles, emotional regulation, and relational boundaries among adult children of parents with bipolar disorder. They further suggest that family-centered psychoeducation should address sibling-specific roles to support adaptive communication and role negotiation. For mental health nurses, integrating sibling- and family-oriented perspectives into assessment and care planning may facilitate more relationally attuned, developmentally sensitive support. By foregrounding sibling dyads as an underexamined unit of analysis, this study advances nursing practice and identifies directions for future sibling-focused research across diverse family and cultural contexts.

This study explores undergraduate nursing students' perception of mental health nursing as a potential career path. Utilising a qualitative phenomenographic approach, semi-structured interviews were conducted with nineteen nursing students enrolled in a comprehensive Bachelor of Nursing program from one metropolitan university located in Melbourne, Australia. Data analysis revealed five distinct categories of description, ranging from unclear role definition and polarised attitudes to a more nuanced understanding of the skills involved. These findings are significant as it illustrates that variations in students' understandings of the mental health nursing role persist even following targeted education, suggesting that deeply held perceptions are not easily shifted within existing curricular approaches.

A self-reported psychological distress and mental health diagnoses as well as use of psychotropic medication is rising among children and adolescents globally. Mental health aspects such as self-esteem, self-confidence, physical activity, and social interaction are crucial for children's and adolescents' well-being and school performance. Parents of children with mental illness often experience heavy care burden, social stigma, and financial strain affecting their physical, psychological, and social health. The study uses reflexive thematic analysis to describe nine parents' experiences of their mentally distressed children's participation in a 12-week equine-assisted therapeutic intervention conducted in accordance with Engels biopsychosocial model in southern Sweden. The results revealed the overarching theme "From deepest despair to a ray of hope," comprising three themes: "Experiencing crisis without getting any help," "An oasis of ease without stress," and "New spark of life and faith in the future." In conclusion, parents emphasized the importance of relaxation and confidence in their own and their children's abilities, gained through participation in the equine-assisted intervention (EAI). Integrating EAI into regular mental healthcare for children could strengthen mental health and resilience among the young and contribute to the Sustainable Development Goals (SDGs), as childhood mental well-being is fundamental to health and life expectancy.

Stress and burnout are significant concerns in nursing academia, as students balance clinical and academic demands, faculty manage teaching and research responsibilities, and staff navigate heavy workloads. Traditional wellness initiatives often address these groups separately, overlooking the value of shared engagement across the life course. This case study examined the development, implementation, and outcomes of an evidence-based wellness program within a College of Nursing. The life course framework reflected the continuum of human development, spanning students entering nursing directly from high school, registered nurses returning to advance their education, staff balancing work and family responsibilities, and faculty navigating the demands of early- to late-career stages. Guided by Yin's embedded case study methodology, data sources included pre-surveys, post-program feedback, and written interview guides from one student, one faculty member, and one staff member. Analysis combined within- and cross-case synthesis to identify similarities and differences across roles. Participants reported reduced stress, stronger wellness practices, improved coping, and greater feelings of belonging, with role-specific areas: students focused on coping and consistency, faculty on role modeling, and staff on recognition and sense of belonging. The intergenerational space was experienced as supportive and nonhierarchical, with participants sustaining at least one wellness practice beyond the program. These findings suggest that nursing academia can function as a whole multigenerational community for holistic wellness, normalizing wellness practices, fostering reciprocal learning, and cultivating an environment that strengthens well-being across the life course.

Prevention of relapses in the care of patients with severe mental illness poses a significant challenge including difficulties with treatment adherence. A more frequent contact between patients and mental health professionals has the potential to positively affect patient stability. The aim of this feasibility study was to explore the perspectives and experiences of patients and mental health professionals on the combination of video consultations and relapse prevention using the early recognition method strategy. Eight patients with severe mental illness and six mental health professionals from two Community Mental Health Care centres in the Region of Southern Denmark were interviewed using semi-structured interviews with open-ended questions. The interviews were analysed using an inductive approach to content analysis as described by Elo and Kyngäs. The analysis resulted in three themes from the patient interviews: (1) A facilitated and expanded contact is not just a talk; (2) Personal perspectives on the optimal room for therapy and communication; (3) Focus on prevention empowers action, and two themes from interviews with Mental Health Professionals (1) An expanded treatment approach; and (2) A more nuanced view of perspective on using VC. The paper concludes that combining video consultations with the Early Recognition Method adds flexibility to treatment and meeting the patients need, although its use may present challenges, such as scepticism among the MHPs, the level of familiarity with using VC among the patients, and technical challenges. Given increasing patient loads, this combination is a suitable addition to treatment.

Peer support is a recovery-oriented collaborative practice where individuals with lived experiences with mental health conditions engage in supporting others experiencing similar challenges. Becoming a peer support worker (PSW) includes a transition from being a service user to becoming a provider of care and personal roles and identity are challenged when adjusting to the new role. Through individual interviews, this study explored eight PSWs' personal stories of mental illness, recovery, and when the possibility of becoming a peer support worker emerged during this process. Thematic analysis led to four themes: 1) Struggles in everyday life, 2) Landmark events, 3) Turning points, and 4) Finding your way. The PSWs told deeply personal stories of how mental illness had impacted their lives. The themes display when the initial idea and then the ambition to become a PSW emerged during the process of recovery. This study provides insight into how the PSWs at different times-and in different ways-became aware of the possibility of using their personal experience to support others. At an overall level, these findings represent descriptions of individual processes in which the PSWs moved towards re-positioning their lived experiences with mental health challenges from deficit to asset.

This integrative review critically examined current evidence on cyberbullying, cyberincivility, and online harassment involving nurses as recipients, perpetrators, or participants in professional and public digital spaces. Guided by Whittemore and Knafl's framework and reported in accordance with PRISMA 2020, peer-reviewed studies (2017-2025) were identified through CINAHL, MEDLINE, and Embase (final search: 3 December 2025). Methodological quality was appraised using Joanna Briggs Institute tools, and findings were synthesised through inductive thematic analysis. Nine studies met the inclusion criteria. Five themes emerged: cyberbullying is widespread and multimodal; shaped by organisational culture and power dynamics; associated with significant psychological and occupational harm; intensified by blurred personal-professional boundaries; and inadequately addressed due to fragmented leadership, education, and policy responses. Cyberbullying and cyberincivility represent pervasive digital extensions of workplace bullying in nursing, with serious implications for nurse wellbeing, professional identity, workforce retention, and patient care. Addressing these behaviours requires recognition of cyber-aggression as workplace violence and coordinated organisational action across leadership, education, policy, and research. Healthcare organisations must move beyond individualised coping approaches and implement proactive and enforceable policies, leadership development, and structural psychosocial supports to prevent and respond to cyberbullying, thereby safeguarding nurses’ mental health, professional identity, and patient care.

Young adults are prone to loneliness and its adverse effects due to the difficulty of transitioning to adulthood. In this context, social networking sites are a crucial platform at their disposal to find connections. However, loneliness in social networking sites lacks conceptual clarity. By using Rodgers's Evolutionary Model, this study was conducted using a systematic search of the literature to help mental health nurses understand the concept of loneliness in social networking sites for young adults. The analysis revealed three categories of attributes: Engagement-based; Consumption-based; and Emotion-based, and two groups of antecedents: Emotion-linked and Skill-linked, with multiple consequences of loneliness. The findings highlight the role of social networking sites as an emerging platform for the multifaceted manifestations of loneliness among the young generation. As mental healthcare professionals increasingly recognise the significance of social networking sites in the lives of young adults, this conceptual understanding will help in the development of interventions and policies based on interaction dynamics. By understanding these patterns, healthcare providers can better support young adults grappling with feelings of loneliness in social networking sites, ultimately promoting enhanced mental health and social connection in a digital world.

Nurses spend up to 40% of their time safely administering medication. Medication administration errors (MAEs) are a concern as they can compromise patient safety and increase the risk of morbidity and mortality. Although some research has investigated factors that influence MAEs, there has been limited attention paid to the impact and unique experiences of mental health nurses directly involved in such errors. The scoping review intended to explore literature on the experiences of mental health nurses regarding MAEs within the hospital setting. A database search found 540 citations, with one extra study identified through reference lists; no new papers were found in the grey literature. Three papers included: an editorial and two qualitative studies. Using MMAT for quality appraisal, the review showed that mental health nurses' experiences of MAEs were shaped by workload, staffing, ward dynamics, patient involvement, and communication. Nurses reported emotional responses such as fear, anxiety, stress, relief, and guilt. Mental health nurses administer medication, yet the effects of MAEs are largely overlooked, with only three studies covering this area. This review highlights the importance of understanding factors and emotions related to MAEs. While nurses shared experiences, the studies did not explain how they interpreted these errors.