While ICU health care workers consistently identify a number of patient factors as important in decisions to withdraw care, there is extreme variability, which may be explained in part by the values of individual health care providers.

Workplace bullying within the nursing community is a global problem, which has spanned decades; it has detrimental effects on nurses and affects patient outcomes (Hartin et al., 2020;Trépanier et al., 2016). Several studies have revealed that nurses face greater risk of workplace bullying than other professions because of the nature of their job which involves high levels of human interaction daily (Waschgler et al., 2013). Furthermore, the stressful work environment contributes to an even higher probability of interpersonal conflicts among the healthcare team which in turn leads to bullying (Zapf et al., 2003). Workplace bullying is strongly associated with nurses' turnover intentions; this is a critical issue faced by nursing organizations worldwide as they are currently working on retaining nurses (Giorgi et al., 2016;Laschinger, 2012; World Health Organization, 2014). It is estimated that there will be a worldwide shortage of nurses and midwives, exceeding nine million by 2030, if the retention rates do not improve (World Health Organization, 2016). Extensive research has been conducted over the years to determine factors contributing to bullying and develop strategies to retain nurses to overcome the global nursing shortage. | BackgroundBullying is described as having intentions to threaten or harm others and is a disruptive behaviour, which often involves the abuse of power (Lewis-Pierre et al., 2019). In the workplace, bullying may also be known as horizontal violence, lateral violence or incivility; this involves persistent exposure to aggression, mistreatment and disrespect from subordinates, colleagues or superiors

Childbirth is usually a joyous occasion. However, a significant proportion of parents experienced traumatic childbirths and suffered post-traumatic consequences, which needs urgent attention. Therefore, this review aimed to explore and understand the traumatic childbirth experiences of parents. A systematic review of qualitative studies was done. The consolidated evidence was meta-summarized and meta-synthesized based on Sandelowski and Barroso’s approach for synthesizing qualitative research. Seven electronic databases, including PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database’s inception to April 2020. Retrieved studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and 19 studies were included in this review. All included studies were meta-summarized and meta-synthesized. An overarching theme, “traumatic birth: an evolving voyage,” with three main themes, (1) “proceedings to traumatic birth,” (2) “internal and external battles,” and (3) “muddling through to beating the odds,” and 10 subthemes were identified. Overall, parents felt fluctuations of emotions that seemed to be never-ending journeys. They expressed that various factors led to their traumatic birth experiences, especially health care providers’ dismissive attitudes. Parents commonly reported feelings of powerlessness and fear for the safety of mothers and infants. Their constant battles to overcome traumatic experiences affected some of their relationships. To deal with the trauma, some mothers displayed avoidance behaviors while others relied on social support. As health care providers play important roles in influencing outcomes of childbirth, they should be mindful of the care provided during labors and childbirths.

Health care providers are often “second victims” of traumatic childbirth events and should be adequately supported by their organizations to alleviate occupational stress and burnout. Therefore, this review aimed to explore and understand the vicarious traumatic childbirth experiences of health care providers, including obstetricians, midwives, nurses, and students. A systematic review of qualitative studies was conducted. Seven electronic databases, namely, PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database’s inception to May 2020. In total, 1,575 studies were retrieved and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in this review and were meta-summarized and then meta-synthesized using the Sandelowski and Barroso approach. The overarching theme of “Tunneling through the trauma with a hope of finding an end” was derived, and four main themes along with 15 subthemes were identified. The four main themes were (1) “instantaneous response to the trauma,” (2) “finding hope in the midst of chaos,” (3) “dealing with the aftermath,” and (4) “resolution to move on.” Communication and teamwork among health care team members were identified as challenges contributed by professional hierarchy and lack of role clarity. Midwives and labor and delivery nurses expressed powerlessness in advocating for women on many occasions, and health care providers often had feelings of guilt and self-blame after adverse events. Health care providers also reported inadequate support from their colleagues and organizations, which influenced their ability to cope with the aftermath of trauma and their decision to stay in the profession.