A national survey of emergency nurses and avian influenza threat

Duty to Work During the COVID-19 Pandemic: A Cross-Sectional Study of Perceptions of Health Care Providers in Jordan

Introduction

This study aimed to assess perceptions of duty to work among health care providers during the coronavirus disease 2019 response and to identify factors that may influence their perceptions.

Methods

This was a cross-sectional study conducted from April 1, 2020, to April 20, 2020, using an online survey distributed to health care providers in Jordan. Descriptive statistics were used, as well as chi-square test for independence to assess relationships between variables.

Results

A total of 302 questionnaires were included. Commitment to serve the community was the primary reason for coming to work (36%), followed by commitment to faith (29.6%). The major perceived barriers for coming to work were lack of appropriate personal protective equipment and appropriate training (62.6% and 53.5%, respectively). Males perceived higher work obligations than females in all potential barriers (P < .05), except for the lack of appropriate training. Nurses perceived higher work obligations than other health care providers despite the lack of appropriate training (χ² = 11.83, P = .005), lack of effective vaccine or treatment (χ² = 21.76, P < .001), or reported infection among coworkers (χ² = 10.18, P = .03).

Discussion

While the majority of health care providers perceive an obligation to work during the coronavirus disease 2019 pandemic, specific conditions, mainly lack of protective gear and training, may significantly alter their perception of work obligation. Providing training and proper personal protective equipment are among the vital measures that could improve the work environment and work obligation during pandemic conditions.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Review article: Impact of pandemics on rural emergency departments: A scoping review

Pandemics can cause much distress to communities and present a major burden to the resources and functioning of hospitals. This scoping review aimed to identify, evaluate and summarise current literature regarding how pandemics impact rural EDs in terms of staff wellbeing, structure, function and resources. A systematic search of six databases using search terms including pandemic, ED and rural and remote was undertaken. Articles were included if they were peer-reviewed, written in English, original research, published between January 2010 and October 2021 and discussed the impact of pandemics on rural EDs. Articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Three articles, one from Canada and two from the United States, met the inclusion criteria. The articles included were quantitative in design and fulfilled most of the MMAT critical analysis criteria. Pandemics reported on included H1N1 and COVID-19. These pandemics impacted rural EDs in terms of functioning and resourcing; no description of staff wellbeing or structure was identified. Rural ED functioning was affected in terms of input; with an increase in patient presentations and time to physician assessment during H1N1, but a decrease in patient presentations and transfers during COVID-19. Rural ED resources were impacted in regard to staffing, difficulty in obtaining stocks of personal protective equipment and medication, and community response. Further research to understand and address the short- and long-term impacts pandemics may have on rural EDs is required.

Disaster Preparedness Training Needs of Healthcare Workers at the US Department of Veterans Affairs

OBJECTIVES

Training healthcare workers in disaster preparedness has been shown to increase their willingness and ability to report to work during disasters. Little is known, however, about the relation between sociodemographic, household, and workforce characteristics and the desire for such training. Accordingly, this study aimed to assess healthcare workers' desire for additional workforce preparedness training, and the determinants that influence the need for such training, for three types of disasters (natural, pandemic, manmade).

METHODS

The US Department of Veterans Affairs (VA) Preparedness Survey was a random, anonymous, Web-based questionnaire fielded nationwide (October-December 2018). Multivariate, logistic regression analyses were conducted.

RESULTS

In total, 4026 VA employees, clinical and nonclinical, responded. A total of 61% of respondents wanted additional training for natural, 63% for pandemic, and 68% for manmade disasters. VA supervisors (natural: odds ratio [OR] 1.28, pandemic: OR 1.33, manmade: OR 1.25, P < 0.05) and clinicians (natural: OR 1.24, pandemic: OR 1.24, manmade: OR 1.24, P < 0.05) were more likely to report the need for additional training. Those who reported that they understood their role in disaster response were less likely to report the need for training (natural: OR 0.25, pandemic: OR 0.27, manmade: OR 0.28, P < 0.001), whereas those who perceived their role to be important during response (natural: OR 2.20, pandemic: OR 2.78, manmade: OR 3.13, P < 0.001), and those who reported not being prepared at home for major disasters (natural: OR 1.85, pandemic: OR 1.92, manmade: OR 1.94, P < 0.001), were more likely to indicate a need for training.

CONCLUSIONS

Identifying which factors encourage participation in disaster preparedness training can help hospitals and other healthcare providers create targeted training and educational materials to better prepare all hospital staff for future disasters.

Household Preparedness and Perceptions of Workforce Preparedness During Pandemics: A Health Care Employee Survey at the US Department of Veterans Affairs

OBJECTIVE

To examine the effects of household preparedness on perceptions of workplace preparedness during a pandemic among all employees at the US Department of Veterans Affairs (VA) medical facilities.

METHODS

The VA Preparedness Survey (October-December 2018, Los Angeles, CA) used a stratified simple random, web-based survey. Multivariate statistical analyses examined the effect of household preparedness on perceptions of workforce preparedness during a pandemic: institutional readiness; desire for additional training; and understanding their role and its importance.

RESULTS

VA employees totaling 4026 participated. For a pandemic, 55% were confident in their VA medical facility's ability to respond, 63% would like additional training, 49% understood their role during a response, and 68% reported their role as important. Only 23% reported being "well prepared" at home during major disasters. After controlling for study-relevant factors, household preparedness was positively associated with perceptions of workforce preparedness during a pandemic.

CONCLUSIONS

Efforts to increase household preparedness for health care employees could bolster workforce preparedness during pandemics. Organizations should consider robust policies and strategies, such as flexible work arrangements, in order to mitigate factors that may serve as barriers to household preparedness.

Barriers and Facilitators of Nurses' and Physicians' Willingness to Work during a Respiratory Disease Outbreak: A Mixed-Methods Systematic Review

This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.

Predicting polytomous career choices in healthcare using probabilistic expectations data

This paper compares career expectations and career outcomes of Swiss healthcare assistants (HCA), an occupation created to increase the supply of nurses. We investigate whether HCAs can predict their own professional careers two years ahead by eliciting their expectations for a range of career alternatives, including nursing and other studies. Polytomous choice situations have rarely been analyzed using numerical probabilities in the expectations literature. Our results show that almost all respondents give informative answers to the probabilistic online survey question. Individuals express considerable uncertainty about their future careers, with over 60% attaching positive probabilities to more than one career alternative. The analyses reveal that individuals' numerical expectations have substantial predictive value for their future careers, even after controlling for many variables. This finding confirms that individuals have private information not directly available to researchers, and that eliciting choice probabilities for polytomous choice situations is a viable approach in surveys. However, the mean shares for career alternatives implied by individual probabilities do not fully coincide with actual shares and are more accurate over 4 than over 2 years. The information conveyed in expectations and their deviations from outcomes enables us to derive policy recommendations to increase transitions to nursing.

Willingness to work during initial lockdown due to COVID-19 pandemic: Study based on an online survey among physicians of Bangladesh

BACKGROUND

During the catastrophic situation of the COVID-19 pandemic, the role of the health care workers (HCWs) is the most crucial, and their absenteeism, whether due to inability or unwillingness, becomes a major concern for the national health system. Hence, the present study aimed to determine the willingness and its associated factors to work during the COVID-19 pandemic among the physicians of Bangladesh.

METHODS

This was a cross-sectional study conducted from April 21 to May 10, 2020, using an online survey among the Bangladeshi physicians living in the country. Both univariate and multivariable binary logistic regression models were used to determine the predictors of the willingness of the physicians to work during the COVID-19 pandemic.

RESULTS

More than 69% physicians reported that they were willing to work during the COVID-19 pandemic, 8.9% reported that they were not willing, while 21.4% of participants were not sure about their willingness. Younger age, having experience of treating patients during previous pandemics, working in the emergency departments and high self-reported compliance to the recommended PPE were important predictors of being willing to work during COVID-19 pandemic. Concern for family and risk of transmitting the infection to family members were most commonly reported as major barriers of working during the pandemic (30%) followed by having comorbidities (25%), lack of adequate safety measures (25%), fear of being infected (12.2%), not involved in clinical practice (12.5%) etc.

CONCLUSIONS

Though the majority of the physicians were willing to work during the COVID-19 pandemic, sufficient supply of PPE, support to maintain recommended quarantine and isolation policy after risky hospital duty along with adequate and effective training can increase their willingness to continue their sacred duty during this crucial pandemic.

Psychosocial support for providers working high-risk exposure settings during a pandemic: A critical discussion

Psychological first aid is a form of support designed to lessen disaster‐related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post‐disaster support and non‐existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low‐income areas such as Sub‐Saharan Africa will need support strategies which compliment local frontline staff and fit with community‐driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.

State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Cross-Sectional Survey Study

INTRODUCTION

State regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments.

METHODS

A cross-sectional approach was used with a nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, X-rays, over-the-counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols.

RESULTS

A total of 350 participants returned surveys from 48 states and the District of Columbia. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with the scope of practice prohibitions. Four categories emerged such as advantages, approval, prohibition, and conditions under which the protocols can be used. Prohibitive language was associated with less protocol use for emergency care.

CONCLUSION

State scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.

Workforce preparedness for disasters: perceptions of clinical and non-clinical staff at the U.S. Department of Veterans Affairs

Background

Most U.S. studies on workforce preparedness have a narrow scope, focusing primarily on perceptions of clinical staff in a single hospital and for one type of disaster. In contrast, this study compares the perceptions of workplace disaster preparedness among both clinical and non-clinical staff at all U.S. Department of Veterans Affairs (VA) medical facilities nationwide for three types of disasters (natural, epidemic/pandemic, and manmade).

Methods

The VA Preparedness Survey used a stratified simple random, web-based survey (fielded from October through December 2018) of all employees at VA medical facilities. We conducted bivariate and multivariate logistic regression analyses to compare the sociodemographic characteristics and perceptions of disaster preparedness between clinical and non-clinical VA staff.

Results

The study population included 4026 VA employees (2488 clinicians and 1538 non-clinicians). Overall, VA staff were less confident in their medical facility’s ability to respond to epidemic/pandemics and manmade disasters. Depending on the type of disaster, clinical staff, compared to non-clinical staff, were less likely to be confident in their VA medical facility’s ability to respond to natural disasters (OR:0.78, 95% CI:0.67–0.93, p < 0.01), pandemics (OR:0.82, 95% CI:0.70–0.96, p < 0.05), and manmade disasters (OR: 0.74, 95% CI: 0.63–0.86, p < 0.001). On the other hand, clinicians, compared to non-clinicians, were 1.45 to 1.78 more likely to perceive their role in disaster response to be important (natural OR:1.57, 95% CI:1.32–1.87; pandemic OR:1.78, 95% CI:1.51–2.10; manmade: OR:1.45; 95% CI: 1.23–1.71; p’s < 0.001), and 1.27 to 1.29 more likely to want additional trainings to prepare for all three types of disasters (natural OR:1.29, 95% CI:1.10–1.51; pandemic OR:1.27, 95% CI:1.08–1.49; manmade OR:1.29; 95% CI:1.09–1.52; p’s < 0.01). Clinicians were more likely to be women, younger, and more educated (p’s < 0.001) than non-clinicians. Compared to clinicians, non-clinical staff had been employed longer with the VA (p < 0.025) and were more likely to have served in the U.S. Armed Forces (p < 0.001).

Conclusions

These findings suggest both a desire and a need for additional training, particularly for clinicians, and with a focus on epidemics/pandemics and manmade disasters. Training programs should underscore the importance of non-clinical roles when responding to disasters.

Emergency Preparedness Competencies Among Nurses: Implications for Nurse Administrators

OBJECTIVE

The aim of this study was to examine current levels of self-reported professional emergency preparedness competence among nurses. In addition, relationships between nurse professional emergency preparedness competence, personal preparation for a disaster, and perceived likelihood of reporting to work after a disaster are examined.

BACKGROUND

Evidence suggests wide gaps in nurses' familiarity with the dimensions of professional emergency preparedness competence and their likelihood to report, potentially impacting human life after a disaster.

METHODS

An exploratory, cross-sectional survey design was used with a sample of 186 RNs and licensed practical nurses.

RESULTS

Results indicate significant weaknesses in nurses' professional emergency preparedness competence. There are positive correlations between likelihood to report, personal preparedness, and professional emergency preparedness competence.

CONCLUSIONS

Nurses across the United States lack sufficient competence in professional emergency preparedness. Results demonstrate the need to improve the education of nurses to meet the demands of populations in urgent situations. Action items nurse administrators can take are provided.

A Cross-Sectional Examination of the Factors Related to Emergency Nurses' Motivation to Protect Themselves Against an Ebola Infection

Introduction

The 2014-2016 West African Ebola outbreak impacted the United States. Owing to the sporadic occurrence of the Ebola infection, there is insufficient research regarding how US emergency nurses provide care to patients potentially infected with the Ebola virus and the nurses’ motivation to protect themselves when providing care to these patients. This study aimed to investigate the predictors of emergency nurses’ protection motivation.

Methods

A cross-sectional design was employed. A survey developed based on a modified Protection Motivation Theory was administered to randomly selected members of the Emergency Nurses Association. Descriptive statistics, nonparametric Kruskal-Wallis H test (as well as post hoc Dunn-Bonferroni test), Spearman rho correlation, and stepwise multiple linear regression were conducted for data analysis.

Results

Protection motivation was found in 2 components: proactive and passive protection motivation. Regression analysis indicated that response efficacy (β = 0.27, P < 0.001) and self-efficacy (β = 0.17, P < 0.01) significantly predict emergency nurses’ proactive protection motivation, whereas perceived vulnerability (β = 0.26, P < 0.001), response cost (β = 0.19, P = 0.001), and knowledge (β = −0.15, P < 0.01) significantly predict emergency nurses’ passive protection motivation.

Discussion

The results indicate the need for interventions to improve emergency nurses’ response efficacy, self-efficacy, and knowledge, while simultaneously reducing the nurses’ perceived vulnerability and response cost. Such interventions would be expected to proactively motivate nurses to protect themselves when providing care to patients who exhibit the signs and symptoms of an Ebola infection and reduce their passive protection motivation.

Active Shooter: What Would Health Care Students Do While Caring for Their Patients? Run? Hide? Or Fight?

OBJECTIVE

The aim of this study was to explore the clinical decisions that health care students would make if faced with an active shooter event while providing patient care.

METHODS

A cross-sectional study design was used to survey 245 students from 6 different professional programs. Participants read 4 case-based scenarios, selected 1 of 4 actions in a multiple-choice format, and responded to an open-ended question. Demographic questions asked whether participants had been a victim of violence and whether they have taken a certified active shooter course. Statistical analysis included descriptive statistics and chi-square testing.

RESULTS

For each case, most students chose "patient-centric" versus "provider-centric" actions (range: 66%-94% and 4%-17%, respectively). The gender of the patient made no difference in actions. Those who attended a certified active shooter course tended to act with more "provider-centric" concerns than those who did not take such a course.

CONCLUSION

A significant majority of interprofessional health care students, when presented with specific case-scenarios, declared they would act to protect themselves and their patients during an active shooter event. This "patient-centric" attitude transcends the oversimplified "Run-Hide-Fight" axiom and must be addressed by all health care educational institutions.

Critical Requirements for Nursing Practice in Rural Disasters Caused by Floods

OBJECTIVE

To identify critical requirements for nursing practice when responding to hydrological disasters in the rural area.

METHOD

A descriptive, exploratory and qualitative study was developed. The Critical Incidents Technique was adopted. Twenty public health nurses who worked during the flood season in the years of 2014 and 2015 in a rural area in Southern Brazil were interviewed. Content analysis of the data was developed.

RESULTS

Critical requirements for nurses' practice were derived from the situations (n=78), critical behaviors (n=98) and consequences to the population (n=43) and to the nurses (n=38) identified.

CONCLUSION / FINAL CONSIDERATIONS

Although the requirements could be related to the established international referential for nurses' practice in disasters, some were described only in this study. They can contribute to the education and practice of nurses in primary health care, strengthening its capacity to face disaster situations by flood in the rural area.

Characterization of nurses’ duty to care and willingness to report

Background:

Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care.

Research aim:

The purpose of this study was to investigate nurses’ perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care.

Research design:

A cross-sectional survey research design was used in this study.

Participants and research context:

Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board.

Ethical considerations:

Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas.

Findings:

Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: “lower level of perceived duty to care group” and “higher level of perceived duty to care group.” The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics.

Discussion:

The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses’ safety, minimize nurses’ risk, and promote nurses’ knowledge to confidently work during disaster situations.

Conclusion:

Level of perceived duty to care affects nurses’ willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses’ perceived duty to provide care and willingness to report to work during disasters.

Healthcare workers' willingness to work during an influenza pandemic: a systematic review and meta-analysis

To estimate the proportion of healthcare workers (HCWs) willing to work during an influenza pandemic and identify associated risk factors, we undertook a systematic review and meta-analysis compliant with PRISMA guidance. Databases and grey literature were searched to April 2013, and records were screened against protocol eligibility criteria. Data extraction and risk of bias assessments were undertaken using a piloted form. Random-effects meta-analyses estimated (i) pooled proportion of HCWs willing to work and (ii) pooled odds ratios of risk factors associated with willingness to work. Heterogeneity was quantified using the I(2) statistic, and publication bias was assessed using funnel plots and Egger's test. Data were synthesized narratively where meta-analyses were not possible. Forty-three studies met our inclusion criteria. Meta-analysis of the proportion of HCWs willing to work was abandoned due to excessive heterogeneity (I(2) = 99.2%). Narrative synthesis showed study estimates ranged from 23.1% to 95.8% willingness to work, depending on context. Meta-analyses of specific factors showed that male HCWs, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness. HCWs' willingness to work during an influenza pandemic was moderately high, albeit highly variable. Numerous risk factors showed a statistically significant association with willingness to work despite significant heterogeneity between studies. None of the included studies were based on appropriate theoretical constructs of population behaviour.

Intentions to perform non-pharmaceutical protective behaviors during influenza outbreaks in Sweden: a cross-sectional study following a mass vaccination campaign

Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45–85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.