Emergency Nursing Care of Patients With Novel Coronavirus Disease 2019

The Impact of Coronavirus Disease 2019 Visitor Restrictions on the Attitudes of Emergency Department Staff

INTRODUCTION

During the first 2 years of the pandemic, visitors for patients with COVID-19 were prohibited from emergency departments in the United States with few exceptions, leaving patients without their caregivers and advocates. Little is known about emergency nurses and nursing assistive personnel beliefs regarding this issue. Therefore, this study's purpose was to describe and assess relationships among emergency nursing and assistive personnel attitudes and perceptions regarding emergency department "no-visitor policies" for patients with COVID-19.

METHODS

This institutional review board-approved observational study was conducted in a health care system in the Southwestern United States. Nursing personnel (n = 180; 21.74% response rate) working in 11 emergency departments completed the survey during the fall of 2021. Bivariate correlations and multivariable linear regression modeling were performed to explore relationships among survey questions.

RESULTS

Most participants (61%) strongly/very strongly believed that restriction of visitors for patients with COVID-19 was necessary for the protection of staff and patients. In addition, 65% reported strongly/very strongly agreeing that it was unethical and 75% felt upset when these patients died alone. Most (81%) strongly/very strongly agreed that exemptions to the policy should be made in some cases, including imminent death. Respondents' recognition of patients' displeasure with visitor policy, recognition that a lack of visitors affected efficiency, and feeling upset when these patients died alone negatively predicted agreement that restriction was necessary.

CONCLUSION

Although most participants favored visitation restrictions for patients with coronavirus disease 2019, their beliefs were complex. Navigating stringent visitation policies and vulnerable patients' needs can result in moral distress for ED personnel.

Impact of the COVID-19 pandemic crisis on turnover intention among nurses in emergency departments in Thailand: a cross sectional study

BACKGROUND

During the COVID-19 pandemic in Thailand, a large volume of COVID-19 patients were referred to hospital emergency departments (EDs). This increased job demand and job strain among ED nurses, resulting in a high risk of intention to leave their organization.

AIMS

To investigate turnover intention during the COVID-19 pandemic among ED nurses and examine the effect of organizational resources, maladaptive regulation, and job burnout on nurses' turnover intention.

METHOD

This cross-sectional study investigated 322 ED nurses. We divided participants into two groups: dark-red zone areas (pandemic crisis areas) and non-red zone areas (non-pandemic crisis areas). Descriptive statistics, Pearson's correlation analysis, and multiple linear regression (forward stepwise method) were used to analyze factors that predicted turnover intention.

RESULTS

Most participants were female and the mean age was 34.54 years. During COVID-19 pandemic crisis, 72.8% of ED nurses in dark-red zone areas desired to leave their organization. The factors of motivation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in dark-red zone areas. Low availability of organizational resources was associated with an increase in the turnover intention rate. Maladaptive regulation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in non-red zone areas.

CONCLUSION

Exhaustion and cognitive impairment stand as significant facets of burnout linked to the intention of turnover among ED nurses. To address this, we recommend fostering secure workplace settings and implementing interventions that alleviate job demands and strains for ED nurses, potentially reducing turnover intentions.

Effect of Clustering Nursing Care on Spreading COVID-19 Infection Among Nurses: A Retrospective Study

Background

The nurse’s first and most important responsibility is to protect themselves from contracting or spreading COVID-19.

Purpose

Investigate the effect of applying clustering nursing care on spreading COVID-19 infection and fatigue level among nurses who provide nursing care for COVID-19 patients.

Methods

Retrospective case–control study, where cases had a COVID-19 infection in the previous six months and controls were free. Internet-based survey sent to nurses at eight hospitals.

Findings

A total of 100 cases and 250 controls. About 36.8% of nurses who did not apply clustering care suffered from COVID-19 infection. Meanwhile, 83.3% and 93.3% of those who clustered three and four procedures, were free of COVID-19 infection.

Discussion

Applying clustering for nurses’ care decreases spreading of infection among nurses and decreases fatigue level related to work. Female nurses, increased fatigue, and a lack of training are all factors that may contribute to the spread of CVID-19 infection among nurses.

Holistic care of patients with diabetic foot ulcers during the COVID-19 era: integration of Henderson's Need Theory

The COVID-19 pandemic has inhibited the practice of diabetic foot ulcer care, particularly in the community. Comprehensive theory-based nursing care is needed to prevent further complications. Unfortunately, a study combining theory with nursing care in diabetic foot ulcer care has not been explored. When caring for patients with diabetic foot ulcers, who are also at increased risk of severe complications from COVID-19, it is important to take a holistic view of the patient and consider all of their needs and the factors affecting them. Henderson's Need Theory and the 14 basic needs contained within it was chosen to be integrated in the care of patients with diabetic foot ulcers during the pandemic, with the hope that the findings will help nurses to optimise care in both hospital-based and community practice.

Managing the unexpected: Stressors and solutions for challenges experienced by RN-BSN students during an unprecedented global pandemic

BACKGROUND

The year 2020 brought the world the Coronavirus and the resulting pandemic. A large contingent of registered nurses (RNs), working as essential workers, were also attending classes in online accelerated programs (OAPs) to earn their BSN degree. Attending school as a working RN, can be stressful. During an active pandemic, it can be overwhelming.

PURPOSE

This quality improvement project was aimed to identify students' stressors in an online accelerated RN-BSN program, and to use the results to make adjustments in coursework to decrease academic stress while improving student success.

METHOD

A Qualtrics survey was distributed to 1992 active RN-BSN students to identify the student's "biggest challenges or stressors", and 302 students responded listing 1105 stress responses and elaborations. The survey included some academic suggestions by faculty to alleviate course stress. Students commented on the usefulness of suggestions and proposed additional ideas. Compassionate interventions were employed in each core nursing course.

RESULTS

After 2 terms a post-intervention survey was conducted to evaluate the effectiveness of the course interventions employed. A total of 276 students participated in the post-intervention survey, with 778 responses to the employed interventions.

CONCLUSIONS

Findings show the importance of faculty vigilance in assessing cause for declines in academic performance. Using an inquiring approach and flexibility to adapt coursework while maintaining student learning outcomes is possible and can play a significant role in student success.

An emergency nursing and monitoring procedure on cognitive impairment and neurological function recovery in patients with acute cerebral infarction

BACKGROUND

The optimization and standardization of emergency nursing and monitoring procedures are of great significance for thrombolytic treatment of acute cerebral infarction.

OBJECTIVE

Studies on the emergency nursing and monitoring procedure on cognitive impairment and neurological function in patients with acute cerebral infarction are still limited.

METHODS

The study was a randomized controlled trial and 134 patients with acute cerebral infarction were recruited. They were randomly arranged into the control group (n = 67) receiving normal nursing procedure and the intervention group (n = 67) receiving emergency nursing and monitoring procedure after pre-intervention assessment. The cognitive impairment, neurological function and levels of inflammatory biomarkers and neuron-specific enolase of the participants were evaluated and analyzed.

RESULTS

Emergency nursing and monitoring procedure improved Mini-mental State Examination and Montreal Cognitive Assessment scores of patients with cerebral infraction compared with the control group. It also improved the scores of National Institutes of Health Stroke Scale, activities of daily living scale, Fugl-Meyer scale in the participants. Emergency nursing and monitoring procedure led to significantly decreased neuron-specific enolase and inflammatory cytokines in the serum of the participants.

CONCLUSION

Emergency nursing and monitoring procedure are beneficial for cognitive impairment and neurological function recovery in patients with acute cerebral infarction.

Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review

BACKGROUND

The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting.

METHODS AND FINDINGS

The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning).

CONCLUSION

Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.

A Qualitative Study on the Care Experience of Emergency Department Nurses during the COVID-19 Pandemic

Background: The rapid spread of the disease has severely impacted healthcare systems around the world. There is a lack of evidence related to the care experience of emergency department nurses. Objective: To understand the care experience and thoughts of emergency department nurses during the COVID-19 epidemic. Methods: Purposive sampling was used to recruit 16 emergency department nurses from a medical center, and a semi-structured interview was used for data collection. The enrollment period was from 28 July 2021 to 30 October 2021. Thematic content analysis was used for data analysis. Results: The care experiences of emergency department nurses during the COVID-19 epidemic can be classified into three themes and six sub-themes. Theme 1: I am the gatekeeper; theme 2: Care and environment challenges: difficulties with equipment and environment, managing patient’s and family members’ emotions, insufficient manpower of care; theme 3: Conflicting emotions: worrying about being infected or transmitting the disease, needs of effective support and empathy, and lack of understanding and discrimination towards the occupation. Conclusion: Emergency department nurses adhered to professional awareness and responsibility during the epidemic and play a critical role in epidemic prevention.

Informing future nursing: An exploration of respiratory teaching in the pre-registration nurse curriculum

AIM/OBJECTIVE

The aim is to examine and map the respiratory skills taught in the pre-registration nursing curriculum (2010).

BACKGROUND

Respiratory assessment and care are fundamental clinical skills enabling nurses to treat and care for people with acute and chronic respiratory diseases. The incidence of respiratory disease is rising, globally and most nurses will care for respiratory patients during their career. The extent of pre-registration respiratory specific education delivered in UK NMC (Nursing and Midwifery Council) approved education institutions (AEIs) is currently unknown. The move to the 2018 revised NMC standards for pre-registration nursing offers AEIs the opportunity to review provision of respiratory education. This study describes respiratory education delivered to pre-registration nurses in UK AEIs prior to implementation of the new NMC standards. Curriculum re-design can be adapted for the global nursing community.

DESIGN

This is a freedom of information survey; to gather, examine and map curriculum content.

METHODS

A survey of UK AEIs was conducted to initially scope provision of respiratory education for pre-registration nursing programmes. AEIs were emailed a freedom of information (FOI) request and provided information about the curriculum between April-June 2019.

RESULTS

Seventy-five UK AEIs providing pre-registration nursing programmes responded. Over half of AEIs dedicated over 4 h of teaching respiratory anatomy and physiology (60.8%), respiratory pathophysiology (75.3%) and long- term respiratory conditions (60.3%). Less than half (44.4%) spent over 4 h teaching respiratory health and prevention of respiratory disease. Just over a third spent over 4 h on respiratory pharmacology (33.8%), local and national respiratory guidelines (33.3%) and information on pulmonary rehabilitation and other interventions for the management of respiratory conditions (35.2%). In most AEIs, skills laboratories were used to teach respiratory skills. Student competence was not always assessed. Respiratory learning was reported to take place during practice placements, but this was variable.

CONCLUSIONS

Variation exists in provision of respiratory education in pre-registration nursing programmes across the UK. Whilst some respiratory topics appear to be covered adequately, others have limited time on knowledge and skills teaching. New standards and curricula offer AEIs the opportunity to enhance this provision. Adaptations can be made and the curriculum transferred to the global nursing workforce.

TWEETABLE ABSTRACT

Gaps have been identified in respiratory teaching pre-registration nurse education. Curriculum redesign to focus on respiratory care.

Prediction on transmission trajectory of COVID-19 based on particle swarm algorithm

This study aimed to predict the transmission trajectory of the 2019 Corona Virus Disease (COVID-19). The particle swarm optimization (PSO) algorithm was combined with the traditional susceptible exposed infected recovered (SEIR) infectious disease prediction model to propose a SEIR-PSO prediction model on the COVID-19. In addition, the domestic epidemic data from February 25, 2020 to March 20, 2020 in China were selected as the training set for analysis. The results showed that when the conversion rate, recovery rate, and mortality rate of the SEIR-PSO model were 1/5, 1/15, and 1/13, its predictive effect on the number of people diagnosed with COVID-19 was the closest to the real data; and the SEIR-PSO model showed a mean-square errors (MSE) value of 1304.35 and mean absolute error (MAE) value of 1069.18, showing the best prediction effect compared with the susceptible infectious susceptible (SIS) model and the SEIR model. In contrary to the standard particle swarm optimization (SPSO) and linear weighted particle swarm optimization (LPSO), which were two classical improved PSO algorithms, the reliability and diversity of the SEIR-PSO model were higher. In summary, the SEIR-PSO model showed excellent performance in predicting the time series of COVID-19 epidemic data, and showed reliable application value for the prevention and control of COVID-19 epidemic.

Evaluating the Novel Coronavirus infection outbreak surveillance results in a state hospital: a retrospective study

Background

Coronavirus disease (COVID-19) has raised the global public health concern and has been declared a pandemic by the World Health Organization.

Objectives

This study was aimed to examine the clinical course and outcomes of the patients with COVID-19 in the southeastern part of Turkey.

Methods

This retrospective study was conducted on the files of 173 patients who were diagnosed with COVID-19. The “COVID-19 Case Information Form” in the patients' medical records was used.

Results

Of the patients with COVID-19, 64.2% were male and 16.2% had a chronic disease. Their mean age was 34.76±25.75 years. Cough and fatigue were the most common clinical symptoms at admission with 38.7%. The patients at the age of 65 and over were treated mostly in the intensive care unit, and the symptoms associated with the cardiovascular and nausea and vomiting were observed more often (p<0.05).

Conclusions

It was found that the majority of the patients were male and there were differences between the age groups in terms of transmission route, the clinic where they were being followed-up, some symptoms, and clinical status outcome. It is recommended that multi-center, prospective, experimental, or observational studies with larger samples should be and the patients should be followed-up for longer periods.

SARS-CoV-2 diagnosis using medical imaging techniques and artificial intelligence: A review

OBJECTIVE

SARS-CoV-2 is a worldwide health emergency with unrecognized clinical features. This paper aims to review the most recent medical imaging techniques used for the diagnosis of SARS-CoV-2 and their potential contributions to attenuate the pandemic. Recent researches, including artificial intelligence tools, will be described.

METHODS

We review the main clinical features of SARS-CoV-2 revealed by different medical imaging techniques. First, we present the clinical findings of each technique. Then, we describe several artificial intelligence approaches introduced for the SARS-CoV-2 diagnosis.

RESULTS

CT is the most accurate diagnostic modality of SARS-CoV-2. Additionally, ground-glass opacities and consolidation are the most common signs of SARS-CoV-2 in CT images. However, other findings such as reticular pattern, and crazy paving could be observed. We also found that pleural effusion and pneumothorax features are less common in SARS-CoV-2. According to the literature, the B lines artifacts and pleural line irregularities are the common signs of SARS-CoV-2 in ultrasound images. We have also stated the different studies, focusing on artificial intelligence tools, to evaluate the SARS-CoV-2 severity. We found that most of the reported works based on deep learning focused on the detection of SARS-CoV-2 from medical images while the challenge for the radiologists is how to differentiate between SARS-CoV-2 and other viral infections with the same clinical features.

CONCLUSION

The identification of SARS-CoV-2 manifestations on medical images is a key step in radiological workflow for the diagnosis of the virus and could be useful for researchers working on computer-aided diagnosis of pulmonary infections.

Working experiences of nurses during the novel coronavirus outbreak: A qualitative study explaining challenges of clinical nursing practice

Aim

To explore the clinical working experiences of Saudi nurses during the novel Coronavirus outbreak, identify the challenges and determine how these challenges affect their nursing practice.

Background

From the current experience of working during the novel Coronavirus outbreak, it is statistically significant to identify the challenges that nurses in Saudi Arabia face in their clinical practice and determine how these challenges affected their practice.

Designs

A qualitative descriptive study.

Methods

An in‐depth interview with eight Registered Nurses in Saudi Arabia who worked in areas where the novel Coronavirus patients are treated were conducted between 10 and 23 April.

Results

The following eight major themes were identified from this study: physical exhaustion, fear of infection, providing care with uncertainty, uncomfortable use of personal protective equipment, missed nursing care, prolonged procedures, lack of guidance during the outbreak and lack of managerial support.

Conclusion

The results suggest that nurses’ leaders should take active roles in empowering nursing staff. The absence of direct monitoring for nursing performance during their practice compromises patient safety and jeopardises the quality of care through missed nursing care. This study also revealed that nurses who worked during the outbreak need psychological support that can enhance their emotional resilience.

Lived experiences of Overseas Filipino Worker (OFW) nurses working in COVID-19 intensive care units

Background

Limited studies focus on the effects of the pandemic on the nurses' overall risks and wellbeing. At present, no single study has been published on Filipino nurses' experiences outside the country during the COVID-19 pandemic.

Objective

This descriptive phenomenological study explored the Overseas Filipino Worker (OFW) nurses' experiences working in COVID-19 intensive care units.

Methods

The study was conducted in Dubai, United Arab Emirates, where there is a high number of COVID-19 cases. This study utilized a qualitative Husserlian phenomenological approach to describe and explore the lived experiences of the OFW nurses' caring for COVID-19 critically ill patients. The research key interview informants were eight ICU nurses who cared for COVID-19 patients in Dubai hospitals. Data saturation was reached. Data collection was done in 2020, and Collaizi's method of data analysis was utilized.

Results

A total of 135 significant statements were extracted from the interview transcripts. There were 36 formulated meanings generated, and four themes emerged from this study. The first theme is Challenges During the Pandemic with the following subthemes: Away from Home, Caring for the COVID-19 Patients, and Fear of the Unknown. The second theme is Patient Care during COVID-19 with the following subthemes: COVID-19 ICU Patient Care and The Nursing Profession. Third, Adapting to Change with the subthemes: Living the New Normal and Protecting One's Self from COVID-19. Lastly, Resilience Amidst the Pandemic with the following subthemes: Being with Others and Seeing Oneself.

Conclusion

Despite the existing challenges like cultural differences and homesickness faced by these OFW nurses and the new challenges they are faced with the pandemic today, they were still able to continue living and do what is expected of them. From the hassle of wearing the PPEs, shortage of PPE, and being transferred from one unit in the hospital to another, the OFW nurses were able to adapt to these changes. The nurses already got used to the routine, but the fear of getting infected by the virus is still there.