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Weaver SH, Steinheiser MM, McNicholas M, Prinzo D, Wertz B. Nurses' Perceptions of Infusion Therapy During the COVID-19 Pandemic. JOURNAL OF INFUSION NURSING 2023; 46:87-96. [PMID: 36853871 PMCID: PMC9977262 DOI: 10.1097/nan.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
During the COVID-19 pandemic, nurses were faced with challenges when caring for patients, safely administering intravenous (IV) medications and solutions, and protecting themselves from the virus. To address these challenges, nurses moved infusion pumps outside of intensive care unit (ICU) rooms of patients with COVID-19 to minimize their exposure to the virus, conserve personal protective equipment, and efficiently administer IV medications and solutions. The purpose of this qualitative descriptive study was to explore and describe nurses' perception of managing infusion pumps outside the ICU rooms of patients with COVID-19 at 6 acute care hospitals. Eight interviews were conducted with ICU nurse managers, assistant nurse managers, clinical nurses, and vascular access team staff. From the interviews, the overarching theme was "figure out a way," with the subtheme "no clear-cut policy." Additional themes were: (1) limiting nurses' exposure, (2) increased risk for infection and error, (3) teamwork, and (4) roller coaster of emotions. The findings from this study revealed that, during this unprecedented pandemic, nurses were innovative and figured out a way to care for patients who were critically ill with COVID-19. Understanding this experience provides insight into creating policies and procedures to guide patient care in future pandemics or emergency care.
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Affiliation(s)
- Susan H. Weaver
- Corresponding Author: Susan H. Weaver, PhD, RN, CRNI®, NEA-BC, Hackensack Meridian Health, Ann May Center for Nursing, 2020 Sixth Avenue, Neptune, NJ 07753 ()
| | - Marlene M. Steinheiser
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, New Jersey (Dr Weaver); Infusion Nurses Society, Norwood, Massachusetts (Dr Steinheiser); Hackensack Meridian Health, Neptune, New Jersey (Dr McNicholas); Hackensack Meridian Health, Old Bridge Medical Center, Old Bridge, New Jersey (Ms Prinzo); Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey (Dr Wertz)
- Susan H. Weaver, PhD, RN, CRNI®, NEA-BC, is a nurse scientist at the Ann May Center for Nursing at Hackensack Meridian Health. She has experience as an intensive care unit nurse, nurse educator, operations manager, and evening administrative supervisor. Dr Weaver received a BS in nursing from Penn State University, a Master's degree in nursing administration from Seton Hall University, and a PhD in nursing from Rutgers, the State University of New Jersey. Her research focus is on the nursing workforce, particularly administrative supervisors and clinical nurses who work the night shift, and improving outcomes. As 2021-2022 Infusion Nurses Society (INS) President, her presidential theme was “ReSEARCH Your Passion,” and she particularly enjoys conducting qualitative research because she believes it is important to hear the perspective of participants
- Marlene M. Steinheiser, PhD, RN, CRNI®, is the INS Director of Clinical Education. In her role, she directs the development of educational programs and resources for INS and develops strategic alliances with other organizations. A nurse for more than 35 years, Dr Steinheiser has experience in acute care, home infusion, long-term care, regulatory affairs, and academia. She received her diploma in nursing from Cleveland Metropolitan General Hospital School of Nursing and her BSN and MSN from the University of Akron. Dr Steinheiser earned her PhD in nursing at the University of Arizona, conducting qualitative research focusing on compassion fatigue among nurses working in skilled nursing facilities. She has published numerous articles on the topics of compassion fatigue, as well as infusion therapy
- Miriam McNicholas, DNP, RN, CNL, NEA-BC, is the Hackensack Meridian Health Director of Professional Practice and Clinical Policy and serves as adjunct faculty at the Hackensack Meridian Georgian Court University, School of Nursing. She received her BS in nursing from Bloomfield College, her Master's in Clinical Nurse Leadership from the College of New Jersey, and her Doctorate of Nursing Practice from Monmouth University. Dr. McNicholas has experience in nursing administration, nursing education, program management, and quality and outcomes. Clinically Dr McNicholas's experience encompasses critical care, operating room, and medical-surgical telemetry. During the COVID-19 pandemic surges, her primary responsibility was researching and writing protocols for the care of patients with COVID-19
- Deborah Prinzo, MSN, RN, MEDSURG-BC, is a nurse leader of the inpatient vascular access and outpatient infusion departments at Old Bridge Medical Center at Hackensack Meridian Health. Deborah has 32 years of nursing experience and is currently the chair of the vascular access device committee for Hackensack Meridian Health network, focusing on best practice in infusion nursing and harmonizing policies and procedures across the network sites. Deborah received a BS in nursing from Kean University and a Master's in nursing administration from Kean University. Deborah presented “Is a Picture Worth 1,000 Rads” at the INS 2019 meeting in Baltimore and is passionate about infusion nursing. Deborah is interested in pursuing additional research opportunities in the future
- Bridget Wertz, DNP, RN, NE-BC, NPD-BC, CCRN, is the Hackensack Meridian Hackensack University Medical Center Co-Magnet Program Director. She has experience as a step down and critical care nurse, education specialist responsible for teaching critical care orientation, and project manager for the organization's Magnet designation. Dr Wertz received her BS in nursing and Master's in Nursing Education from Rutgers University, as well as her Doctorate of Nursing Practice from Monmouth University. Dr Wertz has experience in nursing administration, nursing education, and program management. In March of 2020, during the COVID-19 surge at Hackensack Meridian Hackensack University Medical Center, her primary responsibility was supporting the clinical team for the implementation of the updated and evolving practice guidelines to care for patients with COVID-19
| | - Miriam McNicholas
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, New Jersey (Dr Weaver); Infusion Nurses Society, Norwood, Massachusetts (Dr Steinheiser); Hackensack Meridian Health, Neptune, New Jersey (Dr McNicholas); Hackensack Meridian Health, Old Bridge Medical Center, Old Bridge, New Jersey (Ms Prinzo); Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey (Dr Wertz)
- Susan H. Weaver, PhD, RN, CRNI®, NEA-BC, is a nurse scientist at the Ann May Center for Nursing at Hackensack Meridian Health. She has experience as an intensive care unit nurse, nurse educator, operations manager, and evening administrative supervisor. Dr Weaver received a BS in nursing from Penn State University, a Master's degree in nursing administration from Seton Hall University, and a PhD in nursing from Rutgers, the State University of New Jersey. Her research focus is on the nursing workforce, particularly administrative supervisors and clinical nurses who work the night shift, and improving outcomes. As 2021-2022 Infusion Nurses Society (INS) President, her presidential theme was “ReSEARCH Your Passion,” and she particularly enjoys conducting qualitative research because she believes it is important to hear the perspective of participants
- Marlene M. Steinheiser, PhD, RN, CRNI®, is the INS Director of Clinical Education. In her role, she directs the development of educational programs and resources for INS and develops strategic alliances with other organizations. A nurse for more than 35 years, Dr Steinheiser has experience in acute care, home infusion, long-term care, regulatory affairs, and academia. She received her diploma in nursing from Cleveland Metropolitan General Hospital School of Nursing and her BSN and MSN from the University of Akron. Dr Steinheiser earned her PhD in nursing at the University of Arizona, conducting qualitative research focusing on compassion fatigue among nurses working in skilled nursing facilities. She has published numerous articles on the topics of compassion fatigue, as well as infusion therapy
- Miriam McNicholas, DNP, RN, CNL, NEA-BC, is the Hackensack Meridian Health Director of Professional Practice and Clinical Policy and serves as adjunct faculty at the Hackensack Meridian Georgian Court University, School of Nursing. She received her BS in nursing from Bloomfield College, her Master's in Clinical Nurse Leadership from the College of New Jersey, and her Doctorate of Nursing Practice from Monmouth University. Dr. McNicholas has experience in nursing administration, nursing education, program management, and quality and outcomes. Clinically Dr McNicholas's experience encompasses critical care, operating room, and medical-surgical telemetry. During the COVID-19 pandemic surges, her primary responsibility was researching and writing protocols for the care of patients with COVID-19
- Deborah Prinzo, MSN, RN, MEDSURG-BC, is a nurse leader of the inpatient vascular access and outpatient infusion departments at Old Bridge Medical Center at Hackensack Meridian Health. Deborah has 32 years of nursing experience and is currently the chair of the vascular access device committee for Hackensack Meridian Health network, focusing on best practice in infusion nursing and harmonizing policies and procedures across the network sites. Deborah received a BS in nursing from Kean University and a Master's in nursing administration from Kean University. Deborah presented “Is a Picture Worth 1,000 Rads” at the INS 2019 meeting in Baltimore and is passionate about infusion nursing. Deborah is interested in pursuing additional research opportunities in the future
- Bridget Wertz, DNP, RN, NE-BC, NPD-BC, CCRN, is the Hackensack Meridian Hackensack University Medical Center Co-Magnet Program Director. She has experience as a step down and critical care nurse, education specialist responsible for teaching critical care orientation, and project manager for the organization's Magnet designation. Dr Wertz received her BS in nursing and Master's in Nursing Education from Rutgers University, as well as her Doctorate of Nursing Practice from Monmouth University. Dr Wertz has experience in nursing administration, nursing education, and program management. In March of 2020, during the COVID-19 surge at Hackensack Meridian Hackensack University Medical Center, her primary responsibility was supporting the clinical team for the implementation of the updated and evolving practice guidelines to care for patients with COVID-19
| | - Deborah Prinzo
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, New Jersey (Dr Weaver); Infusion Nurses Society, Norwood, Massachusetts (Dr Steinheiser); Hackensack Meridian Health, Neptune, New Jersey (Dr McNicholas); Hackensack Meridian Health, Old Bridge Medical Center, Old Bridge, New Jersey (Ms Prinzo); Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey (Dr Wertz)
- Susan H. Weaver, PhD, RN, CRNI®, NEA-BC, is a nurse scientist at the Ann May Center for Nursing at Hackensack Meridian Health. She has experience as an intensive care unit nurse, nurse educator, operations manager, and evening administrative supervisor. Dr Weaver received a BS in nursing from Penn State University, a Master's degree in nursing administration from Seton Hall University, and a PhD in nursing from Rutgers, the State University of New Jersey. Her research focus is on the nursing workforce, particularly administrative supervisors and clinical nurses who work the night shift, and improving outcomes. As 2021-2022 Infusion Nurses Society (INS) President, her presidential theme was “ReSEARCH Your Passion,” and she particularly enjoys conducting qualitative research because she believes it is important to hear the perspective of participants
- Marlene M. Steinheiser, PhD, RN, CRNI®, is the INS Director of Clinical Education. In her role, she directs the development of educational programs and resources for INS and develops strategic alliances with other organizations. A nurse for more than 35 years, Dr Steinheiser has experience in acute care, home infusion, long-term care, regulatory affairs, and academia. She received her diploma in nursing from Cleveland Metropolitan General Hospital School of Nursing and her BSN and MSN from the University of Akron. Dr Steinheiser earned her PhD in nursing at the University of Arizona, conducting qualitative research focusing on compassion fatigue among nurses working in skilled nursing facilities. She has published numerous articles on the topics of compassion fatigue, as well as infusion therapy
- Miriam McNicholas, DNP, RN, CNL, NEA-BC, is the Hackensack Meridian Health Director of Professional Practice and Clinical Policy and serves as adjunct faculty at the Hackensack Meridian Georgian Court University, School of Nursing. She received her BS in nursing from Bloomfield College, her Master's in Clinical Nurse Leadership from the College of New Jersey, and her Doctorate of Nursing Practice from Monmouth University. Dr. McNicholas has experience in nursing administration, nursing education, program management, and quality and outcomes. Clinically Dr McNicholas's experience encompasses critical care, operating room, and medical-surgical telemetry. During the COVID-19 pandemic surges, her primary responsibility was researching and writing protocols for the care of patients with COVID-19
- Deborah Prinzo, MSN, RN, MEDSURG-BC, is a nurse leader of the inpatient vascular access and outpatient infusion departments at Old Bridge Medical Center at Hackensack Meridian Health. Deborah has 32 years of nursing experience and is currently the chair of the vascular access device committee for Hackensack Meridian Health network, focusing on best practice in infusion nursing and harmonizing policies and procedures across the network sites. Deborah received a BS in nursing from Kean University and a Master's in nursing administration from Kean University. Deborah presented “Is a Picture Worth 1,000 Rads” at the INS 2019 meeting in Baltimore and is passionate about infusion nursing. Deborah is interested in pursuing additional research opportunities in the future
- Bridget Wertz, DNP, RN, NE-BC, NPD-BC, CCRN, is the Hackensack Meridian Hackensack University Medical Center Co-Magnet Program Director. She has experience as a step down and critical care nurse, education specialist responsible for teaching critical care orientation, and project manager for the organization's Magnet designation. Dr Wertz received her BS in nursing and Master's in Nursing Education from Rutgers University, as well as her Doctorate of Nursing Practice from Monmouth University. Dr Wertz has experience in nursing administration, nursing education, and program management. In March of 2020, during the COVID-19 surge at Hackensack Meridian Hackensack University Medical Center, her primary responsibility was supporting the clinical team for the implementation of the updated and evolving practice guidelines to care for patients with COVID-19
| | - Bridget Wertz
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, New Jersey (Dr Weaver); Infusion Nurses Society, Norwood, Massachusetts (Dr Steinheiser); Hackensack Meridian Health, Neptune, New Jersey (Dr McNicholas); Hackensack Meridian Health, Old Bridge Medical Center, Old Bridge, New Jersey (Ms Prinzo); Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey (Dr Wertz)
- Susan H. Weaver, PhD, RN, CRNI®, NEA-BC, is a nurse scientist at the Ann May Center for Nursing at Hackensack Meridian Health. She has experience as an intensive care unit nurse, nurse educator, operations manager, and evening administrative supervisor. Dr Weaver received a BS in nursing from Penn State University, a Master's degree in nursing administration from Seton Hall University, and a PhD in nursing from Rutgers, the State University of New Jersey. Her research focus is on the nursing workforce, particularly administrative supervisors and clinical nurses who work the night shift, and improving outcomes. As 2021-2022 Infusion Nurses Society (INS) President, her presidential theme was “ReSEARCH Your Passion,” and she particularly enjoys conducting qualitative research because she believes it is important to hear the perspective of participants
- Marlene M. Steinheiser, PhD, RN, CRNI®, is the INS Director of Clinical Education. In her role, she directs the development of educational programs and resources for INS and develops strategic alliances with other organizations. A nurse for more than 35 years, Dr Steinheiser has experience in acute care, home infusion, long-term care, regulatory affairs, and academia. She received her diploma in nursing from Cleveland Metropolitan General Hospital School of Nursing and her BSN and MSN from the University of Akron. Dr Steinheiser earned her PhD in nursing at the University of Arizona, conducting qualitative research focusing on compassion fatigue among nurses working in skilled nursing facilities. She has published numerous articles on the topics of compassion fatigue, as well as infusion therapy
- Miriam McNicholas, DNP, RN, CNL, NEA-BC, is the Hackensack Meridian Health Director of Professional Practice and Clinical Policy and serves as adjunct faculty at the Hackensack Meridian Georgian Court University, School of Nursing. She received her BS in nursing from Bloomfield College, her Master's in Clinical Nurse Leadership from the College of New Jersey, and her Doctorate of Nursing Practice from Monmouth University. Dr. McNicholas has experience in nursing administration, nursing education, program management, and quality and outcomes. Clinically Dr McNicholas's experience encompasses critical care, operating room, and medical-surgical telemetry. During the COVID-19 pandemic surges, her primary responsibility was researching and writing protocols for the care of patients with COVID-19
- Deborah Prinzo, MSN, RN, MEDSURG-BC, is a nurse leader of the inpatient vascular access and outpatient infusion departments at Old Bridge Medical Center at Hackensack Meridian Health. Deborah has 32 years of nursing experience and is currently the chair of the vascular access device committee for Hackensack Meridian Health network, focusing on best practice in infusion nursing and harmonizing policies and procedures across the network sites. Deborah received a BS in nursing from Kean University and a Master's in nursing administration from Kean University. Deborah presented “Is a Picture Worth 1,000 Rads” at the INS 2019 meeting in Baltimore and is passionate about infusion nursing. Deborah is interested in pursuing additional research opportunities in the future
- Bridget Wertz, DNP, RN, NE-BC, NPD-BC, CCRN, is the Hackensack Meridian Hackensack University Medical Center Co-Magnet Program Director. She has experience as a step down and critical care nurse, education specialist responsible for teaching critical care orientation, and project manager for the organization's Magnet designation. Dr Wertz received her BS in nursing and Master's in Nursing Education from Rutgers University, as well as her Doctorate of Nursing Practice from Monmouth University. Dr Wertz has experience in nursing administration, nursing education, and program management. In March of 2020, during the COVID-19 surge at Hackensack Meridian Hackensack University Medical Center, her primary responsibility was supporting the clinical team for the implementation of the updated and evolving practice guidelines to care for patients with COVID-19
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Curtis CA, Nguyen MU, Rathnasekara GK, Manderson RJ, Chong MY, Malawaraarachchi JK, Song Z, Kanumuri P, Potenzi BJ, Lim AKH. Impact of electronic medical records and COVID-19 on adult Goals-of-Care document completion and revision in hospitalised general medicine patients. Intern Med J 2021; 52:755-762. [PMID: 34580964 PMCID: PMC8653102 DOI: 10.1111/imj.15543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conversion from paper-based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals-Of-Care (GOC) documents during hospital admissions, and the COVID-19 pandemic may have further impacted this. AIMS Determine the impact of EMR and COVID-19 on the proper completion of GOC forms, and the factors associated with inpatient changes in GOC. METHODS We conducted a cross-sectional study of adult general medicine admissions (Aug 2018-Sep 2020) at Dandenong Hospital (Victoria, Australia). We used interrupted time series to model the changes in the rates of proper GOC completion (adequate documented discussion, completed ≤2 days) after the introduction of EMR and arrival of COVID-19. RESULTS We included a total of 5147 patients. The pre-EMR GOC proper completion rate was 27.7% (overall completion, 86.5%). There was a decrease in the proper completion rate by 2.21% per month (95% CI: -2.83%, -1.58%) after EMR implementation despite an increase in overall completion rates (91.2%). The main reason for the negative trend was a decline in adequate documentation despite improvements in timeliness. COVID-19 arrival saw a reversal of this negative trend, with proper completion rates increasing by 2.25% per month (95% CI: 1.35%, 3.15%) compared to the EMR period, but also resulted in a higher proportion GOC changes within 2 days of admission. CONCLUSION EMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID-19 reversed the negative trend in proper GOC completion but increased the number of early revisions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Claire A Curtis
- General Medicine, Monash Health, Clayton, Victoria, 3168, Australia
| | - Maria U Nguyen
- General Medicine, Monash Health, Clayton, Victoria, 3168, Australia
| | | | | | - Mae Y Chong
- General Medicine, Monash Health, Clayton, Victoria, 3168, Australia
| | | | - Zheng Song
- General Medicine, Monash Health, Clayton, Victoria, 3168, Australia
| | | | | | - Andy K H Lim
- General Medicine, Monash Health, Clayton, Victoria, 3168, Australia.,Monash University Department of Medicine, School of Clinical Sciences, Clayton, Victoria, 3168, Australia
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