Bridging the gap between guidelines and practice in the management of emerging infectious diseases: a qualitative study of emergency nurses

Hospital health care workers' use of facial protective equipment before the COVID-19 pandemic, implications for future policy

BACKGROUND

Prepandemic routine use of facial (respiratory and eye) protective equipment (FPE) by health care workers was suboptimal. Understanding factors affecting routine use would facilitate escalation to high level use during infectious disease emergencies. This study explored health care workers FPE-related knowledge, attitudes and behaviors.

METHODS

Mixed methods were used in a respiratory ward and adult and pediatric emergency departments (EDs), prior to the COVID-19 pandemic. Study design and thematic analysis were based on the theoretical domains framework. Emergent themes were categorized, using the COM-B behavior model, into capability(C), opportunity(O) and motivation(M), which influence behavior(B).

RESULTS

22 emergent themes, representing factors influencing FPE use, were mapped to theoretical domains framework domains. Personal experience and departmental cultures influenced motivation. Compared with respiratory ward staff, ED clinicians were less knowledgeable about FPE; the unique ED environment and culture inhibited opportunities and motivation for FPE use. Eye protection was infrequently used.

DISCUSSION

Optimal FPE use is challenged by ED care models and settings. Changes are needed to translate pandemic-related improvements into routine care of other respiratory infections.

CONCLUSIONS

This study identified key determinants of FPE behavior. A review of context-specific FPE guidance for ED by infection prevention and control professionals would help to promote practicable, sustainable compliance.

Scenario-based assessment of emergency management of urban infectious disease outbreaks

Infectious diseases pose a severe threat to human health and are accompanied by significant economic losses. Studies of urban outbreaks of infectious diseases are diverse. However, previous studies have neglected the identification of critical events and the evaluation of scenario-based modeling of urban infectious disease outbreak emergency management mechanisms. In this paper, we aim to conduct an empirical analysis and scenario extrapolation using a questionnaire survey of 18 experts, based on the CIA-ISM method and scenario theory, to identify the key factors influencing urban infectious disease outbreaks. Subsequently, we evaluate the effectiveness of urban infectious disease outbreak emergency management mechanisms. Finally, we compare and verify the actual situation of COVID-19 in China, drawing the following conclusions and recommendations. (1) The scenario-based urban infectious disease emergency management model can effectively replicate the development of urban infectious diseases. (2) The establishment of an emergency command center and the isolation and observation of individuals exposed to infectious diseases are crucial factors in the emergency management of urban outbreaks of infectious disease.

Understanding routine (non-outbreak) respiratory protective equipment behaviour of hospital workers in different clinical settings - lessons for the future post COVID-19

BACKGROUND

The COVID-19 pandemic has drawn attention to the importance of facial (respiratory and eye) protective equipment (FPE). Optimal use of FPE in non-outbreak situations, will enable frontline staff, such as emergency department (ED) clinicians, to adapt more rapidly and safely to the increased demands and skills required during an infectious disease outbreak.

METHODS

A survey, designed to determine the attitudes, beliefs and knowledge of HCWs around the use of FPE for protection against respiratory infections, was distributed to staff in a respiratory ward, an adult ED and a paediatric ED in Sydney, Australia prior to COVID-19.

RESULTS

The survey revealed differences between the respiratory ward and the EDs and between professional groups. ED staff, particularly paediatric clinicians, were less likely than ward staff to use FPE appropriately during routine care. Medical staff were more likely to work outside of IPC policies.

DISCUSSION

The busy, relatively chaotic ED environment presents unique challenges for optimal compliance with safe FPE use when caring for patients with respiratory symptoms.

CONCLUSIONS

Building upon the lessons of the pandemic, it is timely to address the specific infection prevention and control needs of the ED environment to improve FPE compliance during non-outbreak situations.

Photovoice Exploration of Frontline Nurses' Experiences During the COVID-19 Pandemic

BACKGROUND

The current COVID-19 global pandemic has had a profound impact on the health care system and on the physical and psychological well-being of nurses. Previous pandemics have led to nurses leaving the profession. Therefore, it is important that we hear the voices of nurses who experienced the pandemic on the frontlines to influence future planning and policy development.

PURPOSE

The purpose of this study was to explore frontline nurses' experiences during the COVID-19 pandemic through photos, narratives, and group discussions.

METHODS

Twelve nurses in two groups shared their lived experiences through Photovoice, a participatory action approach. Photos and narratives were collected over five weeks per group. One group at the beginning of the pandemic and the other group six months later. Focus group discussions were held following each group.

RESULTS

Five themes emerged from the photovoice data: (1) The work of nursing; (2) Miscommunication; (3) Fatigue; (4) Resilience; and (5) Hope for the future. Various subthemes were noted within each theme to delineate the lived experience of frontlines nurses working in the COVID-19 pandemic.

CONCLUSIONS

The voices of nurses and their experiences on the frontlines of the COVID-19 pandemic need to be considered in pandemic planning and integrated into health care policy, guidelines, and structural changes.

Mapping research findings on change implementation in nursing practice: A scoping literature review

AIMS

The aim of this study was to map the diverse factors impacting change implementation in nursing practices and investigate different implementation strategies.

DESIGN

Scoping literature review following PRISMA-ScR extension.

METHODS

Data were collected from PubMed, Ebsco, Scopus and ScienceDirect databases from 1990 onwards. Only English peer-reviewed studies reporting an implementation of change in nursing practice were included. Of 9,954 studies, 425 abstracts were scanned and 98 full-text articles were screened. Finally, 28 studies were selected.

RESULTS

A multifaceted approach, with a tailored intervention, was the most effective implementation strategy. Most identified factors were considered systematic, for example resource availability, leadership and knowledge. However, others related to local social and material context were identified in fewer number of studies. These seem to be operational elements for implementation processes. Both types of factors are essential and must be considered for successful implementation.

CONCLUSION

We advocate the development of framework including systematic factors and which capture the local context flexibility.

Workplace violence against frontline clinicians in emergency departments during the COVID-19 pandemic

Background

Frontline clinicians working in emergency departments (ED) were at disportionate risk of workplace violence (WPV). We investigated the prevalence of WPV and its relationship with quality of life (QOL) in this group of health professionals in China during the COVID-19 pandemic.

Methods

A cross-sectional, online study was conducted. The nine-item Workplace Violence Scale measured WPV.

Results

A total of 1,103 ED clinicians participated in this study. The overall prevalence of WPV against ED clinicians was 29.2% (95% CI [26.5%-31.9%]). Having family/friends/colleagues infected with COVID-19 (Odds Ratio (OR) = 1.82, P = 0.01), current smoking (OR = 2.98, P < 0.01) and severity of anxiety symptoms (OR = 1.08, P < 0.01) were independently and positively associated with WPV, while working in emergency intensive care units (OR = 0.45, P < 0.01) was negatively associated with WPV. After controlling for covariates, clinicians experiencing WPV had a lower global QOL compared to those without (F_{(1, 1103)} = 10.9,P < 0.01).

Conclusions

Prevalence of workplace violence against ED clinicians was common in China during the COVID-19 pandemic. Due to the negative impact of WPV on QOL and quality of care, timely preventive measures should be undertaken for ED clinicians.

A survey of coping strategies among clinical nurses in China during the early stage of coronavirus disease 2019 pandemic: A cross-sectional study

AIMS

To investigate coping strategies and identify their associated factors among Chinese clinical nurses during the early stage of coronavirus disease 2019 pandemic.

DESIGN

A cross-sectional study.

METHODS

This study was conducted in seven designated hospitals involved in the diagnosis and treatment of the coronavirus disease 2019 in the southwest of China between 1 February and 31 March, 2020. Multiple linear regression was conducted to explore the association of different factors with the coping strategies of nurses.

RESULTS

Nurses' positive coping was associated with higher psychological capital (B = 0.185, 95% CI 0.158-0.213), social support (B = 0.292, 95% CI 0.244-0.340) and lower frustration (B = -0.065, 95% CI -0.123 to -0.007). In contrast, higher frustration (B = 0.091, 95% CI 0.044-0.139), lower performance (B = -0.054, 95% CI -0.101 to -0.007) and psychological capital (B = -0.035, 95% CI -0.055 to -0.014) were associated with negative coping.

The Effectiveness of Disaster Education for Undergraduate Nursing Students' Knowledge, Willingness, and Perceived Ability: An Evaluation Study

As future healthcare professionals, nursing students should possess the appropriate knowledge, skills, and positive attitude to respond to public health emergencies or disasters worldwide. This study evaluated the effectiveness of a disaster management training course at improving Hong Kong nursing students' disaster knowledge, willingness, and perceived ability. A mixed-method design using a single group with pre- and post-intervention comparisons followed by qualitative focus group interviews, was conducted. A 45-h disaster management training course with theoretical and practical inputs was conducted. A total of 157 students participated in and completed the pre- and post-intervention questionnaires. Positive significant results in disaster knowledge (t(156) = -8.12, p < 0.01, d = -0.84) and perceived ability (t(156) = -7.95, p < 0.01, d = -0.72) were found, but no substantial change in willingness to respond to disasters was observed. The participants expressed various concerns regarding their willingness to respond, which can be summarized and grouped as (1) personal risk perceptions, (2) contextual factors of the disaster events, and (3) organizational support. Incorporating disaster training into the tertiary education curricula for basic nursing professionals' training could be a long-term strategy to prepare and expand the competent workforce for future disasters. Government or healthcare organizations are recommended to provide strategies and adequate support to alleviate nursing professionals' concerns and enhance their willingness.

The effect of hand hygiene audit in COVID intensive care units in a tertiary care hospital in South India

Background

In the era of COVID-19 pandemic, there is an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICU and providing timely feedback to the stake holders is crucial to reduce HAIs.

Methods

From November 2020- April 2021, HH audit was conducted in COVID ICUs. HH complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analyzed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated.

Results

HHCAR, HHPAR and HHTAR were found as 30.8%, 34.5% and 65.3% respectively. There was a significant increase in the monthly HHTAR from 26.7% to 68.4% (P < .001). The profession-specific HHAR was found to be highest among doctors (67.5%) and nurses (66.4%). As the HHTAR increases there is a significant decrease in device associated infection (DAI) rate from 24.7 to 11.5 per 1,000 device days.

Conclusions

Auditing HH and providing timely feedback significantly improved HH compliance. The need of the hour is to regularly conduct HH audit in COVID locations of all healthcare facilities to reduce HAI rate among the COVID- 19 infected patients in ICUs.

Emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency departments

Purpose: Emerging infectious diseases are considered as a pressing challenge to global public health. Throughout public health response to emerging infectious diseases, emergency nurses are situated at the forefront of the healthcare system. The present study has explored emergency nurses’ perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency department context.

Methods: The present study used a qualitative descriptive approach. A purposive sampling method was employed to recruit emergency nurses who worked in public hospitals in Hong Kong. Semi-structured interviews were conducted to 24 emergency nurses. The data were interpreted using a thematic analysis strategy.

Results: Five overarching themes emerged from the data: (1) the novelty of an emerging infectious disease, (2) the severity of an emerging infectious disease, (3) the proximity to an emerging infectious disease, (4) the complexity of an emerging infectious disease situation, and (5) the response levels towards an emerging infectious disease situation.

Conclusion: It is anticipated that the information may help to predict the attitudes and behaviours of emergency nurses in future impending epidemic events, enhancing emergency nurses’ preparedness towards in such situations.

Abbreviations: EID: Emerging infectious disease; ED: Emergency department; SARS: Severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; WHO: World Health Organization; RN: Registered nurse; APN: Advanced practice nurse; NO: Nursing officer

Investigating the Strategies Adopted by Emergency Nurses to Address Uncertainty and Change in the Event of Emerging Infectious Diseases: A Grounded Theory Study

Emergency nurses frequently encounter uncertainty and changes during the management of emerging infectious diseases, which challenge their capability to perform their duties in a well-planned and systematic manner. To date, little is known about the coping strategies adopted by emergency nurses in addressing uncertainty and changes during an epidemic event. The present study explored emergency nurses’ behaviours and strategies in handling uncertainty and practice changes during an epidemic event. A qualitative study based on the Straussian grounded theory approach was established. Semi-structured, face-to-face, individual interviews were conducted with 26 emergency nurses for data collection. Adapting protocol to the evolving context of practice was revealed as the core category. Four interplaying subcategories were identified: (1) Completing a comprehensive assessment, (2) continuing education for emerging infectious disease management, (3) incorporating guideline updates and (4) navigating new duties and competencies. The nurses demonstrated the prudence to orientate themselves to an ambiguous work situation and displayed the ability to adapt and embrace changes in their practice and duties. These findings offer insights into the need for education and training schemes that allow emergency nurses to acquire and develop the necessary decision-making and problem-solving skills to handle a public health emergency.

A qualitative descriptive study of the contextual factors influencing the practice of emergency nurses in managing emerging infectious diseases

Purpose: Emergency nurses are engaged in the management of epidemic events that unfold along with the evolution of diseases. The goal of this study was to explore the contextual factors that inhibited the ability of emergency nurses to perform their duties in response to an outbreak. Methods: A qualitative descriptive design was used to explore the experiences and perceptions of emergency nurses. Participants were purposively recruited from 12 emergency departments in Hong Kong. Semi-structured face-to-face individual interviews were conducted with 26 emergency nurses. The audio-recorded interviews were transcribed verbatim and interpreted with a thematic analysis approach. Results: Four intertwined themes emerged from the analysis: resource constraints, threats of infection, ubiquitous changes and lingering uncertainties. These themes portrayed the constraints and challenges surrounding the work environment of emergency nurses. Conclusion: This study described the instabilities and vulnerabilities of the circumstances in which the emergency nurses were situated in during epidemic events. The findings shed light on the importance of hospitals and emergency departments in addressing both the technical problems and adaptive challenges that face emergency nurses during epidemic events.

Emergency nurses' perceptions of their roles and practices during epidemics: a qualitative study

BACKGROUND

although emergency nurses have a pivotal role in the public health response to epidemics, little is known about their responsibilities and practice in terms of epidemic management.

AIMS

this study aimed to explore how emergency nurses understand and perform their professional roles and practice during epidemics.

METHODS

a qualitative descriptive study design was used. Data were collected from 24 participants through semistructured interviews and subjected to thematic analysis.

FINDINGS

the analysis yielded two overarching themes: expansion in the practice of emergency care; and the altered role of emergency nurses.

CONCLUSION

emergency nurses perceive their practice during the management of an epidemic expanded in that they shouldered a greater responsibility in the control of infectious diseases. This expansion led to role ambiguity among them.