Nurses' preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence

Occupational safety and health of nurses during the COVID-19 pandemic, the missing part of quality care: a qualitative study

OBJECTIVE

This study explored the consequences of COVID-19 on the occupational safety and health of nurses.

DESIGN

Qualitative conventional content analysis.

PARTICIPANTS

14 nurses selected by purposeful sampling method.

SETTING

Five educational and non-educational hospitals in the Northwest of Iran.

DATA COLLECTION AND ANALYSIS

Semistructured interviews were used for data collection and analysed using conventional content analysis.

RESULTS

Two main categories have emerged from the data: reduced quality of professional life and post-traumatic growth. Reduced quality of professional life, which has two subcategories including job dissatisfaction and burnout, has a negative nature, and has had many negative effects on the physical, mental and well-being of nursing personnel during the coronavirus era. On the other hand, post-traumatic growth, with two subcategories that include promoting safe behaviour and gaining a positive self-concept, has a positive nature.

CONCLUSIONS

Maintaining the occupational health and safety of nurses plays an important role in providing quality services to patients. Therefore, it is necessary for managers and policymakers to use the experiences related to the COVID-19 crisis, to prevent negative factors and strengthen positive factors, to maintain the safety and occupational health of nurses, and increase the quality of care.

Exploration of the Challenges of COVID-19 from the Perspective of Emergency Medicine Specialists

Background

Emergency physicians are at the forefront of the medical system in the face of the COVID-19 crisis. Identifying the challenges, along with the strategies and effective measures implemented by them in the face of the COVID-19 crisis, can be a roadmap for future crisis management planning. This study aims to explain the challenges faced by emergency physicians regarding COVID-19.

Methods

This study is a qualitative content analysis. Data were collected using individual and semistructured interviews. Twenty-seven emergency medical specialists in Fars University of Medical Sciences, Iran, participated in the study by purposive sampling method and were interviewed using semistructured interviews.

Results

Participants' experience of COVID-19 led to the extraction of four main themes, including structural factors, threats to the health of the medical team, fluctuations of extremism and wastage in the face of COVID-19, and the country's policymaking hierarchy.

Conclusions

Emergency physicians face challenges such as structural factors, health threats, extreme fluctuations, and national policymaking. To avoid surprises and threats, they must predict acute scenarios, provide necessary equipment, address skilled manpower shortages, and adopt appropriate management policies. This includes culture-building, cross-sector coordination, planning, and efficient management to prevent virus spread.

Assessment of Final Year Nursing Students' Willingness and Readiness to Work With Patients With COVID-19 During the Pandemic: A Cross-Sectional Survey

Introduction

During the COVID-19 pandemic, Indonesia faced shortages of medical supplies and healthcare workers. With a limited supply of healthcare workers, we examined the possibility of bringing final-year nursing students into COVID-19 patient care.

Methods

We conducted a cross-sectional survey among final-year nursing students to assess their willingness and readiness to work with patients with COVID-19 in Indonesia. We recruited 1,028 final-year nursing students in East Java, Indonesia, during October 7-20, 2021. Data were collected using an online questionnaire designed for this study using Google Forms. Response data were extracted from Google Forms to MS Excel 2016 for analysis. We performed univariate analysis for descriptive statistics, followed by multivariate analysis using binary logistic regression to analyze the effect of independent variables on study outcomes.

Results

The characteristics of the study participants showed that most respondents were female (97.1%) and of Javanese ethnicity (75.3%). More than 90% of participants reported no chronic diseases (96.2%) and were vaccinated (81.4%). Most participants were willing to work (84.3%) and ready to work (94.4%) with patients with COVID-19. Adjusted analysis showed that sex, type of institution, ethnicity, household condition, and history of chronic diseases were independent determinants of willingness to work with patients with COVID-19. Male and private university students were significantly more willing to work with patients with COVID-19.

Conclusions

Nursing students were willing to work with patients with COVID-19 during the pandemic; however, a longitudinal study is recommended for trend analysis.

Learning to Fly in the Time of COVID-19: Nurse Resident Experiences During the First Surge

This qualitative study, designed by nursing professional development specialists, explored novice nurses' experiences working during the first COVID-19 surge of 2020. Semistructured focus group interviews were conducted in June-December 2020 with 23 novice nurses who cared for patients with COVID-19 in March-April 2020. Sixteen themes were identified under three broad categories (viz., stimuli, coping, and adaptation). These themes and participant exemplars are shared along with recommendations on how best to support novice nurses working through the ongoing pandemic.

Moral courage, job-esteem, and social responsibility in disaster relief nurses

BACKGROUND

Social responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public health. However, few studies focused on the relationship of moral courage, job-esteem, and social responsibility among disaster relief nurses.

OBJECTIVE

To explore the influence of moral courage and job-esteem on the social responsibility in disaster relief nurses and clarify the relationship model between them.

METHODS

A cross-sectional study was conducted among 716 disaster relief nurses from 14 hospitals in central China through an online survey, including moral courage scale, job-esteem scale, and social responsibility questionnaire. The data were analyzed by Pearson's correlation, and the mechanism of the effect of moral courage and job-esteem on social responsibility was completed.

ETHICAL CONSIDERATIONS

This study was approved by the Medical Ethics Committee of the Second Xiangya Hospital of Central South University (Approval Number: 2019016).

RESULTS

Disaster relief nurses' moral courage positively impacted social responsibility (r = 0.677, p < 0.01), and moral courage could affect social responsibility through the mediating role of job-esteem.

CONCLUSION

Job-esteem mediated between moral courage and social responsibility among disaster relief nurses. Nursing managers regular assessment of nurses' moral courage and interventions such as meetings and workshops can reduce moral distress, foster morally courageous behavior, enhance job-esteem, and improve social responsibility performance among disaster relief nurses.

Nursing and midwifery education, regulation and workforce in Kenya: A scoping review

AIM

To explore contextual literature on nursing and midwifery education, regulation and workforce in Kenya to develop an understanding of the current state and inform opportunities to strengthen the nursing and midwifery professions.

INTRODUCTION

Kenya has yet to achieve the minimum nursing and midwifery workforce threshold, despite the exponential increase in population and epidemiologic disease transitions.

BACKGROUND

There are glaring health gaps and inequities in sub-Saharan African countries. Health systems are evolving into complex and costly utilities, increasing the demand for nurses and midwives. It is, therefore, necessary to re-examine systems that educate, deploy and retain the nursing workforce, especially given the ongoing COVID-19 pandemic and increase in non-communicable diseases.

METHODS

This scoping review was guided and reported following the PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, CINAHL and Web of Science) were probed for relevant studies conducted in Kenya between 1963 and 2020. The search was supplemented using Google Scholar. Findings from selected studies were extracted and analysed thematically.

RESULTS

Of the 238 retrieved studies, 37 were included in this review: 10 articles on nursing and midwifery education, 11 on regulation and 16 on the workforce.

DISCUSSION

There have been changes in regulation and an increase in nursing and midwifery enrolment and graduates. However, maldistribution and shortage of nurses and midwives persist.

CONCLUSIONS

Kenya's nursing and midwifery professions have undergone significant changes to meet the demand for a skilled workforce. However, the shortage of qualified and specialised nurses and midwives persists. Moreover, this shortage is exacerbated by underinvestment, outmigration and a need for more reforms to expand the nursing and midwifery workforce.

IMPLICATION FOR NURSING AND MIDWIFERY POLICY

Investment in nurse and midwifery education, mentorship and legislation is needed to build the capacity of the profession to provide quality health services. Several nursing and midwifery policy changes utilising a multipronged approach involving stakeholders' collaboration are suggested to address the bottlenecks from education to deployment.

Middle Eastern nurses' views/experiences of work and well-being with the support measures during past disease outbreaks and COVID-19: a qualitative systematic review

BACKGROUND

The potential psychological health impact of pandemics on nurses has been increasingly widely recognised, as have recommendations to establish support measures for nurses' well-being. Despite the availability of support measures significant number of nurses still experienced burnout and mental distress during Covid-19. Few efforts have been made in the wider literature to understand how nurses experience well-being support or how they perceive it affects their well-being during pandemics. In the Middle East, understanding and exploring well-being support measures during pandemics from nurses' perspectives has not received significant attention.

OBJECTIVE

To investigate nurses' perspectives and experiences of well-being support measures during prior pandemics and the Covid-19 pandemic in the Middle East.

METHODS

A systematic qualitative review was undertaken utilising the JBI model as a framework. Searches were carried out in databases comprised CINAHL, MEDLINE, NUsearch Library of Nottingham University and Google Scholar. Moreover, a manual search through reference lists for relevant studies were carried out.

DATA EXTRACTION AND SYNTHESIS

Eleven studies were included in the review. The findings from the included qualitative studies were extracted using the JBI-QARI data extraction tool for qualitative research. The results were synthesised using a meta-synthesis in line with the JBI approach.

RESULTS

The included studies yielded an aggregate of 111 findings and were categorised into 14 categories, followed by four synthesised findings. These were: [1] nurses experienced challenges during MERS, yet different strategies were implemented by leaders and nurses to manage these challenges; [2] some well-being support measures were unfulfilled during Covid-19; [3] additional aspects compounded negatively on nurses' well- being; and [4] nurses showed maturity during Covid-19.

CONCLUSION

In comparison to prior health emergencies, well-being support measures during Covid-19 were not sufficiently adopted. Nurse policymakers and managers should consider these support measures to correspond with nurses' needs and explore the contextual factors that affect their implementation.

TRIAL REGISTRATION

PROSPERO (CRD42022344005).

Self-efficacy in Clinical Nurse Specialists During the COVID-19 Pandemic

PURPOSE

The purpose of this study was to examine the perceived self-efficacy of the clinical nurse specialist working in the United States during the COVID-19 pandemic and explore whether there was any difference in self-efficacy based on practice focus (spheres of impact) and if differences existed between self-efficacy and demographics.

DESIGN

This study used a nonexperimental, correlational, cross-sectional design utilizing a voluntary, anonymous, 1-time survey administered through Qualtrics (Qualtrics, Provo, UT).

METHODS

The National Association of Clinical Nurse Specialists and 9 state affiliates distributed the electronic survey starting late October 2021 through January 2022. Survey content consisted of demographics and the General Self-efficacy Scale, which measures the individual's perceived ability to cope and execute tasks when faced with hardship or adversity. Sample size was 105.

RESULTS

Results included a high perception of self-efficacy of the clinical nurse specialist working during the pandemic, no statistical significance in practice focus, and a statistically significant difference in the scores of self-efficacy for participants with previous infectious disease experience compared with those without experience.

CONCLUSIONS

Clinical nurse specialists with previous infectious disease experience can guide policy, be utilized in multifaceted roles to support future infectious disease outbreaks, and develop training to prepare and support clinicians during crises such as pandemics.

Exploration of Ward-Based Nurses' Perspectives on Their Preparedness to Recognize Clinical Deterioration: A Scoping Review

BACKGROUND

Despite initiatives in the early recognition of clinical deterioration, the incidence of failure to recognize clinical deterioration in patients continues to occur contributing to the ongoing rise of in-hospital mortality and morbidity.

OBJECTIVE

The aim of the study was to explore and appraise the research evidence that related to ward-based nurses' preparedness to recognize the clinically deteriorating patient.

METHODS

A scoping review was undertaken as this approach enabled the researchers to investigate the breadth of the available evidence through broad inclusion criteria. A comprehensive database search was conducted through the Cochrane Library; Cumulative Index to Nursing and Allied Health Literature; MEDLINE; ProQuest; PubMed; and Wiley Online Library. Each article was critically appraised and analyzed using a critical appraisal tool and thematic analysis, respectively. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist.

RESULTS

Twelve primary sources of literature met the eligibility criteria. Through thematic analyses 6 primary themes were identified: implication of experience on preparedness; interprofessional and intraprofessional relationships; knowledge of calling criteria, process and procedures; requirement for a supportive system and culture; existence of hierarchy within healthcare impacting care; and clinical deterioration as an education opportunity.

CONCLUSIONS

This review identified central issues that impacted on ward-based nurses' preparedness. Further development of collaborative, supportive professional relationships across-and-within disciplines is needed. Effective use of clinical deterioration situations as educational opportunities would also assist nurses' preparedness through skill and knowledge development. However, more research evidence will be needed because of the limited data available on the topic.

Using Technology to Facilitate Evidence-Based Practice During the COVID-19 Pandemic

The COVID-19 pandemic brought many challenges to the health care workforce. A novel infectious disease, COVID-19 uncovered information gaps that were essential for frontline staff, including nurses, to care for patients and themselves. The authors developed a Web-based solution consisting of saved searches from PubMed on clinically relevant topics specific to nurses' information needs. This article discusses the objectives, development, content, and usage of this Internet resource and also provides tips for hospitals of all sizes to implement similar tools to evidence-based practice during infectious disease outbreaks.

[Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students]

PURPOSE

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students.

METHODS

A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test.

RESULTS

The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning.

CONCLUSION

The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

Influence of social responsibility and pandemic awareness of nursing students on COVID-19 preventive behaviours: a cross-sectional online survey in South Korea

OBJECTIVES

Factors influencing COVID-19 preventive behaviour require exploration to strengthen the response competencies of prehealthcare professionals and reduce the pandemic's impact. This study aimed to identify the level of COVID-19 preventive behaviour among Korean nursing students and to determine the influence of social responsibility and pandemic awareness to present educational strategies for reducing disaster impact.

METHODS AND ANALYSIS

As a cross-sectional descriptive survey study using an online questionnaire, the participants were convenience sampled from one online community for nursing students and three nursing colleges located in Seoul, South Korea. The data from 590 participants were analysed by t-test, analysis of variance, Pearson's correlation and linear multiple regression using SPSS.

RESULTS

The factors influencing COVID-19 preventive behaviour were identified to be social responsibility (linear regression coefficient 0.354, 95% CI 0.243 to 0.464), pandemic awareness (linear regression coefficient 0.131, 95% CI 0.025 to 0.237), impact of COVID-19 on daily life (linear regression coefficient 0.085, 95% CI 0.019 to 0.152) and living in Daegu/Gyeong-buk area (linear regression coefficient 0.134, 95% CI 0.024 to 0.244).

CONCLUSION

Based on the findings that social responsibility and pandemic awareness are key predictors of COVID-19 preventive behaviour, customised educational programmes and additional studies are recommended for raising social responsibility and pandemic awareness among prehealthcare professionals as a part of disaster response.

Creating an online educational intervention to improve knowledge about systematic reviews among healthcare workers: mixed-methods pilot study

BACKGROUND

Lack of knowledge about systematic reviews (SRs) could prevent individual healthcare workers (HCWs) from using SRs as a source of information in their clinical practice or discourage them from participating in such research. In this study, we aimed to explore in-depth the opinion of a sample of HCWs about the newly created online educational intervention designed to improve knowledge about SRs.

METHODS

We created a brief online educational intervention on SRs, consisting of 11 textual modules. We evaluated it among practicing HCWs who graduated from a university-level health sciences program using a mixed-methods pilot study that consisted of pre- and post-intervention questionnaires and qualitative evaluation via semi-structured interviews. We assessed participants' knowledge about SR methodology before and after the intervention, and compared the responses. We sought their opinions about the characteristics of SRs. Also, the participants were presented with four scientific abstracts, where they were asked to distinguish whether those abstracts presented summaries of a systematic or a non-systematic review.

RESULTS

Twelve participants took part in the study. In the pilot study, the participants' knowledge about SRs was improved after the intervention compared to the baseline. Participants provided positive feedback regarding the educational intervention. Suggestions to improve the educational intervention were to provide more details about the forest plot, add more digital content or images, provide more details about the methodological steps of an SR, add descriptions about practical applications of SRs and provide links to additional educational materials. The participants suggested that HCWs could be motivated to take part in such an education if it is offered as continuing medical education (CME) course or credit for academic/career advancement.

CONCLUSION

HCWs provided positive feedback about the newly designed online educational intervention on SRs; they considered it an appropriate tool for learning about SRs and resulted in increased knowledge about SRs. In addition, participants gave suggestions for improving education, which can be used to tailor the education for end-users. In future studies, it would be useful to examine the effectiveness of the modified educational intervention on increasing knowledge in a larger sample and in the form of a randomized controlled trial.

Web-Based Educational Intervention to Improve Knowledge of Systematic Reviews Among Health Science Professionals: Randomized Controlled Trial

Background

Lack of knowledge of systematic reviews (SRs) could prevent individual health care professionals from using SRs as a source of information in their clinical practice or discourage them from participating in such research.

Objective

In this randomized controlled trial, we evaluated the effect of a short web-based educational intervention on short-term knowledge of SRs.

Methods

Eligible participants were 871 Master’s students of university health sciences studies in Croatia; 589 (67.6%) students who agreed to participate in the trial were randomized using a computer program into 2 groups. Intervention group A (294/589, 49.9%) received a short web-based educational intervention about SR methodology, and intervention group B (295/589, 50.1%) was presented with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. The participants’ knowledge of SRs was assessed before and after the intervention. The participants could not be blinded because of the nature of the intervention. The primary outcome was the difference in the percentage of correct answers about SR methodology per participant between the groups after the intervention, expressed as relative risk and 95% CI.

Results

Results from 162 and 165 participants in the educational intervention and PRISMA checklist groups, respectively, were available for analysis. Most of them (educational intervention group: 130/162, 80.2%; PRISMA checklist group: 131/165, 79.4%) were employed as health care professionals in addition to being health sciences students. After the intervention, the educational intervention group had 23% (relative risk percentage) more correct answers in the postintervention questionnaire than the PRISMA checklist group (relative risk=1.23, 95% CI 1.17-1.29).

Conclusions

A short web-based educational intervention about SRs is an effective tool for short-term improvement of knowledge of SRs among health care studies students, most of whom were also employed as health care professionals. Further studies are needed to explore the long-term effects of the tested education.

Trial Registration

OSF Registries 10.17605/OSF.IO/RYMVC; https://osf.io/rymvc

Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy

During the COVID-19 health emergency, healthcare professionals faced several ethical demanding job stressors, becoming at particular risk of moral distress. To date, only a few scales have been developed to evaluate moral distress among frontline professionals working in contact with COVID-19 patients. Moreover, although many healthcare professionals from various disciplines were converted to COVID-19 patient care, no study has yet analyzed whether the resulting change in duties might represent a risk factor for moral distress. Thus, this study aimed to investigate how and when the change in duties during the emergency would be related to healthcare professionals' psycho-physical malaise. To this aim, a first Italian adaptation of the Stress of Conscience Questionnaire (SCQ) was provided. In total, 272 Italian healthcare professionals participated in this cross-sectional study. Healthcare professionals who had to perform tasks outside their usual clinical duties were more likely to experience moral distress and then psycho-physical malaise. This was particularly likely for those who were extremely concerned about becoming infected with the virus. The results also indicated that the Italian adaptation of the SCQ had a one-factor solution composed of six items. This study provides the first Italian adaptation of SCQ and practical suggestions on how supporting professionals' well-being during emergencies.

Australian dentists' knowledge, preparedness, and experiences during the COVID-19 pandemic

BACKGROUND

COVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists' knowledge, preparedness, and experiences of managing COVID-19 in Australia.

METHODS

A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021.

RESULTS

Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads.

CONCLUSION

COVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

Hospitals as disaster victims: Lessons not learned?

OBJECTIVE

Hospitals are a key component to disaster response but are susceptible to the effects of disasters as well, including infrastructure damage that disrupts patient care. These events offer an opportunity for evaluation and improvement of preparedness and response efforts when hospitals are affected directly by a disaster. The objective of this structured review was to evaluate the existing literature on hospitals as disaster victims.

METHODS

A structured and scoping review of peer-reviewed literature, gray literature, and news reports related to hospitals as disaster victims was completed to identify and analyze themes and lessons observed from disasters in which hospitals are victims, to aid in future emergency operations planning and disaster response.

RESULTS

The literature search and secondary search of referenes identified 366 records in English. A variety of common barriers to successful disaster response include loss of power, water, heating and ventilation, communications, health information technology, staffing, supplies, safety and security, and structural and non-structural damage.

CONCLUSIONS

There are common weaknesses in disaster preparedness that we can learn from and account for in future planning with the aim of improving resilience in the face of future disasters.

[Collaborative Disaster Governance Recognized by Nurses during a Pandemic]

PURPOSE

We aimed to identify collaborative disaster governance through the demand and supply analysis of resources recognized by nurses during the COVID-19 pandemic.

METHODS

We used a descriptive study design with an online survey technique for data collection. The survey questions were developed based on focus group interviews with nurses responding to COVID-19 and expert validity testing. A 42-question online survey focusing on disaster governance was sent to nurses working in COVID-19 designated hospitals, public health offices, and schools. A total of 630 nurses participated in the survey. Demand and supply analysis was used to identify the specific components of disaster governance during a pandemic situation and analyze priority areas in disaster governance, as reported by nurses.

RESULTS

Demand and supply analysis showed that supplies procurement, cooperation, education, and environment factors clustered in the high demand and supply quadrant while labor condition, advocacy, emotional support, and workload adjustment factors clustered in the high demand but low supply quadrant, indicating a strong need in those areas of disaster governance among nurses. The nurses practicing at the public health offices and schools showed major components of disaster governance plotted in the second quadrant, indicating weak collaborative disaster governance.

CONCLUSION

These findings show that there is an unbalanced distribution among nurses, resulting in major challenges in collaborative disaster governance during COVID-19. In the future and current pandemic, collaborative disaster governance, through improved distribution, will be useful for helping nurses to access more required resources and achieve effective pandemic response.

Effectiveness of the Infectious Disease (COVID-19) Simulation Module Program on Nursing Students: Disaster Nursing Scenarios

PURPOSE

This study aimed to develop an emerging infectious disease (COVID-19) simulation module for nursing students and verify its effectiveness.

METHODS

A one-group pretest-posttest quasi-experimental study was conducted with 78 under-graduate nursing students. A simulation module was developed based on the Jeffries simulation model. It consisted of pre-simulation lectures on disaster nursing including infectious disease pandemics, practice, and debriefings with serial tests. The scenarios contained pre-hospital settings, home visits, arrival to the emergency department, and follow-up home visits for rehabilitation.

RESULTS

Disaster preparedness showed a statistically significant improvement, as did competencies in disaster nursing. Confidence in disaster nursing increased, as did willingness to participate in disaster response. However, critical thinking did not show significant differences between time points, and neither did triage scores.

CONCLUSION

The developed simulation program targeting an infectious disease disaster positively impacts disaster preparedness, disaster nursing competency, and confidence in disaster nursing, among nursing students. Further studies are required to develop a high-fidelity module for nursing students and medical personnel. Based on the current pandemic, we suggest developing more scenarios with virtual reality simulations, as disaster simulation nursing education is required now more than ever.

Are nurses prepared to respond to next infectious disease outbreak: A narrative synthesis

Aim

The review aimed to present a synthesis of nurses' preparedness for infectious disease and the components of emergency preparedness.

Design

Narrative synthesis.

Methods

A systematic search and screening for relevant studies were conducted to locate the relevant articles. The included studies were examined for scientific quality using the Mixed Methods Appraisal Tool. The findings of included studies were synthesized by a narrative synthesis approach.

Results

Totally 15 studies were included, and 4 themes associated with nurses' preparedness for pandemic were identified: knowledge and skills, psychological preparation, external resources, and attitude and intention.

Conclusions

Most nurses express a positive willingness to respond to epidemics, although they do not believe they are adequately prepared. Some measures should be taken for improving nurses' emergency preparedness, including providing ongoing training, protective equipment, safe working environment and psychological intervention, improving nurses' resilience and accelerating the sharing of scientific information about epidemics.

Nursing ethics for prevention and control of major infectious disease outbreaks: Chinese expert consensus

Objectives

Major infectious disease has become a serious threat to people's health worldwide. As the world's largest healthcare workforce and the core forces fighting against the epidemic, nurses are on the frontline of this battle. A number of ethical issues have given rise to numerous concerns that have largely affected nurses in different ways as they respond to the epidemic. In addition, excessive expectations from people can exert undue pressure, which can easily lead to burnout in nurses.

Methods

In this consensus, the expert panel method was used to develop and reach a consensus. The members involved in the formation of the consensus included an expert discussion panel and a consensus writing expert group, a methodologist, and four secretaries. After 16 rounds of online expert consultation and two rounds of expert panel meetings, the writing team analyzed and reviewed the 78 amendments suggested by the experts to develop a consensus on nursing ethics for prevention and control of major infectious disease outbreaks based on the ethical vision of life care.

Results

This expert consensus focuses on five essential domains: the responsibilities and rights of nurses, the nurse-patient relationship, the doctor-nurse relationship, and the relationship between society and nurses throughout the epidemic.

Conclusions

We hope this consensus can help nurses better understand and respond to the ethical issues and challenges in public health emergencies, and raise reasonable public expectations of the roles and responsibilities of nurses in these situations.

Exploration of Factors Influencing Nurses’ Preparedness and Response to the COVID-19 Outbreak

Introduction and Objective

Nurses as the core of the health care workforce affect an organization's preparedness and response. This study explores the factors and unique determinants influencing nurses’ preparedness and response to the coronavirus disease 2019 (COVID-19) outbreak in Singapore.

Methods

This qualitative phenomenological study utilized purposive sampling and in-depth interviews with 10 registered nurses and two enrolled nurses who had worked or were still working in an infectious disease (ID) hospital during the COVID-19 outbreak at the point of recruitment. The data were collected from September 2020 to December 2020.

Results

(1) Before the outbreak: Factors such as knowledge, skills, and experiences that enhanced nurses’ adaptability and response through training and exposure prior to the outbreak influenced preparedness. In addition, the importance of nurses’ knowing their purpose and the role of their institute during the outbreak also influenced preparedness. (2) The COVID-19 phase: Factors such as the novelty of the disease, communication, load and demand, and coping mechanisms affected participants’ working response to the outbreak. (3) Learning and looking forth: Lessons learnt to enhance preparedness and response to future outbreaks, and positive sentiments as part of the nation's effort to combat the disease.

Conclusion

Ground nurses should be actively involved in outbreak planning to gain a better view of their responsibilities and unpredictable events that may occur. A transparent and bidirectional communication among management and nurses is crucial amidst rapid changes in an outbreak to strike a balance between the needs of nurses and leadership and to enhance nurses’ resilience throughout this challenging journey.

"We will have to learn to live with it": Australian dentists' experiences during the COVID-19 pandemic

BACKGROUND

Australian dentists are among the frontline healthcare workers providing dental and oral health care during the COVID-19 pandemic, and therefore have been affected in multiple ways. In this study, we explore their experiences of practising and living in this pandemic.

METHODS

A qualitative study analysed responses of 333 Australian dentists' who participated in a survey with open-ended questions about the challenges and positive outcomes of practising during the COVID-19 pandemic. The questions were embedded in a national online survey of Australian dentists' knowledge, preparedness and experiences conducted between March and April 2021. Data were analysed using content analysis.

RESULTS

Australian dentists reported their challenging experiences to be four-fold, including 'public health orders and restrictions', 'Infection prevention and control measures (IPC), 'Personal concerns about COVID-19' and 'Detracting opinions about COVID-19'. Conversely, they reported positive outcomes in relation to their practice during COVID-19, including 'Awareness of and adherence to IPC practices', 'Teamwork and interpersonal dynamics', 'Decompressed workload', 'Perceived support' and 'unintended positive outcomes'.

CONCLUSION

The COVID-19 pandemic generated several challenges for Australian dentists, but it also engendered some positive outcomes. Understanding of these can help tailor the professional support plans to address the needs and priorities of Australian dentists during the current and future pandemics.

Depression, Anxiety, and Stress Among Nurses During the COVID-19 Wave III: Results of a Cross-Sectional Assessment

Purpose

The current study was aimed to evaluate depression, anxiety, and stress among nurses during the COVID-19 (wave III) at a public hospital in Quetta city, Pakistan.

Participants and Methods

By using the validated Depression, Anxiety and Stress Scale - 21, three hundred and twenty-five nurses practicing at the Sandeman Provincial Hospital, Quetta were approached for data collection. Through SPSS, both descriptive and inferential statistics were used during data analysis. Chi-square test was used to assess the goodness-of-fit between observed values and demographic variables. The factors that were significantly associated with depression, anxiety, and stress were further assessed by binary logistic regression analysis. The statistical significance was set at 0.05.

Results

Out of the 325 nurses, 297 participated in the study with a response rate of 91.3%. Mild depression and stress were reported in the current cohort of nurses (6.00 ± 5.30 and 8.01 ± 4.47), respectively. The mean anxiety score was 6.68 ± 4.86 indicating moderate anxiety among the study respondents. Marital status, working department, and job experience were significantly associated with depression, anxiety, and stress with moderate effect size (>0.3). The logistic regression reported department in which nurses were stationed (adjusted OR = 2.54, 95% CI = 1.118–1.415, p < 0.001) and job experience (adjusted OR = 1.004, 95% CI = 1.001–1.215, p = 0.002) as significant predictors of depression, anxiety and stress. Nurses working in the corona ward were more likely to develop depression, anxiety and stress by a factor of 2.54 and married nurses with a factor of 1.004 provided controlling other confounding factors.

Conclusion

Moderate depression, anxiety, and stress were observed among nurses and it calls for hospital management to consider interventions for all nurses irrespective of their present working departments. Facilitating continuous and comprehensive support mechanisms aimed at protecting nurses’ mental health is of great importance during pandemics. The findings of the study have some clear suggestions for mental health advocacy among nurses that are essential for improving the quality of services and patients’ safety.

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.

Knowledge, attitude, and use of protective measures against COVID-19 among nurses: a questionnaire-based multicenter cross-sectional study

Background

During this pandemic, nurses have always been on the frontline and are probably the first healthcare providers to interact with patients presenting with symptoms of COVID-19. The main aim of this multicenter study was to assess knowledge, attitude, and use of protective measures against COVID-19 among nurses across the Occupied Palestinian Territory (oPt) during the ongoing pandemic.

Methods

This was a questionnaire-based multicenter cross-sectional study that was conducted in the period between October 2020 to December 2020. The study tool tested knowledge (8-item), attitude (2-item), and use of protective measures against COVID-19 (3-item) among nurses. Associations between nurses’ characteristics and their knowledge, attitude, and use of protective measures were investigated using Student’s t-test, Analysis of Variance, and Pearson’s correlations. To control potentially confounding variables, predictors of higher knowledge, attitude, and use of protective measures were identified using multiple regression analyses.

Results

The study tool was complete by 455 nurses. The mean of knowledge, attitude, and use of protective measures scores were 75.7% (SD:12.4%), 75.1% (SD: 17.7%), and 91.6% (SD: 18.2%), respectively. Multiple linear regression models showed that high knowledge was predicted by being female (p-value = 0.004) and self-rating social status as high (p-value = 0.005). Higher attitude was predicted by being female (p-value = 0.005), self-rating academic achievements as high (p-value = 0.007), and having contracted COVID-19 (p-value = 0.001). Higher use of protective measures was predicted by self-rating academic achievements as high (p-value = 0.010).

Conclusion

Findings of this study suggested that nurses in the oPt had high knowledge, relatively optimistic attitude, and appropriately used protective measures against COVID-19 during the ongoing pandemic. Knowledge, attitude, and use of protective measures among nurses should continuously be updated as information unfold during the ongoing pandemic. More efforts are still needed to ensure protection of healthcare providers including nurses from contracting COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00689-x.

The hand-brain-heart connection: ICU nurses' experience of managing patient safety during COVID-19

Background

COVID‐19 has challenged critical care nursing through increased critical care service utilization. This may have a profound impact on intensive care unit (ICU) nurses' ability to maintain patient safety. However, the experiences of ICU nurses in managing patient safety during an infectious disease outbreak remains unexplored.

Aims and objectives

To explore ICU nurses' narratives in managing patient safety in the outbreak ICUs during the COVID‐19 pandemic.

Design

A narrative inquiry design.

Methods

A purposive sample of 18 registered nurses who practiced in the outbreak ICUs during the COVID‐19 pandemic were recruited between June and August 2020. Individual semi‐structured interviews were conducted, transcribed verbatim, and narratively analysed.

Results

Findings reviewed an overarching anatomy‐specific storyline of a ‘hand‐brain‐heart’ connection that describes nurses' experience with managing patient safety during the COVID‐19 pandemic. Firstly, stories on ‘the hands of clinical practice’ revealed how critical care nursing is practiced and adapted by ICU nurses during the pandemic. In particular, ICU nurses banded together to safeguard patient safety by practicing critical care nursing with mastery. Secondly, stories on ‘the brain of psychosocial wellness’ highlights the tumultuous impact of COVID‐19 on the nurses' psychosocial well‐being and how nurses demonstrated resilience to continually uphold patient safety during the pandemic. Lastly, stories on ‘the heart of nursing’ drew upon the nurses' intrinsic professional nursing identity and values to safeguard patient safety. Specific patient tales further boosted the nurses' commitment to render safe nursing care during the pandemic.

Conclusions

Through their stories, ICU nurses reported how they continually seek to uphold patient safety through clinical competence, resilience, and heightened nursing identity.

Relevance to clinical practice

ICU nurses require sustainable clinical resources and references such as clinical instructors, as well as visible psychosocial support channels, for ICU nurses to continue to uphold patient safety during COVID‐19.

'From Expert to Novice', Perceptions of General Ward Nurses on Deployment to Outbreak Intensive Care Units during the COVID-19 Pandemic: A Qualitative Descriptive Study

AIMS AND OBJECTIVES

This study aimed to explore the perceived preparedness and psychosocial well-being of general ward nurses prior to their deployment into the outbreak intensive care units (ICUs) during the COVID-19 pandemic.

BACKGROUND

With the surge in COVID-19 cases requiring ICU care, non-ICU nurses maybe deployed into the ICUs. Having experienced through SARS, hospitals in Singapore instituted upskilling programs to secure general ward nurses' competency in providing critical care nursing. However, no studies have explored the perceptions of general ward nurses on deployment into the ICUs during the COVID-19 pandemic.

DESIGN

Qualitative descriptive study.

METHODS

The study was conducted at Singapore's epicentre of COVID-19 management. Five focus groups were conducted following purposive sampling of 30 general ward nurses identified for outbreak ICU deployment. Focus groups were audio-recorded, transcribed verbatim and data thematically analysed. This study was conducted and reported in accordance with the COREQ checklist.

RESULTS

Three salient themes arose, exemplifying the transition from clinical experts in the general wards to practising novices in the outbreak ICUs. Firstly, 'Into the deep end of the pool' described general ward nurses' feelings of anxiety and stress associated with higher exposure risk and expanded responsibilities to nurse critically ill patients. Secondly, 'Preparing for "war"' illustrated deployed nurses' need for clear communication and essential critical care nursing training. Lastly, 'Call of duty' affirmed the nurses' personal and professional commitment to embrace this transition into the ICUs, and their desire for greater psychosocial support.

CONCLUSION

The study findings highlight that though general ward nurses perceived their impending ICU deployment positively, they require ongoing support to facilitate a smoother transition.

RELEVANCE TO CLINICAL PRACTICE

Findings provided an evidence base to improve the preparedness of general ward nurses deployed into the ICUs during the COVID-19 pandemic within key areas of training, information dissemination and psychosocial resilience.

Hospice Emergency Planning and COVID-19

Objectives: Centers for Medicare and Medicaid Services requirements for Emergency Preparedness Planning (EPP) by hospice organizations significantly increased in 2017. This study seeks to assess the involvement of various hospice personnel in EPP before and since the onset of the novel coronavirus disease COVID-19 pandemic. Methods: A link to an anonymous online survey was sent to members of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association, targeting members involved in hospice care in the United States. A descriptive analysis of the data was performed. Results: Prior to the pandemic, 39.8% of respondents were "moderately" or "very" involved with the development and revisions of the Emergency Preparedness Plan. Since the beginning of the pandemic, this increased to 59%, which largely occurred among physicians. Clinical Nurse and Nurse Practitioner involvement in development/revisions remained low. Approximately 30% of respondents desired more involvement across the areas of EPP. Conclusion: The involvement of personnel of various disciplines is varied and the involvement of physicians appears to have increased with the onset of the COVID-19 pandemic. A notable portion of personnel desired more involvement across all aspects of EPP. More research is needed in this important but little-understood area.

General practitioners' knowledge, preparedness, and experiences of managing COVID-19 in Australia

BACKGROUND

COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia.

METHODS

A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020.

RESULTS

Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload.

CONCLUSION

Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.

Leadership, professional quality of life and moral distress during COVID-19: A mixed-methods approach

AIM

To understand the impact of professional stressors on nurses' and other health care providers' professional quality of life and moral distress as they cared for patients during the COVID-19 pandemic.

BACKGROUND

Health care providers caring for patients during the COVID-19 pandemic are at increased risk of decreased professional quality of life and increased moral distress.

METHODS

A convergent mixed-methods design and snowball sampling was used to collect survey data (n = 171) and semi-structured interviews (n = 23) among health care providers working in the inpatient setting.

RESULTS

Perceived lack of support from executive leadership, access to personal protective equipment and constantly changing guidelines led to decreased professional quality of life and increased moral distress among health care providers.

CONCLUSION

Findings from this study indicate that shared governance, disaster management training and enhanced communication may assist executive leadership to reduce the likelihood of decreased professional quality of life and increased moral distress in front line health care providers.

IMPLICATIONS FOR NURSING MANAGEMENT

Following the principles of shared governance may assist executive leadership to promote and acknowledge the significance of the role of health care providers at the bedside. Additionally, disaster management training and open communication are crucial to ensure that health care providers are adequately informed and supported at the bedside.

An Umbrella Review of the Work and Health Impacts of Working in an Epidemic/Pandemic Environment

This umbrella review of reviews examined the evidence on the work and health impacts of working in an epidemic/pandemic environment, factors associated with these impacts, and risk mitigation or intervention strategies that address these factors. We examined review articles published in MEDLINE, PsycINFO and Embase between 2000 and 2020. Data extracted from the included reviews were analyzed using a narrative synthesis. The search yielded 1524 unique citations, of which 31 were included. Included studies were focused on health care workers and the risk of infection to COVID-19 or other respiratory illnesses, mental health outcomes, and health care workers’ willingness to respond during a public health event. Reviews identified a variety of individual, social, and organizational factors associated with these work and health outcomes as well as risk mitigation strategies that addressed study outcomes. Only a few reviews examined intervention strategies in the workplace such as physical distancing and quarantine, and none included long-term outcomes of exposure or work during an epidemic/pandemic. Findings suggest a number of critical research and evidence gaps, including the need for reviews on occupational groups potentially exposed to or impacted by the negative work and health effects of COVID-19 in addition to health care workers, the long-term consequences of transitioning to the post-COVID-19 economy on work and health, and research with an equity or social determinants of health lens.

Information flow and nursing care during the early phase of the COVID-19 pandemic

AIMS

This study aimed to understand the dissemination of information relating to coronavirus disease 2019 (COVID-19) and its impact on nursing care in the early phase of transmission.

BACKGROUND

COVID-19 has spread globally, causing an unprecedentedly large number of casualties. Nurses face challenges in dealing with patients with COVID-19 with limited information about the pathogen.

DESIGN

This qualitative study followed the COREQ guidelines.

METHODS

Fifteen nurses were recruited from two university hospitals in South Korea using a snowballing technique for in-depth interviews in May 2020. All interviews were recorded and transcribed verbatim. Content analysis was performed on the interview data.

RESULTS

Two themes emerged: access to COVID-19 information and the impact of information on nursing care. The categories of access to COVID-19 information were lack of nursing-specific information, limited information cascading from top management and confusion due to varying points of view. The categories of the impact of information on nursing care were unprepared management that aggravates exhaustion, lack of personal protective equipment that creates anxiety and being a nurse leader to overcome the pandemic.

CONCLUSION

During a pandemic of emerging infectious diseases, nurses should have access to up-to-date information tailored to their working environment. Human resources, material resources and systematic support are needed for nurses who provide care for patients with an infectious disease.

RELEVANCE TO CLINICAL PRACTICE

A collaborative interprofessional education system for emerging infectious diseases is needed for effective communication and consistent care during a pandemic. Nurse leaders should be prepared to deliver profession-specific information for standardised care and respond to nursing management needs by using resources and tailoring the workforce.

Infection control professionals' and infectious diseases physicians' knowledge, preparedness, and experiences of managing COVID-19 in Australian healthcare settings

BACKGROUND

COVID-19 has placed unprecedented demands on infection control professionals (ICPs) and infectious disease (ID) physicians. This study examined their knowledge, preparedness, and experiences managing COVID-19 in the Australian healthcare settings.

METHODS

A cross-sectional study of ICPs and ID physician members of the Australasian College for Infection Prevention and Control (ACIPC) and the Australasian Society for Infectious Diseases (ASID) was conducted using an online survey. Descriptive statistics were used to summarise and report data.

RESULTS

A total of 103 survey responses were included in the analysis for ICPs and 45 for ID physicians. A majority of ICPs (78.7%) and ID physicians (77.8%) indicated having 'very good' or 'good' level of knowledge of COVID-19. Almost all ICPs (94.2%) relied on state or territory's department of health websites to source up-to-date information While most ID physicians (84.4%) used scientific literature and journals. A majority of ICPs (96%) and ID physicians (73.3%) reported feeling 'moderately prepared' or 'extremely prepared' for managing COVID-19. Most respondents had received specific training about COVID-19 within their workplace (ICPs: 75%; ID physicians: 66.7%), particularly training/certification in PPE use, which made them feel 'mostly or entirely confident' in using it. Most ICPs (84.5%) and ID physicians (76.2%) reported having 'considerably' or 'moderately more' work added to their daily duties. Their biggest concerns included the uncertainties under a rapidly changing landscape, PPE availability, and the community's compliance.

CONCLUSION

Harmonised information, specific COVID-19 training and education, and adequate support for front-line workers are key to successfully managing COVID-19 and other future outbreaks.

The perception of training and professional development according to nursing students as health workers during COVID-19: A qualitative study

Aim

To explore the perception of education and professional development of final-year nursing students who carried out health relief tasks during the COVID-19 pandemic.

Background

The COVID-19 pandemic has led to a global health emergency. This situation has exacerbated the need for additional healthcare employees, forcing the Spanish government to incorporate volunteer nursing students as auxiliary health staff.

Design

A qualitative study framed in the constructivist paradigm.

Methods

Twenty-two students of nursing were recruited. A purposeful sampling was implemented until reaching saturation. A semi-structured interview as a conversational technique was used to collect information based on three dimensions: academic curriculum, disciplinary professional development, and patient care. Subsequently, a content analysis of the information was carried out. Three phases were followed in the data analysis process: theoretical, descriptive-analytical, and interpretive. The COREQ checklist was used to evaluate the study.

Results

The most important results are linked to the students’ professional and academic preparation, how the nurses handled the pandemic situation and the characteristics of the COVID-19 patients.

Conclusions

Students require training in order to offer holistic care to patients, adapted to the context. Participants highlight the importance of professional values and recognise a high level of competence and autonomy in nurses.

Nurses' uncertainty about medical gloves safety during the COVID-19 pandemic

Background

Nurses, as the largest group of health professionals, are at the frontline of the healthcare system in response to COVID-19 epidemic. This study aimed to evaluate the nurses’ certainty and satisfaction with medical gloves when exposed to coronavirus in Fars province, south of Iran.

Methods

Using convenience sampling, 400 hospital nurses during the COVID-19 outbreak were selected from eight hospitals of Shiraz University of Medical Sciences (SUMS). A questionnaire about glove reliability, including protection in tasks, durability, integrity and tear resistance, feeling fearful, and focusing on duties, and the nurses’ anxiety regarding their infection with coronavirus was distributed to the selected nurses to complete. 375 questionnaires were completed (response rate of 93.75%). Among the participants, 180 (48%) were in the corona section and 195 (52%) were hardly possible to have contact with coronavirus pneumonia patients.

Results

The mean score (SD) of anxiety about infection with COVID-19 for nurses in the COVID-19 section and those in the non-COVID-19 section were 6.08 (2.8) and 4.56 (2.58), respectively (p < 0.05). The mean duration of gloves usage in a day was almost similar in the two groups (about 5 h), but the number of glove replacements was significantly higher among the nurses in the corona section (6 times) compared to those in the non-corona section (3 times). The two groups were also significantly different regarding glove protection in daily tasks and glove durability.

Conclusion

The nurses in the corona section had more concerns about medical gloves as a type of personal protective equipment. In addition to health education on controlling and preventing the spread of diseases, raising awareness about the reliability of personal protective equipment can improve nurses’ performance.

Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey

Background

The Coronavirus disease (COVID-19) pandemic is an ongoing pandemic all over the world, leading to 126, 372, 442 people diagnosed and 2, 769, 696 deaths globally as of March 28, 2021. Nurses are providing care to patients with COVID-19 who require hospitalization. To ensure adequate response capacity and to maintain the health of nurses, it is important to analyse the actual work hours and the nurses reported preferred work hours per shift among frontline nurses.

Objective

To analyse the actual work hours and preferred work hours per shift of nurses reports among frontline nurses fighting the COVID-19 epidemic and to explore the influencing factors on the nurses reported preferred work hours.

Design

Cross-sectional survey.

Settings

This study was conducted in 10 designated hospitals providing treatments to patients with COVID-19 in China.

Participants

Nurses providing care to patients with COVID-19 in designated hospitals in China.

Methods

A questionnaire with open-ended questions was used to assess frontline nurses caring for COVID-19 cases in 10 designated hospitals. Quantitative and qualitative methods were used to analyse the actual work hours, the nurses reported preferred work hours and factors influencing nurses reported preferred work hours among the frontline nurses.

Results

A total of 109 nurses responded to the survey. The shift length exceeded the nurses' preferred work hours [Median (interquartile range): 5.00 (2.00) h vs 4.00 (2.00) h; Minimum-Maximum: 4-12 h vs 4-8 h], and 60.55% (66/109) of the nurses regarded 4 h as the preferred number of work hours per shift. Five key themes associated with the influencing factors emerged, including circumstances; personal preventable equipment; the nurses' physical and emotional needs of nurse; and the nurses' safety needs and work intensity.

Conclusions

These findings suggest that there is a gap between the actual work hours and the nurses preferred work hours among frontline nurses in different units and different posts. The main influencing factors were circumstances, personal protective equipment, the nurses' physical and emotional needs, and the nurses' safety needs and work intensity.

Disaster preparedness among nurses of developing countries: An integrative review

BACKGROUND

Nurse preparedness and prompt response are essential to save lives and reduce the consequences of disasters and emerging pandemics. This paper aimed to synthesize the available evidence that demonstrates the adequacy on disaster preparedness among nurses in developing countries.

METHODS

Five stages of the integrative review approach were employed. Seventeen articles from 2010 to 2019 were selected using different databases after a quality appraisal performed by two researchers independently. The findings were summarized and synthesized based on the themes concerning disaster preparedness among nurses.

RESULTS

The major themes emerged were disaster knowledge and perceived self-preparedness. Nurses were found to have a weak-to-average or a low-to-moderate level of disaster preparedness based on their knowledge and perception. Education and training were discovered to be vital factors, often requiring a variety of strategies, for the enhancement of the nurses' preparedness level.

CONCLUSION

This review concludes that nurses in developing countries remain inadequately prepared on all domains of disaster nursing competencies. Therefore, providing well-designed disaster nursing educational packages, training manuals, and support to attend disaster drills or partake in actual disaster events are essential to the enhancement of disaster preparedness and the retention of relevant skills among nurses in all sectors.

Experiences and needs of nursing students during pandemic outbreaks: A systematic overview of the literature

Background

Recent epidemics have placed overwhelming demands on health systems, leading at times to the deployment of nursing students during the crisis. Little is known about the impact this experience has on students. Although studies have explored nursing students' knowledge about infection control, there are no specific recommendations regarding how these issues should be addressed in nurse education.

Purpose

To conduct a comprehensive systematic overview of the literature concerning nursing students in the context of emerging infectious disease epidemics or pandemics caused by zoonotic viruses.

Methods

Systematic overview.

Results

Forty-eight articles were included. Five themes were identified: education; knowledge, concern about risk and preventive behaviour; willingness to work during a pandemic outbreak; experiences and emotional impact; and ethical dilemmas.

Conclusions

There is a need to enhance nurse education to ensure that students have adequate education in infection prevention and control and the opportunity to develop the skills and attitudes required to provide care to infected patients during a pandemic. The outcomes of these education programmes would need to be evaluated using valid and reliable instruments so as to enable comparisons to be made to prepare future nurses to deal with new pandemics in an increasingly globalized world.

Surviving an infectious disease outbreak: How does nurse calling influence performance during the COVID-19 fight?

AIM

To assess the performance of front-line nurses, who believed they were living out their calling, during the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND

Although as a profession nursing generally requires high levels of performance, the disruption arising from an infectious disease outbreak increases the work stress and decreases the performance of front-line nurses. How this situation can be improved has yet to be thoroughly examined.

METHOD

We used a snowball sampling technique to recruit 339 nurses who were originally from outside Hubei but volunteered to join medical teams going to Hubei to tackle COVID-19.

RESULTS

Drawing on the theory of work as a calling, we found that living a calling had a positive effect on front-line nurses' performance through the clinical and relational care they provided. Perceived supervisor support strengthened these mediated relationships.

CONCLUSION

Our findings indicate that despite the constraints associated with pandemics, front-line nurses who are living a calling are able to provide better clinical and relational care to infected patients, which in turn improves their performance.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study suggest that hospitals can introduce career educational interventions to enhance nurses' ability to discern and live out their calling to improve their performance.

Examining the UK Covid-19 mortality paradox: Pandemic preparedness, healthcare expenditure, and the nursing workforce

AIM

To examine the UK pandemic preparedness in light of health expenditure, nursing workforce, and mortality rates in and relation to nursing leadership.

BACKGROUND

The Global Health Security Index categorized the preparedness of 195 countries to face a biological threat on a variety of measures, producing an overall score. The United States of America and the United Kingdom were ranked 1st and 2nd most prepared in 2019.

METHOD

A cross-nation comparison of the top 36 countries ranked by Global Health Security Index score using a variety of online sources, including key data about each nation's expenditure on health and the nursing workforce, and compared these with mortality data for COVID-19.

RESULTS

The extent of a country's pandemic preparedness, expenditure on healthcare and magnitude of the nursing workforce does not appear to impact mortality rates at this stage of the pandemic which is something of a paradox.

CONCLUSION

It is important that arrangements for dealing with future global pandemics involve a range of agencies and experts in the field, including nurse leaders.

IMPLICATIONS FOR NURSING

To achieve the best outcomes for patients, nurse leaders should be involved in policy forums at all levels of government to ensure nurses can influence health policy.

The influence of experiences of involvement in the COVID-19 rescue task on the professional identity among Chinese nurses: A qualitative study

Aims

To explore the influence of experiences of involvement in the COVID‐19 rescue task on professional identity among Chinese nurses from a qualitative method perspective.

Background

Professional identity of nurses is not static and easily affected by many factors. The COVID‐19 epidemic brings the tremendous physical and psychological challenges for rescue nurses. At present, there are limited data on the influence of rescue experiences on the nurses’ professional identity.

Methods

This study used a face‐to‐face interview with semi‐structured questions to learn about the influence of rescue experiences on the professional identity of nurses. Purposeful sampling was used to collect participants (n = 14), and interview data were analysed following the Colaizzi's phenomenological analysis.

Results

The ‘impression of exhaustion and fear’, ‘feeling the unfairness’, ‘perceiving incompetence in rescue task’ and ‘unexpected professional benefits’ were the main factors affecting the professional identity of rescue nurses.

Conclusion

The present study showed that special attention and targeted support measures should be provided to improve the professional identity of rescue nurses.

Implications for Nursing Management

Nurse managers should make a post‐epidemic recovery plan to help nurses to improve the professional identity. Designed education programmes and complete disaster response system should be developed to deal with infection disease in the future.

Exploring the experience of health professionals who cared for patients with coronavirus infection: Hospitalised isolation and self-image

AIMS AND OBJECTIVES

This study aimed to examine the lived experience of physicians and nurses who underwent hospitalised isolation during the Middle East respiratory syndrome coronavirus outbreak that hit Korea in 2015, and how it may have affected their professional self-image.

BACKGROUND

Health professionals caring for patients during infectious outbreaks such as the Middle East respiratory syndrome have reported negative psychological effects. However, little is known about how the experience influences their professional self-image.

DESIGN

An interpretive phenomenological approach was applied using individual in-depth interviews.

METHODS

Through purposeful and snowball sampling, 11 health professionals who had experienced hospital isolation due to suspicious symptoms of Middle East respiratory syndrome during the outbreak, participated in face-to-face interviews (50-90 min). We adhered to the Consolidated Criteria for Reporting Qualitative Research guideline for reporting.

RESULTS

Six themes were identified: (a) engulfed in chaos and exhaustion; (b) feeling hurt and constrained by the rejection and blame; (c) anxiety induced by the enclosed environment; (d) dread of this uncertain and critical disease; (e) sustained by family and colleagues; and (f) reflection at this turning point, expanding self-understanding and seeking a balance.

CONCLUSION

Hospitalised isolation was a "turning point" that appeared to change health professionals' sense of identity and direction.

RELEVANCE TO CLINICAL PRACTICE

Preparedness for infectious epidemics should ensure tangible assistance, protection, and clear communication with health professionals, with careful attention to their psychological needs and affirmation of their self-image in the aftermath.

Nursing students' experiences and perceptions of learner-centred education in a disaster nursing course: A qualitative study

Learner-centred education has been shown to be an effective teaching method in the healthcare disciplines that integrate practical skills and theoretical knowledge. However, the elements of learner-centred education that influence students' motivation and engagement in learning remain unclear. In this descriptive qualitative research study, 43 nursing students in a baccalaureate nursing programme in Hong Kong who enrolled in a disaster and trauma nursing course were recruited through purposive sampling. Data were collected through semi-structured, face-to-face, focus group interviews. The transcribed interviews were interpreted through the use of qualitative analysis. This study revealed that adopting learner-centred education techniques in a disaster nursing course could cater to the hedonic nature and practical nature of learning disaster nursing, which consequently strengthens student's motivation and engagement in learning. The findings also suggested that learner-centred education could improve nursing students' learning experience and promote their transformation from passive and receptive students into proactive learners. The present study provides a greater and more focused understanding of the elements of learner-centred education that promote motivation and engagement in learning among nursing students. This study could offer insights into the development and evaluation of disaster nursing courses and other subjects in the undergraduate nursing curriculum.

Beyond the fear: Nurses' experiences caring for patients with Middle East respiratory syndrome: A phenomenological study

AIM AND OBJECTIVES

To explore the experiences of Korean nurses who had directly cared for patients with Middle East respiratory syndrome (MERS) and to derive the structure and meaning of these experiences.

BACKGROUND

In 2015, the MERS epidemic struck Korea, and ill-prepared nurses had to care for patients with MERS. Nurses experienced conflict between their fear of the disease and their work and professional ethic.

DESIGN

We employed a phenomenological qualitative approach.

METHODS

Inductive, qualitative, in-depth interviews were performed with 17 nurses. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS

The qualitative inductive content analysis generated seven theme clusters and 18 themes. The theme clusters were "Fear of Uncertainty," "Beyond Hesitation," "A Scene Like a Battlefield," "Chaotic Nursing Identity," "Buttresses for Sustainability," "Lingering Trauma" and "Expanded Horizon of Nursing." The final analysis revealed that the core theme was "Beyond the fear of uncertainty."

CONCLUSIONS

This study contrives a more in-depth, holistic understanding by describing the experiences of nurses who directly cared for patients with MERS-the first large-scale infectious disease in Korea. Although nurses saw themselves as vital caregivers, they were frightened of the disease, had to work in a harsh environment, experienced various internal conflicts and had to deal with varying forms of uncertainty.

RELEVANCE TO CLINICAL PRACTICE

This study sheds light on the nursing situation during crises involving serious infectious diseases; to combat these, more medical facilities are needed, and staff should be proactively guided on how to care for patients. It can serve as part of a good foundation for further study of medical staff during recurring epidemics.

WITHDRAWN: Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis

BACKGROUND

This review is one of a series of rapid reviews that Cochrane contributors have prepared to inform the 2020 COVID-19 pandemic. When new respiratory infectious diseases become widespread, such as during the COVID-19 pandemic, healthcare workers' adherence to infection prevention and control (IPC) guidelines becomes even more important. Strategies in these guidelines include the use of personal protective equipment (PPE) such as masks, face shields, gloves and gowns; the separation of patients with respiratory infections from others; and stricter cleaning routines. These strategies can be difficult and time-consuming to adhere to in practice. Authorities and healthcare facilities therefore need to consider how best to support healthcare workers to implement them.

OBJECTIVES

To identify barriers and facilitators to healthcare workers' adherence to IPC guidelines for respiratory infectious diseases.

SEARCH METHODS

We searched OVID MEDLINE on 26 March 2020. As we searched only one database due to time constraints, we also undertook a rigorous and comprehensive scoping exercise and search of the reference lists of key papers. We did not apply any date limit or language limits.

SELECTION CRITERIA

We included qualitative and mixed-methods studies (with a distinct qualitative component) that focused on the experiences and perceptions of healthcare workers towards factors that impact on their ability to adhere to IPC guidelines for respiratory infectious diseases. We included studies of any type of healthcare worker with responsibility for patient care. We included studies that focused on IPC guidelines (local, national or international) for respiratory infectious diseases in any healthcare setting. These selection criteria were framed by an understanding of the needs of health workers during the COVID-19 pandemic.

DATA COLLECTION AND ANALYSIS

Four review authors independently assessed the titles, abstracts and full texts identified by our search. We used a prespecified sampling frame to sample from the eligible studies, aiming to capture a range of respiratory infectious disease types, geographical spread and data-rich studies. We extracted data using a data extraction form designed for this synthesis. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool. We used a 'best fit framework approach' to analyse and synthesise the evidence. This provided upfront analytical categories, with scope for further thematic analysis. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence intervention implementation and developed implications for practice.

MAIN RESULTS

We found 36 relevant studies and sampled 20 of these studies for our analysis. Ten of these studies were from Asia, four from Africa, four from Central and North America and two from Australia. The studies explored the views and experiences of nurses, doctors and other healthcare workers when dealing with severe acute respiratory syndrome (SARS), H1N1, MERS (Middle East respiratory syndrome), tuberculosis (TB), or seasonal influenza. Most of these healthcare workers worked in hospitals; others worked in primary and community care settings. Our review points to several barriers and facilitators that influenced healthcare workers' ability to adhere to IPC guidelines. The following factors are based on findings assessed as of moderate to high confidence. Healthcare workers felt unsure as to how to adhere to local guidelines when they were long and ambiguous or did not reflect national or international guidelines. They could feel overwhelmed because local guidelines were constantly changing. They also described how IPC strategies led to increased workloads and fatigue, for instance because they had to use PPE and take on additional cleaning. Healthcare workers described how their responses to IPC guidelines were influenced by the level of support they felt that they received from their management team. Clear communication about IPC guidelines was seen as vital. But healthcare workers pointed to a lack of training about the infection itself and about how to use PPE. They also thought it was a problem when training was not mandatory. Sufficient space to isolate patients was also seen as vital. A lack of isolation rooms, anterooms and shower facilities was a problem. Other important practical measures described by healthcare workers included minimising overcrowding, fast-tracking infected patients, restricting visitors, and providing easy access to handwashing facilities. A lack of PPE, and equipment that was of poor quality, was a serious concern for healthcare workers and managers. They also pointed to the need to adjust the volume of supplies as infection outbreaks continued. Healthcare workers believed that they followed IPC guidance more closely when they saw the value of it. Some healthcare workers felt motivated to follow the guidance because of fear of infecting themselves or their families, or because they felt responsible for their patients. Some healthcare workers found it difficult to use masks and other equipment when it made patients feel isolated, frightened or stigmatised. Healthcare workers also found masks and other equipment uncomfortable to use. The workplace culture could also influence whether healthcare workers followed IPC guidelines or not. Across many of the findings, healthcare workers pointed to the importance of including all staff, including cleaning staff, porters, kitchen staff and other support staff when implementing IPC guidelines.

AUTHORS' CONCLUSIONS

Healthcare workers point to several factors that influence their ability and willingness to follow IPC guidelines when managing respiratory infectious diseases. These include factors tied to the guideline itself and how it is communicated, support from managers, workplace culture, training, physical space, access to and trust in personal protective equipment, and a desire to deliver good patient care. The review also highlights the importance of including all facility staff, including support staff, when implementing IPC guidelines.

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.