Assessing the country-level involvement of nurses in COVID-19 vaccination campaigns: A qualitative study

BACKGROUND

As each country individually manages the COVID-19 pandemic, mass vaccination campaigns have varied considerably. Implementation campaigns often depend on nurses; however, nurses are not consistently involved in higher-level planning, prioritization, and policy development decisions. This study aimed to examine the involvement and engagement of nurses in country-level COVID-19 mass vaccination policies and practices in 10 Office of Economic Cooperation and Development countries, identify barriers and factors to enhancing the engagement of nurses in the evidence-informed mass vaccination decision-making processes, and suggest areas for improvement.

METHODS

A qualitative study using in-depth semi-structured interviews was conducted as a follow-up study to an International Council of Nurses survey. The study sample included a purposeful sample of 14 country-representative nurses from 10 Office of Economic Cooperation and Development countries. Interview questions focused on each country's overall COVID-19 vaccination campaign and policies, participants' perspectives regarding the involvement of nurses in the planning, design, and implementation of the mass vaccination program observed outcomes, and the impact of nursing on the outcomes. Interviews were recorded, transcribed, translated where necessary, coded, and thematically analyzed.

RESULTS

Main areas of involvement identified by participants were membership in advising and decision-making committees, operationalization planning, implementation and coordination processes, education efforts, and nurses' interactions with the media. Seven themes emerged among perceived facilitators of nursing involvement: existing systems and infrastructure, nursing profession-related skills and competencies, communication and messaging, multidisciplinary and interagency work, recognition and visibility of nurses and nursing, trust in nurses, and nursing pride. Meanwhile, perceived barriers included lack of a voice, recognition and appreciation for nursing, workforce-related challenges, decentralization of responsibility and authority, supply and access issues, downstream effects of the pandemic, and non-COVID-related nursing barriers. Three main themes emerged among suggestions made by participants for improved involvement of nursing: culture change within nursing and healthcare, opportunities and momentum to build upon, and perceptions of responsible parties.

CONCLUSIONS

Nurses play a central role in providing health services but are inconsistently included in the policy, planning, and decision-making processes. Findings highlighted the critical importance of nursing leadership roles and expanded roles for nurses. Nursing should be represented by high-level leaders as part of multidisciplinary decision-making groups, educational initiatives for involvement in health policy should be implemented in nursing schools and continuing education, and advocacy and inclusion efforts should utilize bottom-up and top-down approaches concurrently.

Nursing our planet

AIM

The aim of this article is to explore the role of nurses with regards to climate change and other humanitarian challenges.

BACKGROUND

The climate crisis facing our planet is not just about extreme weather events. To be properly understood and addressed, climate change should be recognised as a global public health emergency that needs urgent attention from governments everywhere.

DISCUSSION

In this article, International Council of Nurses (ICN) Chief Executive Officer Howard Catton discusses the links between climate change, nursing practice and advocacy. He argues that the crises the world faces, including those related to global warming, can be handled better if they are understood as public health crises, and that having nurses involved in policymaking at every level in society provides the best chance of individuals' health needs being met. Conclusion and Implications for Nursing and/or Health Policy: Nurses must be actively involved in policymaking that addresses the humanitarian and public health impact of climate change and natural and human-made disasters. Only half the world's countries have a government-level chief nursing officer who is able to represent the nursing profession at the highest levels of policymaking. This deficit should be corrected as soon as possible so that the voices of nurses are heard and respected, and patients everywhere can benefit from the direct input of nursing into all government policies that influence people's health and well-being.

International Nurses Day: Nurses can change the world, given the investment and support they deserve

Every year on International Nurses Day (IND), the International Council of Nurses (ICN) releases a report with resources that can be used by nurses around the world. This year's report responds to the World Health Organization's (WHO) latest strategy for nursing and midwifery, and the findings of the State of the World's Nursing report. In this article, ICN Chief Executive Officer Howard Catton describes the main points of the IND report and recommends that nurses everywhere read it, alongside the WHO strategy, and use that information to increase their knowledge of the global nursing workforce and influence global healthcare policy. It is a toolkit that can assist nurses, other healthcare providers, governments and international organisations to turn global strategy into meaningful local action and improved clinical practice on the ground.

Two years into the pandemic massive investment in nursing is more urgent than ever

The COVID‐19 pandemic has taught us some very painful lessons about underinvestment in healthcare and the lack of adequate preparation for a pandemic. In this article, ICN Chief Executive Officer Howard Catton examines the World Health Organization's review of global preparedness and looks to the future and how nursing can contribute to better planning and health outcomes for all.

International Council of Nurses representing nursing at the World Health Organization: COVID-19, policy and holding politicians to account

The International Council of Nurses is in a unique position to represent nurses at the World Health Organization, and its task has never been more urgent than this year. Amid the global COVID‐19 pandemic, the death rates of nurses and other health care workers are truly shocking, with around 115 000 deaths. However, many countries do not collect statistics on health and care workers’ deaths and infections from COVID‐19, so the full extent of this awful situation is not known.

At this year's World Health Assembly, the body that sets the World Health Organization's agenda for the following year, the International Council of Nurses’ 50‐strong delegation voiced the concerns of nurses and ensured that the views and advice of nurses were heard by the World Health Organization's 194 member states’ delegates. Here, the International Council of Nurses’ Chief Executive Officer Howard Catton describes how the Council is influencing health and care policy worldwide. He urges nurses everywhere to hold their politicians to account.

Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene

PURPOSE

To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide.

DESIGN

Discussion paper.

METHODS

Literature review.

FINDINGS

Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems.

CONCLUSIONS

Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels.

CLINICAL RELEVANCE

Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.

ROLE OF NURSING IN REHABILITATION

Evidence shows that, in order to attain optimum outcomes, rehabilitation interventions should be delivered by multi-professional teams. A rehabilitation nurse is one of the relevant rehabilitation professionals. The model of nursing care has shifted from the traditional model (a passive role of patients) to a complex and modern concept of nursing in supporting patients to independently and actively perform self-care. This paper briefly introduces the role of nurses in rehabilitation, from the point of view of rehabilitation service delivery, which is relevant in all phases and types of rehabilitation care, including acute rehabilitation, post-acute rehabilitation, long-term rehabilitation, nursing home and geriatric care, and in community- based rehabilitation service.

COVID-19: The future of nursing will determine the fate of our health services

Preparing the world to manage future pandemics must take priority. It is clear that we were not prepared for the COVID‐19 pandemic which continues to cause great suffering around the world. Nurses and other health professionals everywhere must be involved in health policy planning and implementation of public health measures to combat this and future pandemics. Such preparation needs community policy involvement at grassroots levels and needs to be collaboratively instigated at international levels. The death so far of over 2000 nurses is unacceptable in this pandemic, and we need to better protect and sustain the workforce. The International Council of Nurses has been instrumental in data gathering of nurses' experiences during COVID‐19. Key points from analysis of this data have been included in Second Progress Report of the World Health Organization's Independent Panel for Pandemic Preparedness and Response. This paper summarises the key messages from this report, as well as the nursing shortage. The International Council of Nurses resounds the call for massive investment in nursing education, leadership and jobs, as well as protection for our nurses on the frontlines of the pandemic.

Nursing - a core element of rehabilitation

AIM

2020 was been acknowledged by the World Health Organization as the International Year of the Nurse and the Midwife. On this occasion, the Global Rehabilitation Alliance and the International Council of Nurse would like to conceptually reflect the role of nurses in rehabilitation.

BACKGROUND

Rehabilitation and nursing are strictly ingrained. Rehabilitation aims at improving, reaching and maintaining optimal functioning of persons with disability and persons with health conditions experiencing disability. Nursing is defined as use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life. Nursing has a crucial role in all phases of rehabilitation care (acute, post-acute and long-term rehabilitation). Nurses deliver rehabilitation in many settings, in nursing homes and community-based rehabilitation. The main principle is not to deliver care for the patient but deliver care with the patient. This includes explaining, demonstrating and practising with the goal to help the patient to (re-)gain independence.

DISCUSSION

Nurses play an important role in delivering rehabilitation and are involved in all aspects of the multidimensional rehabilitation process. One of the important points is that in most settings, nurses are the professionals with a prolonged relationship with patients and families, and may have the best insight into the patients' personal and contextual factors with regard to the rehabilitation process.

CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

Strengthening nursing in rehabilitation is a vital factor to deliver high-quality rehabilitation and to achieve optimum outcomes. For this reason, we urge all relevant stakeholders at governmental and rehabilitation service provider levels to work towards these goals.

Nursing and health policy perspectives 2020 - a year to remember or one to forget?

2020 has certainly been a year of challenges for nurses and healthcare workers around the world with the relentless spread of COVID-19. These challenges are many, including countries and health systems not being prepared for a pandemic, shortages of personal protective equipment and acute shortages of nurses, poor communication from governments and the lack of accurate data regarding COVID-19 morbidity and mortality among nurses and health workers. Nurses are suffering from psychological distress and are exhausted and burntout as the pandemic's second wave moves around the world. Many have been subjected to violence and aggression from people in their communities. Against this backdrop, nurses' contributions have been vital in saving lives and the profession has learnt many powerful lessons that will resonate in nursing practice for the future. But governments must do more, including ensuring nurses receive vaccinations early to protect them when a successful vaccine becomes available.

Tackling diabetes: how nurses can make the difference

This year, World Diabetes Day on 14 November coincides with the International Year of the Nurse and the Midwife, and therefore focuses on highlighting the role of nurses in the prevention and management of diabetes.

Diabetes is recognized as an important cause of premature death and disability globally and in the Eastern Mediterranean Region, where its prevalence has been steadily increasing since 1990. Although the annual decline of the risk of dying from a major noncommunicable disease between the ages of 30 and 70 years is slowing globally, diabetes is showing a 5% increase in attributed premature mortality. In 2016, diabetes was the direct cause of 1.6 million deaths globally and 43% of all deaths before the age of 70 years occur due to high blood glucose. Overweight and obesity are the strongest risk factors for type 2 diabetes. In addition, diabetes increases the risk of heart disease and stroke and is a leading cause of blindness, lower limb amputation and kidney failure. A study conducted in 35 countries indicated that people living with diabetes are more likely to experience catastrophic health expenditures with an estimated increase of 4% between diabetic and non-diabetic individuals, regardless of their insurance status.

Global nursing leadership: alive and kicking in the midst of the COVID-19 pandemic

As the COVID-19 pandemic continues its journey around the world, it has triggered a global nursing response, with nurses everywhere working to save the lives of their extremely sick patients. In parallel with the frontline response, the International Council of Nurses, the World Health Authority and the International Confederation of Midwives have used their biennial Triad meetings to set out what needs to be done from a global perspective to protect nurses and the people they serve. At a time of crisis, it is imperative that the world's nursing leaders, through ICN's National Nursing Associations, step up to give support and guidance at this historically unsettling time.

Nursing in the COVID-19 pandemic and beyond: protecting, saving, supporting and honouring nurses

As the world tackles the largest public health event in more than a century, the COVID‐19 pandemic, the true value of nursing is being seen by politicians and the public. But while nurses are being praised for the vital work they do, many are being put into high‐risk situations, and some have died, because of a shortage of appropriate, high‐quality personal protective equipment. The International Council of Nurses has called for governments to make the provision of such equipment their number one priority to prevent further loss of life among the nurses caring for the world’s most vulnerable patients.

Global challenges in health and health care for nurses and midwives everywhere

The next decade is likely to produce any number of global challenges that will affect health and health care, including pan‐national infections such as the new coronavirus COVID‐19 and others that will be related to global warming. Nurses will be required to react to these events, even though they will also be affected as ordinary citizens. The future resilience of healthcare services will depend on having sufficient numbers of nurses who are adequately resourced to face the coming challenges.

We need to rethink global spending priorities

The Alma-Ata declaration, signed by 134 countries in 1978, was a landmark for public health. It recognised that the 'attainment of health by people in one country directly concerns and benefits every other country', and that economic and social development, alongside improved access to primary healthcare, is critical to attaining health for all.

WHO director-general's address marks a major moment for nursing

There was a palpable sense of a profession on the move and on a mission last month, as more than 8,000 nurses from over 100 countries gathered in Barcelona for the International Council of Nurses (ICN) congress.

Every country must commit to improving working conditions

Global institutions understand the importance of the health workforce in improving healthcare and are worried about staff shortages.

Costs of prevention are dwarfed by the costs of failure

The stand-out message from this year's Global Patient Safety Summit, held in Germany last month, is that there is big money in prevention.

'Women are the ingredients of development'

The executive board of the World Health Organization (WHO) comprises 34 countries with expertise in health, including the UK.

Nursing is stronger when we work together

There are some striking similarities between Brexit and the election of Donald Trump as president of the United States: anger with an out-of-touch establishment, a desire to take back control and many people feeling left behind by globalisation.

We must convince the government to invest in the health workforce

In New York on 21 September, a potentially game-changing report was submitted to the secretary general of the United Nations.

It takes a brave heart to be a nurse in a war-torn country

Nurses and health workers are being targeted for attack on unprecedented levels. We need to take action now to stop this.

Building bridges in an uncertain world

Three months into my new role at the International Council of Nurses (ICN), it is clear that nursing is high on the agenda of big global institutions.

The profession needs to come together like never before

As I prepare to leave the RCN to join the International Council of Nurses, I am struck by what a huge moment this is for the profession.

Planning nurse staffing: are we willing and able?

Academic research and public enquiries demonstrate the link between adequate staffing levels and patients’ experiences and outcomes. Health care providers have a legal duty to ensure (and demonstrate to care regulators) that staffing levels are safe. Yet evidence of effective workforce planning, locally or nationally, is scarce. A plethora of tools exist to help employers to determine nurse staffing required. Although not perfect, the technical resource is none the less available to support planning, but are we willing to use it? In England the different systems have not been reviewed or tested and there is no consensus about the best approach to use. This paper asserts that decisions about current and future configurations of the nursing workforce are currently taken in a data vacuum. Fundamental aspects of nurse deployment – the proportion of registered nurses, the ratio of patients to nurse – are not systematically captured or recorded, either nationally or locally. We argue that a first step in planning is to establish this baseline. We need data on nursing inputs to relate to the growing body of data on patient outcomes, to enable managers and policy makers to understand the efficacy of current workforce configurations and inform future plans.

Healthcare support staff must be regulated

Every day tens of thousands of dedicated healthcare support workers (HCSWs) provide personal and complex care to patients, often with little supervision and support.

Devolution: the effects on health policy

Health policy modernisation and political devolution in the UK creates a challenge for all involved. This article examines this challenge from a nursing perspective.