Ethics and frontline nursing during COVID-19: A qualitative analysis.

BACKGROUND: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. RESEARCH AIM: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. RESEARCH DESIGN: Qualitative analysis using a directed content methodology. PARTICIPANTS AND RESEARCH CONTEXT: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. ETHICAL CONSIDERATIONS: Participant privacy and data confidentiality were addressed. FINDINGS: Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. DISCUSSION: This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. CONCLUSIONS: Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.

Update in cutaneous manifestations of COVID-19: Special populations.

Cutaneous abnormalities were among the first clinical findings reported in patients infected with SARS-CoV-2 at the onset of the COVID-19 pandemic, but the significance was initially unclear. Correlations have since been drawn between many of these cutaneous eruptions and their diagnostic or prognostic value. Additionally, COVID-19 vaccines have generated acute and delayed cutaneous reactions with which clinicians should be familiar. In this narrative review, we update the cutaneous abnormalities associated with COVID-19 infection for pediatric and non-White populations, and common cutaneous reactions to COVID-19 vaccines.

Optimizing the Role of the Hospital-Based Nurse Scientist in a Changing Nursing Environment: Recommendations for Nurse Leaders.

Nurses and nurse leaders directing clinical organizations can elevate scholarly inquiry by employing a PhD-prepared hospital-based nurse scientist (HBNS). This individual will shape the culture of clinical inquiry, leading and driving efforts to close the gap between knowledge and practice. As the nursing workforce struggles to recover from the COVID-19 pandemic, now more than ever, collaborations between HBNSs and nurse leaders are essential to explore and test new nursing care delivery systems. Given the national shortage in the PhD-prepared nurse scientist talent pool, attracting and hiring the right candidate is critical. The purpose of this article is to provide practical recommendations for nurse leaders to introduce an HBNS into an organization as an important building block for nursing science and improved clinical practice. The role of the HBNS has evolved in tandem with increased education in the nursing workforce, evidence-based practice, and the explosion of implementation science. Before recruiting an HBNS, the organization must create a job description that outlines responsibilities, paying attention to the HBNS position within the organizational structure. Additionally, leaders must consider the candidate's characteristics for interacting with clinical staff. The senior nursing leadership team must recognize and appreciate the HBNS as a scholar and advisor.

Nursing perspectives about the critical gaps in public health emergency response during the COVID-19 pandemic.

INTRODUCTION: The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses. DESIGN: We conducted a secondary thematic qualitative analysis using grounded theory methodology. METHODS: Data collection occurred through semi-structured, in-depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.'s Public Health Emergency Preparedness Framework and inductively for emergent themes. RESULTS: Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need. CONCLUSION: From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.

COVID-19 PANDEMIC IMPACT ON RADIOTHERAPY IN PATIENTS WITH HEAD AND NECK CANCER

Introduction: The COVID-19 pandemic has a significant impact on the primary, secondary and tertiary levels of the health system. In a low-middle income countries such as Bosnia and Herzegovina, ensuring optimal oncology care was challenging even before the COVID-19 pandemic. Since the beginning of the COVID-19 pandemic, there was a warning of the possible impact of worsening mortality and/ or morbidity due to delayed diagnosis and suboptimal treatment.1 The COVID 19 pandemic has impact on reducing the number of patients treated with radiotherapy.2 The aim of our study was to analyze the impact of the COVID-19 pandemic on radiotherapy in a patient with head and neck cancer who were treated with radiotherapy in a tertiary health care facility. Methods: We analyzed data from the institutional databases for radiotherapy of the Oncology Department at University Clinical Hospital Mostar, Bosnia and Herzegovina. We performed data extraction for patients with head and neck cancer who were treated with primary or adjuvant radiotherapy with or without chemotherapy from January 2018 to December 2021. Results: A total of 114 patients were treated with radiotherapy for head and neck cancer in the pre- COVID-19 period (2018-2019) and COVID-19 period (2020-2021). There were more patients treated with radiotherapy in the preCOVID19 period, 64 (56%) compared to the COVID19 period, 50 (44%). In the COVID 19 period, the number of patients treated with radiotherapy was reduced by 22% compared to the preCOVID19 period. Conclusion: A decline innumber of patients treated with radiotherapy in the COVID 19 period was detected. Health system optimization and education of the general population about the negative indirect impact of COVID 19 on the health system, diagnosis and treatment of cancer is needed.

INPATIENT ONCOLOGY CARE - IMPACT OF COVID-19 PANDEMIC, SINGLE-CENTER EXPERIENCE

Introduction: Last two pandemic years significantly changed our lives in many ways and also oncology care. Medical centers adapted to the situation and reorganized the service, including service on oncology departments. Inpatient Oncology Department, University Clinical Hospital Mostar, had a reduced number of hospital beds for oncology patients, patients had to own a negative RT-PCR COVID-19 test before admission, visits to patients were prohibited and patients were restricted from moving outside the department. We were interested in how these measures impacted our inpatient care in terms of the number of visits. Methods: We retrospectively analysed data from the Hospital Information System (BIS) for the University Clinical Hospital Mostar, Inpatient Oncology Department. We looked for the number of inpatient visits at our department within the 'pre-pandemic period', between 9 March 2018 to 31 January 2020, compared with the 'pandemic period', between 9 March 2020 to 31 January 2022. Furthermore, we made additional analyses by subunits: radiotherapy subunit and chemotherapy subunit. We calculated the percentage difference between the 'pre-pandemic period' and the 'pandemic period'. Results: Within the 'pre-pandemic period', the total number of inpatient visits was 1818, of which 1601 were at the chemotherapy subunit, and 217 were at the radiotherapy subunit. In the 'pandemic period' we had the total number of inpatient visits 1591, 1443 at the chemotherapy subunit, and 148 at the radiotherapy subunit. In the 'pandemic period' we had 87.5% of the total number of inpatient visits from the 'pre-pandemic period', 90.1% of the chemotherapy inpatient visits, and 68.2% of the radiotherapy visits. This was a 12.5% decrease in the total number of inpatient visits in the 'pandemic period' as compared with the 'pre-pandemic period'. The decrease in the number of chemotherapy visits was 9.9% and 31.8% for radiotherapy visits in the 'pandemic period' compared with the 'pre-pandemic period'. Conclusion: Measures that were taken to control the COVID-19 pandemic had a noticeable impact on inpatient oncology care in terms of patient visits, especially in terms of radiotherapy admissions. The extent to which these measures affect patient outcomes will be shown in the future and should be the subject of research.

HOW OFTEN ONCOLOGISTS RECORD THE PATIENTS' COVID-19 INFECTION IN THEIR FINDINGS

Introduction: COVID-19 pandemic significantly affects cancer care and the work of oncologists. Also, in cancer patients experiencing COVID-19 infection, oncological care, and therapeutic sequence may be disrupted by the infection itself. In our Inpatient Oncology Department at University Clinical Hospital Mostar, during the pandemic, all patients that are hospitalized in the regular procedure should possess a negative RT-PCR COVID-19 test. Until this pandemic, the epidemiological history for most infectious diseases was not part of the standard information collected for cancer patients by their oncologists. There is also a known fact of under-reporting by physicians.Talking about toxicities, under-reporting of severe toxicities ranged from 13 to 50% even in prospectively randomized trials. During the pandemic, our Hospital Information System (BIS) was adjusted, so if the patient has been RT-PCR COVID-19 tested in our institution, oncologists can see the last test results through the BIS and the Electronic Medical History (EPB), also for all previous test results too. But we were interested in how much oncologists changed their practice, and whether they record information about patients' COVID-19 infection in their findings. Methods: We retrospectively reviewed data from the Hospital Information System (BIS) of the Oncology Department at University Clinical Hospital Mostar. We extracted data on patients who tested positive for COVID-19 in our hospital before visiting the Inpatient Oncology Department, for patients hospitalized in the period from 1st December 2021 to 20 February 2022. Determining the date of the positive RT-PCR COVID-19 test, we reviewed oncological findings after infection in Electronic Medical History (EPB) to detect whether the prevalence of the COVID-19 infection was recorded in the oncological findings of these patients. Results: Within the period from 1st December 2021 until 20 February 2022, we detected 41 patients with previous RT-PCR COVID-19 positive test results, tested at University Clinical Hospital Mostar. We found records of the COVID-19 infection in oncological findings for 25 of detected 41 patients (60.9%). All other patients, 16 of them (39%), did not have records of previous COVID-19 infection or positive results in oncological findings. Conclusion: Even thoughCOVID-19 infection can affect the morbidity and mortality of cancer patients and the therapeutic sequence, and although oncologists in their findings do report this infection, it is still under-reported in high percent.

Moral Injury and Moral Resilience in Health Care Workers during COVID-19 Pandemic.

Background: The 2019 coronavirus (COVID-19) pandemic placed unprecedented strains on the U.S. health care system, putting health care workers (HCWs) at increased risk for experiencing moral injury (MI). Moral resilience (MR), the ability to preserve or restore integrity, has been proposed as a resource to mitigate the detrimental effects of MI among HCWs. Objectives: The objectives of this study were to investigate the prevalence of MI among HCWs, to identify the relationship among factors that predict MI, and to determine whether MR can act as buffer against it. Design: Web-based exploratory survey. Setting/Subjects: HCWs from a research network in the U.S. mid-Atlantic region. Measurements: Survey items included: our outcome, Moral Injury Symptoms Scale-Health Professional (MISS-HP), and predictors including demographics, items derived from the Rushton Moral Resilience Scale (RMRS), and ethical concerns index (ECI). Results: Sixty-five percent of 595 respondents provided COVID-19 care. The overall prevalence of clinically significant MI in HCWs was 32.4%; nurses reporting the highest occurrence. Higher scores on each of the ECI items were significantly positively associated with higher MI symptoms (p < 0.05). MI among HCWs was significantly related to the following: MR score, ECI score, religious affiliation, and having ≥20 years in their profession. MR was a moderator of the effect of years of experience on MI. Conclusions: HCWs are experiencing MI during the pandemic. MR offers a promising individual resource to buffer the detrimental impact of MI. Further research is needed to understand how to cultivate MR, reduce ECI, and understand other systems level factors to prevent MI symptoms in U.S. HCWs.

Design of an Affordable Module for Body Temperature Measurement and Capacity Control in Commercial Establishments to Avoid the Increase of Contages by Sars-Cov2

This research presents a solution to increase the protection and security in health control in supermarkets and other places where lots of people make different activities. The design of the module includes body’s temperature measurement and control of the capacity that a commercial place can have with the restrictions given by current state of pandemic. Also, this project provides an affordable approach by using through low-cost electronic components. © 2020. Review of International Geographical Education. All Rights Reserved.

United States nurses' experiences during the COVID-19 pandemic: A grounded theory.

OBJECTIVE: The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored. DESIGN: A qualitative study design was used. METHODS: Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty-three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study. RESULTS: The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self-care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping. CONCLUSIONS: Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses face added distress as frontline at-risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions.

Diabetes as a risk factor for in-hospital mortality in patients with covid-19: A systematic review

Diabetes mellitus has been directly related to an increase in mortality associated with COVID-19, for which reason it was decided to carry out this analysis. Objective: to systematically examine the available empirical studies that report on diabetes as a risk factor for in-hospital mortality in patients with COVID-19. Methodology: A systematic review of publications indexed in the following browsers were performed: Pubmed, Scielo, Hindawi, Latindex, Redalyc, Scopus, Taylor and Francis, Springer Link, Web of Science, EBSCO, in a period between the end of 2019 and the beginning of 2021, choosing those that were related to the topic to be treated, in a complementary way this search was made using the keywords mentioned below: “coronavirus disease 2”, “COVID-19”, “SARS-CoV2”, “Coronavirus”, “Mortality”, “Prediction”, “Predictor”, “adults”, “diabetes”, “hyperglycemia”, “death”, and the connections of these with Boolean connectors” AND” and “OR” were made. Results: 23 articles were studied that met the selection criteria, where most of the publications were retrospective with distribution according to the sex of 56.6% for males and 43.4% for females, with a prevalence of diabetes in patients with COVID-19 on average of 20.71% with 54.41% in men and 45.59% for women, at an average age of 66.57 years. Conclusion: in general, this comorbidity has a higher incidence in people infected by the type of coronavirus, in the same way, in almost all of the articles evaluated it was identified that diabetes was an independent risk factor for mortality from COVID-19.

An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19.

BACKGROUND: During the COVID-19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis. PURPOSE: To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes. METHODS: We conducted an integrative review of team nursing and delegation using Whittemore and Knafl's (2005) methodology. RESULTS: We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses' delegation knowledge, decision-making, and competency. LINKING EVIDENCE TO ACTION: Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.