Fear of COVID-19 among critical care nurses of public hospitals in Lahore: empirical evidence during third wave

The world has seen a pandemic that dis-rupted life. Till now there are aftershocks of COVID-19 such as Omicron instilling fear among individuals. Healthcare staff is on alert specifically the nurses have suffered a lot mentally due to this issue by developing fatigue. The study was conducted during the deadly 3rd COVID-19 wave. The data were collected by developing the questionnaire of the previously validated measures related to the variables under study from nurses working in the intensive care unit, critical care unit, and floor wards of COVID-19 at Services Hospital, Lahore. A total of 140 questionnaires were used for data analysis. The study used Statistical Package for Social Sciences for frequency and descrip-tive statistics. Whereas the outcomes of fear of COVID-19 were assessed by using the latest Smart Partial Least Squares software which allows to assess the complex research frameworks. The results of the study revealed that the fear of COVID-19 results in poor quality of life among nurses and fatigue. Resilience among nurses can reduce the negative consequences but did not get statistical support.

Graduating Student Nurses' Preparedness for Nursing Practice amid COVID-19

Student nurses must be prepared professionally to provide nursing care, especially during a critical time such as COVID-19. Regardless of undergraduate nursing programmes focusing on preparedness for practice, the concept of preparedness for nursing practice is not well understood. In this descriptive quantitative study, we determined the extent of the nursing practice preparedness of graduating student nurses amid COVID-19 as perceived by these nurses and nurse educators and the possible interventions to enhance the preparedness for practice of these nurses. In the study, we used an adapted Nursing Practice Readiness Tool, employed the complete enumeration survey method and analysed through frequency, percentages and weighted means. A total of 118 student nurses and 51 nurse educators from a selected university completed the questionnaire. The data were analysed through SPSS version 25. The findings revealed that the scales, which ranked from greatest to lowest preparedness for practice, were: professionalism (4.83), communication (4.65), management of responsibilities (4.61), critical thinking (4.36), clinical knowledge (4.26), and technical skills (4.02). We concluded that the students' performance in the nursing competency items under clinical knowledge, critical thinking, and especially technical skills, demand increased attention to be better equipped as they transition into nursing practice. Specifically, of the 36 competency items, they were least prepared in using clinical and information technologies, and performing clinical procedures. Finally, as the top intervention, we proposed the development of contingency plans for unusual situations such as a pandemic (75.74%) to enhance the student nurses' preparedness for practice.

Cladribine Tablets: A Review of the Practical Considerations in Multiple Sclerosis Nursing Practice

Nurses specializing in the care of patients with multiple sclerosis (MS) are uniquely positioned to provide personalized care. Patients prescribed cladribine tablets (taken for <=10 days per year for 2 years), indicated for adults with highly active relapsing MS in the EU and Australia, can benefit from an active partnership with their healthcare professionals, including MS nurses, who can promote an understanding of and the adherence to treatment. In clinical studies, patients treated with cladribine tablets had lower annual relapse rates, greater odds of being relapse free, a longer time to sustained progression of disability and a significant reduction in radiological disease activity compared with patients receiving placebo. Patients should be advised that, although everyone will have a different experience, the safety of cladribine tablets is supported by 16 years of clinical trial and post-approval data. Furthermore, there is no indication of a more serious disease course or more severe outcomes for patients with MS treated with cladribine tablets who acquire coronavirus disease 2019 compared with the general population or other patients with MS. This article presents practical considerations that may help achieve a greater understanding of the potential benefits and drawbacks of MS treatment, build the patient-nurse relationship, encourage shared decision-making and ultimately may improve careCopyright © Touch Medical Media 2022

Race/Ethnicity Differences in COVID-19 Vaccine Uptake Among Nurses.

INTRODUCTION: There is evidence for relatively lower COVID-19 vaccine uptake among people of color in the United States. The purpose of this study was to investigate associations between race/ethnicity and COVID-19 vaccine uptake among nurses. METHODS: Nurses in Southern California (N = 1183) completed a one-time, web-based survey to assess COVID-19 vaccine perceptions and uptake. RESULTS: In all, 82.8% of respondents (N = 979) received at least one COVID-19 vaccine dose. Identifying as East Asian was associated with 14% higher odds of COVID-19 vaccine uptake relative to identifying as White (odds ratio [OR] = 1.14/95% confidence interval [CI] = [1.06, 1.24]); identifying as Filipino was associated with 14% higher odds of uptake (OR = 1.14/95% CI = [1.08, 1.20]); and identifying as Hispanic/Latinx was associated with 6% higher odds of uptake (OR = 1.06/95% CI = [1.00, 1.12]). DISCUSSION: Although nurses and people of color have been identified as groups with low levels of COVID-19 vaccine uptake, this study found that nurses of color received the vaccine at higher levels than their White counterparts.

An exploration of the experiences of respiratory clinical nurse specialists (CNS) and advance nurse practitioners (ANP) in Irish healthcare settings

Background: Nursing practice in Ireland are continually evolving. The introduction of the respiratory CNS/ANP role is one of the most significant changes in recent years. Respiratory CNS/ANP have responsibilities under their scope of practice NMBI (2015) to contribute to the education of their colleagues and patients. The respiratory CNS and ANP brings benefits for patients and consultants, however, raises issues in relation to boundaries affecting identity. Aim(s): Exploring the experience of respiratory CNS/ANP education, knowledge, learning and wellbeing in their clinical health environment. Methodology: This qualitative study is influenced by hermeneutic phenomenology. Ethical approval and permission were obtained, and a gatekeeper forwarded study information to potential participants. Fifteen participants participated in one-to-one semi-structured interviews, via digital media, recorded and transcribed. Result(s): Findings suggest that respiratory CNS/ANP enhance nursing professionalisation which was especially during COVID-19 pandemic and contribute to the empowerment of nursing and nurse education. Respiratory CNS/ANP enhances, compliments nursing practice, enabling a more agentic practitioner, though challenges to this have been identified. Conclusion(s): This study provides an account of the practice and experiences of respiratory CNS/ANP in the Irish health care setting, developing direct knowledge from those experiences. Findings from this research can inform those with direct responsibility for the regulation of respiratory CNS/ANP nursing practice and those responsible for education and research in the nurse context.

Abdominal Haematomas following subcutaneous heparin injections in COVID19 patients, Food for thought in daily practice

Introduction: Abdominal haematomas are an uncommon complication of subcutaneous injection of low molecular weight heparin (LMWH) although the latter is widely administered. Aim(s): To review clinical cases of abdominal haematomas following subcutaneous LMWH injection, discover the root causes and identify appropriate solutions to improve clinical practice. Material(s) and Method(s): Retrospective case review of all clinical cases linked to abdominal haematomas secondary to LMWH injection. Result(s): Between 09.2020-01.2022, 760 patients were admitted in our Department due to COVID19 pneumonia. 4 cases of abdominal haematomas were reported (all females, mean age 70.5 years). All patients received therapeutic LMWH(3 for atrial fibrillation). All patients presented haematomas on rectus abdominis muscle and subsequently in the pelvic area. All patients presented with haemodynamic instability and required blood transfusions. Clinical outcomes included death (1), nephrostomy (1) (due to haematoma expansion and ureteral obstruction) and prolonged hospital stay by 12 days (2). Route cause analysis revealed improper injection technique in the following order;narrow abdominal margins, no skin folding, injection speed<10secs. Solutions were identified and followed including multidisciplinary nursing re-training that was implemented across the board and was accompanied by continuous monitoring of nursing practice. Conclusion(s): The rare complication of abdominal haematomas following LMWH was closely reviewed in our department and was turned into an opportunity to reconsider daily clinical practice, to contribute to quality improvement and improve patient safety.

The long-term impact of COVID-19 on nursing: An e-panel discussion from the International Network for Child and Family Centred Care.

AIM: To explore the International Network for Child and Family Centred Care (INCFCC) members' experiences and views on the long-term impact of COVID-19 on the nursing workforce. BACKGROUND: On the 11 March 2020, the World Health Organization declared COVID-19 a global pandemic. While some countries adopted a herd immunity approach, others imposed stricter measures to reduce the transmission of the virus. Hospitals in some countries faced an avalanche of extremely sick admissions, whereas others experienced an early surge in cases or were able to control the spread. DESIGN: Discursive paper. METHODS: A web-based survey was e-mailed to 63 INCFCC members from 28 March to 30 April 2022, as an invitation to share their experience concerning the long-term impact of COVID-19 on their role as a nurse educator, clinician or researcher. RESULTS: Sixteen members responded, and the responses were grouped under the themes stress and anxiety, safe staffing and pay, doing things differently, impact on research, impact on teaching and learning, impact on clinical practice, nursing made visible and lessons for the future. CONCLUSION: The INCFCC members provided their views and highlighted the impact on their role in nursing education, administration, research and/or practice. This discussion of international perspectives on the similarities and differences imposed by COVID-19 found that the impact was wide-ranging and prolonged. The overarching theme revealed the resilience of the participating members in the face of COVID-19. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of all areas of nursing, be it in academia or in clinical practice, to work together to learn from the present and to plan for the future. Future work should focus on supporting organizational and personal resiliency and effective interventions to support the nursing workforce both during a disaster and in the recovery phase. Nursing workforce resilience in the face of COVID-19.

From the first to the fourth critical period of COVID-19: what has changed in nursing practice environments in hospital settings?

BACKGROUND: The COVID-19 pandemic reinforced the need to invest in nursing practice environments and health institutions were led to implement several changes. In this sense, this study aimed to analyze the impact of the changes that occurred in nursing practice  environments between the first and fourth critical periods of the pandemic. METHODS: Quantitative, observational study, conducted in a University Hospital, with the participation of 713 registered nurses. Data were collected through a questionnaire with sociodemographic and professional characterization and the Scale for the Environments Evaluation of Professional Nursing Practice, applied at two different points in time: from 1 to 30 June 2020 and from 15 August to 15 September 2021. Data were processed using descriptive and inferential statistics. RESULTS: Overall, the pandemic had a positive impact on nursing practice environments. However, the Process component remained favourable to quality of care, while the Structure and Outcome components only moderately favourable. Nurses working in Medicine Department services showed lower scores in several dimensions of the Structure, Process and Outcome components. On the other hand, nurses working in areas caring for patients with COVID-19 showed higher scores in several dimensions of the Structure, Process and Outcome components. CONCLUSIONS: The pandemic had a positive impact on various dimensions of nursing practice environments, which denotes that regardless of the adversities and moments of crisis that may arise, investment in work environments will have positive repercussions. However, more investment is needed in Medicine Department services, which have historically been characterised by high workloads and structural conditions that make it difficult to promote positive and sustainable workplaces.

Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity.

BACKGROUND: Organizational supported evidence-based practice (EBP) enables nurses to be change agents and impact patient outcomes. Globally, a multitude of barriers limits EBP implementation, evaluation, and dissemination, which include time constraints, staff, resource access, education, technology, and fiscal support. These barriers and other disenfranchising elements hinder nurses' ability to actualize EBP and change practice within their workplace. AIMS: This study describes the EBP readiness, barriers, and facilitators reported by inpatient registered nurses (RNs) employed in a nationwide healthcare system before COVID-19. METHODS: The study employed a cross-sectional descriptive survey design using the 2005 Nursing EBP Survey for RN EBP readiness. The setting included 14 hospitals in Southern California. The survey was deployed in November 2016 and closed after 23 weeks. Descriptive statistics analyzed demographics and EBP scores, with inferential statistics for associations between demographics and EBP scores. ANOVA examined differences between EBP scores, service lines, years of employment, and education level. A content approach synthesized open-ended barrier and facilitator questions into seven specific themes. RESULTS: Seven hundred and twenty-four nurses completed the survey. Overall, the scores of inpatient RNs were highest scores for Practice Climate, suggesting the health system fosters a climate conducive to EBP. Scores were lowest for Data Collection and Implementation. Qualitative themes were: (1) Everyone Involved in EBP Implementation, (2) Fear and Resistance to Change, (3) Protected Release Time, (4) Knowing EBP Culture Outside of Current Organization, (5) Organizational Communication and Education, (6) Management and Leadership Support, and (7) Pragmatic Solutions to Facilitate EBP. Fear and Resistance to Change cut across all themes. LINKING EVIDENCE TO ACTION: Nurses at all organizational levels from the C-suite to the bedside can create strategies to determine essential EBP readiness components, including EBP mentors to guide knowledge uptake activities. Pragmatic solutions for EBP capacity require frontline nurse feedback, commitment, and partnership with nursing leaders.

Nursing process, derived from the clinical care classification system components, as an earlier indicator of nursing care during a pandemic.

BACKGROUND: During COVID pandemic response, an early signal was desired beyond typical financial classifications or order sets. The foundational work of Virginia K Saba informed the essential, symbiotic relationship of nursing practice and resource utilization by means of the Clinical Care Classification System [CCC]. Scholars have confirmed the use of the CCC as the structure for data modeling, focusing on the concept of nursing cost [1]. Therefore, the purpose of this retrospective, descriptive study was to determine if analysis of CCC Care Component codes could provide a high granularity signal of early shifts in patient demographics and in nursing care interventions and to, then, determine if nursing care intervention shifts indicated changes in resource utilization. METHODS: For a large multi-facility healthcare system in the USA, patients cared for in an acute care setting/hospital-based care unit were the population of interest. Through prior and ongoing efforts of ensuring Evidenced-Based Clinical Documentation [EBCD], a data model was utilized to determine changes in the patient's nursing diagnoses, nursing interventions, during care episodes, for patients with acute symptoms or diagnosed/confirmed COVID. RESULTS: The structure of CCC revealed 22 billion individual instances of the CCC Care Component/Concept codes for the data sets for 2017 and during COVID, a considerably large data set suitable for pre- and post- event analyses. The component codes were included in a string data set for concept/diagnosis/intervention. DISCUSSION: By our analysis, these CCC Information Model elements determined a clear ability to detect increasing demands of nursing and resources, prior to other data models, including supply chain data, provider documented diagnostic codes, or laboratory test codes. Therefore, we conclude CCC System structure and Nursing Intervention codes allow for earlier detection of pandemic care nursing resource demands, despite the perceived challenges of "timeliness of documentation" attributed to more constrained timelines of data models of nursing care.

Cancer nurses have experienced ‘moral injury' due to the pandemic

First, a Happy New Year to you all. I hope you enjoyed the festive break. In this issue, our cover article (evidence and practice, page 21) explains how emotional labour can lead to exhaustion and burnout, which contributes to a high turnover in the nursing workforce. It examines the differences in resilience and coping strategies of less experienced nurses compared with their more experienced counterparts.

Toward Evidence-Based Practice

Experts suggest how 6 research articles can be used in nursing practice.

Nurse Burnout in Hospice and Palliative Care: A Scoping Review

Burnout in hospice and palliative care nurses is a growing issue, especially in light of the COVID-19 pandemic. However, few studies have focused specifically on burnout in this population. A scoping review was undertaken to identify what is known about burnout among hospice and palliative care nurses, and to unify disparate findings. Analysis of eight articles revealed three overarching categories: personal factors, organizational/workplace factors, and nursing professional development factors. Each category was then divided into three cross-cutting subcategories: contributory and noncontributory factors, mitigating factors, and workplace issues. Recommendations for individuals include self-care as well as self-awareness of intrinsic characteristics that can predispose one to burnout. Within the workplace, leaders are challenged to support evidence-based practice and ongoing education. Role modeling positive communication skills, effective conflict mitigation, responsiveness, promotion of equity, and workplace commitment also help to create a culture of wellness. Nursing professional development may aid in resilience-building, and promotion of self-efficacy, self-confidence, and assertiveness. Although all identified recommendations were derived from the literature, no interventional studies have been conducted to test the effects of suggested interventions. Future research should include interventional studies as well as qualitative research to capture nuanced experiences of burnout in hospice and palliative care nurses.

What a year!

The author discusses the continuing work inequalities endured by general practice nurses (GPN) in 2022 despite nursing's stature as being the most trusted of professions, and the time for nurses to reflect and be proud to be a GPN in 2023.

Valuing tacit nursing knowledge during the COVID-19 pandemic.

Public health nurses in Ontario, Canada, support the healthy growth and development of children across the province through a variety of programs including home visits for pregnant individuals and families with young children. During the COVID-19 global pandemic the needs of families increased while access to health and social services decreased. During this time, home visiting teams closely involved in supporting families also experienced staff redeployment to support pandemic efforts (e.g., case and contact management, vaccinations) and changes to the nature of home visiting work, including shifts to remote or virtual service delivery. To support nursing practice in this new and evolving context, a framework for capturing and sharing the tacit or how-to knowledge of public health nurses was developed. A valuing of this type of knowledge for informing future public health nursing practice - well beyond the pandemic response - was recognized as a pandemic silver lining when reflecting on two years of supporting home visiting teams in our province.

Public health nurses' perceptions and experiences of emergency preparedness, responsiveness, and burnout during the COVID-19 pandemic.

OBJECTIVE(S): To describe PHNs' perceptions and experiences of the COVID-19 pandemic, including training, response activities, and work-related challenges. DESIGN: This was a qualitative study using interpretive description for analysis. SAMPLE: PHN participants who worked in public health departments in Wisconsin were recruited using purposive sampling. A total of 15 PHNs participated in the study, including both general and supervisor-level PHNs. MEASUREMENTS: Data were collected via semi-structured interviews from March to May 2021. Interview questions focused on PHNs' perceptions, experiences, response activities, and burnout in relation to the current pandemic as well as perceptions and experiences of emergency preparedness and response in general. RESULTS: Five themes emerged in the study. These were: (1) experiences and observations of the COVID-19 pandemic, (2) organizational changes and their impacts, (3) public health emergency preparedness and response, (4) public health emergency response activities, and (5) role strain and burnout. CONCLUSIONS: Findings presented here have important implications for PHN training and support in emergency preparedness and response. A wide array of strategies focused on developing and supporting the PHN workforce in response to the public health crisis this area need to be implemented at the organizational, community, and policy levels.

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.