Researching nurses' use of digital technology during the COVID-19 pandemic.

The adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic.

Australian sonographers' perceptions of patient safety in ultrasound imaging: Part 1 - identifying the main safety concerns, a qualitative study.

Introduction: Patient safety has been an undervalued component of quality healthcare but is a challenging area of research.Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration.This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects.The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients. Methods: A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes. Results: A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control. Conclusion: This study presents a comprehensive analysis of sonographers' perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety.

Special education staff well-being and the effectiveness of remote services during the COVID-19 pandemic.

Since March 2020, many school districts across the country have employed remote learning procedures in response to the COVID-19 pandemic. During the pandemic, schools continued to provide special education services, yet little is known about how services were adapted for remote or hybrid learning during the height of the pandemic in the United States. In the current study, 332 respondents completed a web-based survey that asked what special education services were provided remotely, whether services were deemed effective, and how remote learning has influenced their well-being. Most respondents identified as White (79.5%), females (92.4%), and worked as special education teachers (52.9%) and school psychologists (35.4%). In compliance with federal guidelines, most respondents continued to hold individualized education plan meetings, conduct assessments, and provide interventions and related services. There was a significant decrease in respondents' reports of efficacy and sense of school connectedness during remote and hybrid learning. Respondents' identification as a person of color, along with reports of higher school connectedness and self-efficacy were positive predictors of their perceived effectiveness of remote special education service delivery. Recommendations are made for school districts to inform decisions regarding their approach to special education services and staff support during remote or hybrid learning.

Occupational Social Work: A Field of Practice in Need of Revival

The COVID-19 pandemic focused attention on the high levels of occupational stress experienced by frontline and essential workers. Occupational stress is also not unique to these workers as demonstrated by the consistently high rates of suicide within certain occupational groups. Occupational social work is the specialized field most suited to address the needs of workers under stress, yet it has been in decline in the United States since the 1990s. The factors contributing to this decline are put forward, including managed care, the dominance of the advanced clinical social work license, and the lack of a social work presence in occupational stress effectiveness research. The implications for practice regarding the actions that can be taken by the profession to revive this field and be more responsive to vulnerable workers are discussed. © The Author(s) 2023.

Critical care nursing policy, practice, and research priorities: An international cross-sectional study.

PURPOSE: To examine the status of critical care nursing internationally, assess the impact of the COVID-19 pandemic, and identify research priorities by surveying professional critical care nursing organizations (CCNOs) worldwide. DESIGN: A descriptive survey methodology was used. This study is the sixth worldwide quadrennial review to assess international critical care nursing needs and provide evidence to inform critical care nursing policy, practice and research priorities globally. METHODS: The sixth World Federation of Critical Care Nurses survey of CCNOs was emailed to potential participants from countries with CCNOs or known critical care nurse leaders. Data were collected online using Survey Monkey™. Responses were entered into SPSS version 28 software (IBM Corp.) and analyzed by geographical region and national wealth group. FINDINGS: Ninety-nine national representative respondents participated in the survey (70.7% response rate). The most important issues identified were working conditions, teamwork, staffing levels, formal practice guidelines, wages, and access to quality education programs. The top five CCNO services that were of most importance were providing national conferences, local conferences, workshops and education forums, practice standards and guidelines, and professional representation. Important pandemic-related services and activities provided by CCNOs included addressing emotional and mental well-being of nurses, providing guidance related to nurse staffing/workforce needs, assisting to coordinate efforts to obtain personal protective equipment supplies, serving as a country liaison with the World Health Organization's COVID-19 response activities, and assisting in the development and implementation of policies regarding standards of care. The most important contributions expected from the World Federation of Critical Care Nurses were standards for professional practice, standards for clinical practice, website resources, professional representation, and providing online education and training materials. The top five research priority areas were: stress levels (inclusive of burnout, emotional exhaustion and compassion fatigue); critical care nursing shortage, skill mix and workforce planning; recruitment, retention, turnover, working conditions; critical care nursing education and patient outcomes; and adverse events, staffing levels, patient outcomes. CONCLUSIONS: The results highlight priority areas for critical care nursing internationally. The COVID-19 pandemic impacted critical care nurses as direct care providers. As a result, addressing the ongoing needs of critical care nurses remains a priority area of focus. The results also highlight important policy and research priorities for critical care nursing globally. Results of this survey should be incorporated into strategic action plans at the national and international levels. CLINICAL RELEVANCE: Issues of importance to critical care nurses including research and policy priorities during and following COVID-19 are now clarified through this survey. The impact and importance that COVID-19 has had on critical care nurses and their preferences and priorities are provided. Clear guidance to leaders and policy makers on where critical care nurses would like to see greater focus and attention to help strengthen the contribution of critical care nursing practice to the global healthcare agenda.

The modest impact of the COVID-19 pandemic on training expectations at internship programs offering specialization in neuropsychology.

Objective: Given the decreased clinical training opportunities during the COVID-19 pandemic, this study aimed to provide insights into how training directors and supervising neuropsychologists from internships offering neuropsychology training adjusted expectations of competitive applicants. Method: Respondents (n = 50) from internships offering at least an "exposure" in neuropsychology completed questions about how training expectations of competitive applicants have changed because of the COVID-19 pandemic. Results: Most respondents reported decreased expectations for clinical hours and research productivity and increased expectations for telehealth experience and involvement in working with culturally diverse populations. Additionally, more than half of respondents from programs at university-affiliated and Veteran Affairs medical centers indicated reduced expectations for average number of integrated reports. Furthermore, compared to respondents at Veteran Affairs medical centers, respondents at university-affiliated medical centers stated decreased expectations for average number of paper presentations. Conclusions: The COVID-19 pandemic has motivated subtle changes in expectations of competitive neuropsychology-oriented internship applicants, specific to clinical experience, research productivity, and prioritization of certain application materials. Qualitative responses suggest that many respondents endeavored to improve applicant screening rather than lower expectations for applicants. As a result, consistent with previous recommendations, the importance of fit between trainee and training program should continue to be emphasized by prospective applicants. These findings have important implications for trainees for the next several years, as graduate students at all stages of training ultimately progress to the internship application stage.

Supporting children's nurses to deliver trauma-informed care.

World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.

Developing a leadership programme for junior nurses.

Lifelong learning is an expectation of all nurses and nursing associates. However, after preceptorship there is limited guidance on how junior nurses can progress in their careers. Formal training programmes were limited by pressures associated with the coronavirus disease 2019 (COVID-19) pandemic, as well as long-term financial and resource restrictions across the NHS. Nurses' expectations of professional development and well-being have also been affected by their experiences during the pandemic. This article explores how nurses in management positions can create professional development opportunities for nurses, particularly in leadership. The author identifies how leaders can support their staff to broaden their skills and knowledge despite pressures on staffing and resources.

Supporting nursing, midwifery and allied health professional teams through restorative clinical supervision.

The mental health and wellbeing of healthcare staff have been significantly affected by the demands resulting from the recent COVID-19 pandemic. Restorative supervision is a type of clinical supervision that supports reflective practice that can help build practitioners' resilience by focusing on the individual's experience, aiming to sustain their wellbeing and their motivation at work. This model has been shown to reduce stress and burnout and increase compassion satisfaction. This article discusses the implementation of a restorative clinical supervision programme used to support staff wellbeing in nursing, midwifery and allied health professional teams in a large London-based NHS trust.

Doing things you never imagined: Professional and ethical issues in the U.S. outpatient physical therapy setting during the COVID-19 pandemic.

OBJECTIVE: Despite being the most prevalent physical therapy practice setting in the United States, no literature to date has examined the professional and ethical issues faced by outpatient physical therapists during the COVID-19 pandemic. The purpose of this study was to explore professional and ethical issues experienced by outpatient physical therapists in the United States during the COVID-19 pandemic. DESIGN: An explorative semi-structured interview study using reflexive thematic analysis METHODS: Virtual semi-structured interviews explored physical therapists' experiences during COVID-19 in the OP setting. Data was analyzed using reflexive thematic analysis as described by Braun and Clarke. RESULTS: Respondents worked predominantly with patients with orthopaedic impairments. Six primary themes and associated subthemes were identified: 1) Disruption of routine professional and personal life. 2) Negative impacts on health and wellbeing (physical, mental, and social). 3) Barriers to relationships, communication, and providing quality care. 4) Telehealth as a safe option to increase access with opportunities and challenges. 5) Discomfort practicing in an environment of misinformation, mistrust, and divisiveness. 6) New & pre-existing ethical issues in the COVID-19 context. CONCLUSIONS: Results of this study indicate that physical therapists in the outpatient setting wrestled with critical questions regarding outpatient physical therapy practice during the COVID-19 pandemic: the role of touch in professional identity, challenges to the therapeutic alliance, effect of productivity and fiscal expectations and whether outpatient physical therapy is essential during public emergencies.

Overcoming Disaster Through Critical Consciousness and Ideological Change

In this commentary, I argue that the systemic inequities driving and resulting from the wide-ranging immediate and long-term effects of COVID-19 are the key issue around which our field should rally as we reconceptualize school psychology in the 21st century. I offer this commentary as complementary to the growing body of scholarship describing reforms and practices to address the current and long-term challenges of COVID-19, as well as to broader calls to address systemic racism wherein critical consciousness and interrogation of the roles of systematic racism in the field are prerequisite to action and sustained practice change. I first enumerate the multisystem, intersectional complexities of the COVID-19 disaster, synthesizing scholarship on how it has been particularly detrimental to minoritized communities and students, as a basis for fostering critical awareness. I then propose three core ideological shifts as the basis for expansive reflection and re-envisioning across all areas of professional activity. I conclude with implications for graduate educators and scholars to support fieldwide transformation as the field endeavors to rise to the challenge of this historic unfolding and advance social justice and antiracism. Impact Statement COVID-19 as more than a matter of health or disparities thereof-indeed, it is a disaster-because of the consequences across all domains of life and social systems. School psychology's short and long-term responses to COVID-19 and advancing social justice and antiracism should be grounded in ideological shifts foundational to lasting change in rhetoric and other practices. These include centering the most marginalized, uprooting white supremacy in our field, and conceptualizing trauma and associated professional responses intersectionally.

Innovation: It's in Our DNA.

Colleen M. Kigin, PT, DPT, MS, MPA, FAPTA, the 52nd Mary McMillan Lecturer, is a consultant focused on innovation. She is a visiting clinical professor at the University of Colorado physical therapy program, University of Colorado School of Medicine, and an adjunct associate professor at the MGH Institute of Health Professions (MGH IHP). From 1998-2014, she held the positions of chief of staff and program manager for the Center of Integration of Medicine and Innovative Technology, a 12-institution consortium based in Boston, Massachusetts, developing innovative solutions to health care problems. She subsequently has served as a consultant to such efforts as the University of Manchester, Manchester Academic Health Science Centre, United Kingdom, to develop an innovation culture. In 1994, she joined the newly formed Partners HealthCare System in Boston, coordinating the system's cost reduction efforts through 1998. Kigin previously served as director of physical therapy services at Massachusetts General Hospital (MGH) (1977-1984) and as assistant professor at MGH IHP (1980-1994). While at MGH, she was responsible for the merger of 2 separate physical therapy departments, the establishment of the first nonphysician specialist position, and practice without referral for the physical therapy services. Kigin has held numerous positions within the American Physical Therapy Association (APTA), serving on the Board of Directors from 1988-1997, including as vice president; co-chair of The Physical Therapy Summit in 2007; and co-chair of FiRST, the Frontiers in Rehabilitation, Science and Technology Council. She also served as prior chair of the APTA Committee on Clinical Residencies and served on the American Board of Physical Therapy Specialties. Kigin earned a bachelor of science degree in physical therapy at the University of Colorado, a master of science degree at Boston University, a master's degree in public administration from the Harvard Kennedy School of Government, and a doctor in physical therapy degree from the MGH IHP.

Moral distress in advanced practice nurses during the COVID-19 pandemic.

BACKGROUND: Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic. AIM: To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic. METHOD: This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues. FINDINGS: A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All of the respondents expressed concerns about patients due to delayed care and about the mental well-being of their colleagues, particularly those who were redeployed to COVID-19 wards. CONCLUSION: The COVID-19 pandemic has caused moral and psychological distress for APNs. However, the type of distress and its direct causes varied among these practitioners. Tailored support is required to address moral distress and subsequently improve staff retention.

Supporting nurse leaders to recognise and mitigate the effects of moral injury.

The concept of moral injury has been around for several decades, yet its effect on nurses remains under-recognised. Moral injury is defined as the biopsychosocial harm that arises from a violation of one's moral code, meaning that a person is powerless to uphold and enact what they believe is morally right. The coronavirus disease 2019 (COVID-19) pandemic has brought the issue of moral injury into focus because many nurses and other healthcare professionals have encountered potentially morally injurious events, resulting in increased pressure and emotional demands. It is essential that nurse leaders recognise moral injury if its effects are to be addressed. This article describes moral injury and its effects on nurses, and offers nurse leaders a practical framework for mitigating this issue. The framework aims to support nurse leaders to increase their understanding of moral injury, address any ethical challenges, ensure they are adequately prepared to provide support to nurses, and enhance their awareness of various interventions that can mitigate moral injury.

Measuring moral distress in nurses during a pandemic: Development and validation of the COVID-MDS.

The COVID-19 pandemic created novel patient care circumstances that may have increased nurses' moral distress, including COVID-19 transmission risk and end-of-life care without family present. Well-established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID-19 Moral Distress Scale (COVID-MDS), which was designed to provide a short MDS that includes both general and COVID-19-specific content. Researcher-developed COVID-19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach's alpha. A two-factor CFA model had good model fit and strong loadings, providing evidence of a COVID-19-specific dimension of moral distress. Reliability for both the general and COVID-19-specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID-MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID-19 specific sources.

A School Nurse and a Technology Specialist: Partnering for Improved Processes During COVID-19.

School nurses have worked tirelessly during the COVID-19 pandemic. At times, the workload has been unsustainable and there were not enough hours in the day for school nurses to complete their duties. In one school district, the high school nurse and instructional technology specialist collaborated on improving the process of collecting COVID-19 information. This resulted in dramatically reducing the amount of time it took to process information and improved the way the data were collected and shared. This article describes the steps in pandemic-related data collection and communication used before and after implementation of the improved tools and processes. The authors also provide forms, email templates, and the resulting district COVID-19 metric figures helpful to school nurses desiring to replicate the process.

Supporting the well-being of nursing students and student midwives during the COVID-19 pandemic.

Throughout the coronavirus disease 2019 (COVID-19) pandemic the Queen's University Belfast Connections (QUB Connections) project has provided online well-being support to nursing students and student midwives. The project, which was co-designed and led by students and academic staff, provided an online well-being service for students who took on front-line roles during the early part of the pandemic and for those who had to pause their studies. Insights gained from responses to an evaluation of the support sessions suggested that some students felt stigmatised, frightened, lost, isolated and abandoned during this period, but that QUB Connections gave them a sense of 'being held' and 'attended to' in a time of uncertainty. The evaluation findings are a reminder of the need to continue to help nursing and midwifery students and newly qualified staff develop self-care and support mechanisms. QUB Connections is now embedded in the university's school of nursing and midwifery pre-registration programmes to support students and those new to nursing and midwifery practice.

Using coaching and action learning to support staff leadership development.

During the coronavirus disease 2019 pandemic, nurse leaders and managers have been compelled to prioritise immediate issues in their clinical areas and put aside the professional development of staff. However, leadership development for individuals and teams is essential to ensure nurses feel valued and develop the skills required for team cohesion, problem-solving, decision-making and innovation. Simple and effective approaches to staff leadership development are needed. Two such approaches are coaching and action learning. This article provides an introduction to coaching and action learning as approaches nurse leaders and managers can use to promote leadership development among individual team members and within the team. It describes how coaching and action learning work and their potential benefits and challenges. It explains how the two approaches can be used to underpin effective problem-solving and goal setting, and support nurses in their professional development, the ultimate aim being to deliver safe and effective patient care.

A most vulnerable population: Black men.

Black men disproportionately experience the worst health outcomes among U.S. populations. Systemic social, political, and healthcare problems are important intersecting issues of Black men's poor health outcomes. As nursing is one of the most trusted professions, it is nurses' responsibilities to include care for vulnerable populations. In this creative controversy an alternative perspective of Black men as a vulnerable population is proposed. Potential tensions and an introspective call to action for all nurses is included.

Out and about: Factors associated with nurses' use of COVID-19 personal protective behaviors when not at work.

AIM: To characterize nurses' engagement in Centers for Disease Control and Prevention promoted personal protective behaviors (PPBs) outside the work setting during the COVID-19 pandemic and factors that inform engagement in these behaviors. BACKGROUND: Nurses' health is of vital importance to the functioning of the healthcare system. Little is known as to what informs nurses' use of PPBs outside the work setting. DESIGN: Cross-sectional survey study. SETTINGS: A large healthcare system in the southeastern region of the United States. PARTICIPANTS: Nine hundred fifty eight registered nurses. METHODS: Participants surveyed during the week of September 14th. Survey contained questions regarding factors that may be linked to nurses' compliance with PPBs. RESULTS: The most frequently reported behavior practiced outside work was "cover mouth with cough or sneeze." Concern for COVID-19 infection and confidence in masks to control the spread of COVID-19 were positively related to both frequency and number of protective behaviors engaged in (p < .01), while fatigue was inversely related to engagement with PPBs (p = .01). There was some evidence that viewing self as role model may predict behavior. CONCLUSIONS: Personal factors drive engagement with protective behaviors outside the work setting. Implications for nursing management and education are explored.