[Measuring missed nursing care during the Covid-19 pandemic: methodological reflections]. / Misurare le missed nursing care in tempi di Covid-19: riflessioni di metodo.

. Measuring missed nursing care during the Covid-19 pandemic: methodological reflections. Missed care phenomenon has demonstrated an increasingly interest of the researchers over the years. Even during the pandemic period, many studies have been published with the aim of describing missed care during this healthcare emergency. The comparative studies (Covid-19 versus non-Covid-19) were innovative; however, no important differences have emerged. On the other hand, many studies have been published with a descriptive intent, also in this case without highlighting substantial differences as compared to the pre-pandemic period. These findings bring out a series of methodological reflections, which should be considered to advance research in this field.

The nursing care for the medical device related pressure injury patient with a mucosal pressure injury due to an endotracheal tube: a case report.

BACKGROUND: Pressure injury (PI) due to medical devices is one of the most common PIs, especially in patients treated in intensive care. Medical device-related pressure injuries (MDRPIs), as part of their treatment, require extra care and prevention interventions than injuries caused by immobilization. Standardized nursing models are needed to care for PIs caused by medical devices on mucous membranes. PURPOSE: To provide information about the evaluation and care of the MDRPIs in the mucosal membrane due to the endotracheal tube (ET). CASE REPORT: A 35-year-old male with chronic obstructive pulmonary disease (COPD) and coronavirus disease has MDRPIs on the lower lip edge due to the ET on the fifteenth day after intubation. North American Nursing Diagnosis Association (NANDA) diagnoses were determined by systematically analyzing the data using the Gordon's Functional Health Patterns (GFHP) model in the patient. Nursing care was planned and applied in line with the determined NANDA diagnoses, Nursing Outcomes Classification (NOC) interventions, and using the recommendations of current PI guides for treatment of MDRPIs. CONCLUSION: This case report illustrates MDRPIs resulting from ET and provides information about the formation of MDRPIs and appropriate maintenance therapy. Future research is recommended to examine and evaluate the nursing care and outcome of MDRPIs in different mucosal membranes.

Anesthetic considerations for the management of the surgical patient with COVID-19 / Consideraciones anestésicas para el abordaje del paciente quirúrgico con COVID-19

Resumen Introducción: La situación actual causada por el COVID-19 demanda la implementación de nuevas técnicas en el manejo anestésico y los riesgos preexistentes en los servicios quirúrgicos. Objetivo: Identificar las consideraciones anestésicas para pacientes con COVID-19 con el fin de sugerir intervenciones en el área quirúrgica. Metodología: Revisión integrativa de alcance descriptivo en conjunto con el cumplimiento de los pasos metodológicos de Whittemore-Knafl y los parámetros PRISMA. Se realizó la búsqueda en las bases de datos: PubMed, BVS, Coronavirus Research Database, SCOPUS, Elsevier y SAGE. Se obtuvieron 953 artículos que, junto a un análisis crítico por CASPe, cumplieron los criterios establecidos de inclusión y exclusión. Resultados: Se seleccionaron 27 artículos clasificados en: criterios de selección de técnica anestésica; anestesia general y el uso de medicamentos específicos para el manejo anestésico que disminuyan la tos y prevengan la liberación de aerosoles; manejo de la vía aérea encaminada a evitar intubaciones fallidas; anestesia regional y consideraciones de enfermería sobre la preparación de elementos y dispositivos de manera previa al ingreso del paciente al quirófano; identificación y monitorización de pacientes sintomáticos y asintomáticos durante el proceso perioperatorio. Conclusión: Con respecto a la técnica anestésica, es importante priorizar el uso, en cuanto sea posible, de la anestesia regional guiada con ultrasonido. En caso de requerirse la anestesia general, es recomendable mantener las precauciones para prevenir el contagio con el virus. Para enfermería, es destacable el rol en la preparación de un entorno quirúrgico seguro, del conocimiento sobre la técnica anestésica empleada y los cuidados individualizados según las necesidades requeridas.

Abstract Introduction: The current situation caused by COVID-19 demands the implementation of new techniques in anesthetic management and pre-existing risks in surgical services. Objective: to identify the anesthetic considerations for patients with COVID-19 to suggest interventions in the surgical area. Methodology: Integrative review of descriptive scope in conjunction with compliance with the methodological steps of Whittemore-Knafl and the PRISMA parameters. The search was performed in the following databases: PubMed, VHL, Coronavirus Research Database, SCOPUS, Elsevier, and SAGE. A total of 953 articles were obtained, which together with a critical analysis by CASPe, met the established inclusion and exclusion criteria. Results: Twenty-seven articles classified as: selection criteria for anesthetic techniques; general anesthesia and the use of specific medications for anesthetic management that reduce cough and prevent the release of aerosols; airway management to avoid failed intubations; regional anesthesia and nursing considerations in the preparation of elements and devices prior to the patient's admission to the operating room; identification and follow-up of symptomatic and asymptomatic patients during the perioperative process. Conclusion: Regarding the anesthetic technique, it is important to prioritize the use, as far as possible, of ultrasound-guided regional anesthesia. If general anesthesia is required, it is advisable to maintain precautions to prevent infection with the virus. For nursing, the role in preparing a safe surgical environment, knowledge of the anesthetic technique used and individualized care according to the required needs stand out.

The relationship between nurse burnout, missed nursing care, and care quality following COVID-19 pandemic.

OBJECTIVES: To determine the relationship between nurse burnout, missed nursing care, and care quality following the COVID-19 pandemic. BACKGROUND: Quality of care and missed nursing care can be consequences of nurse burnout. Little is known about how these factors related to nurse burnout following the COVID-19 pandemic. DESIGN: This study used a cross-sectional correlational design and was conducted in 12 general hospitals across Thailand from August to October 2022. METHODS: 394 nurses providing direct nursing care to patients during the COVID-19 pandemic completed the survey. The Emotional Exhaustion (EE) subscale of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), MISSCARE survey, and quality of care reported by nurses were used to collect data. Descriptive statistics and logistic regression models were used to analyse the data. RESULTS: Approximately thirty-six percent of nurses had burnout following the COVID-19 pandemic. Missed nursing care was higher among nurses with burnout. Most participants reported illness/symptoms such as anxiety, fatigue, a lack of concentration, and sleeping problems. After adjusting for demographic characteristics, every additional unit of emotional exhaustion was associated with 1.61 times higher odds of missed nursing care, 3.37 times higher odds of poor quality of nurse care, and 2.62 times higher odds of poor quality of care for the overall unit. CONCLUSION: The study findings demonstrate that burnout is associated with missed nursing care and poor quality of care following the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Policymakers, hospital administrators, and nurse managers should invest in strategies to reduce nurse burnout, which can increase patient safety and quality of care.

Psychological experiences of nurses caring for patients with COVID-19: Integrative review based on qualitative research.

AIM: To analyse the literature on nurses' psychological experiences caring for COVID-19 patients, focusing on qualitative research. DESIGN: An integrative review. REVIEW METHODS: Whittemore & Knafl's approach was used. DATA SOURCES: Six databases were searched using the terms 'nurses', 'psychological experiences' and 'COVID-19'. RESULTS: Ten studies were selected and analysed. Five characteristics related to nurses' negative psychological experiences, four characteristics related to positive psychological experiences and seven coping strategies of nurses were identified. CONCLUSION: This study demonstrated the need for psychological, social, financial and organizational support for nurses to improve mental well-being and the level of nursing care. No Patient or Public Contribution.

Three Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic.

OBJECTIVE: To examine the relationships of three missed critical nursing care processes on labor and delivery units with reduced nursing time at the bedside and adequacy of unit staffing during the COVID-19 pandemic in the United States. DESIGN: A cross-sectional survey. SETTING: Online distribution from January 14 to February 26, 2021. PARTICIPANTS: A national convenience sample (N = 836) of registered nurses employed on labor and delivery units. METHODS: We conducted descriptive analyses on respondent characteristics and critical missed care items adapted from the Perinatal Missed Care Survey. We conducted robust logistic regression analyses to assess the relationships of three missed critical nursing care processes (surveillance of fetal well-being, excessive uterine activity, and development of new maternal complications) with reduced nursing time at the bedside and adequacy of unit staffing during the COVID-19 pandemic. RESULTS: Less nursing time at the bedside was associated with greater odds of missing any of the critical aspects of care, adjusted odds ratio = 1.77, 95% confidence interval [1.12, 2.80]. Adequate staffing greater than or equal to 75% of the time was associated with lower odds of missing any of the critical aspects of care compared to adequate staffing less than or equal to 50% of the time, adjusted odds ratio = 0.54, 95% confidence interval [0.36, 0.79]. CONCLUSION: Perinatal outcomes are dependent on the timely recognition of and response to abnormal maternal and fetal conditions during childbirth. In times of unexpected complexity in care and resource constraints, a focus on three critical aspects of perinatal nursing care is needed to maintain patient safety. Strategies that enable bedside presence of nurses, including maintaining adequate unit staffing, may help to mitigate missed care.

Relationship between moral sensitivity of nurses and quality of nursing care for patients with COVID-19.

AIM: This study aimed to: (1) assess the level of moral sensitivity of nurses and the quality of nursing care for patients with COVID-19 in Iran; and (2) identify the relationship between the moral sensitivity of nurses and the quality of nursing care for patients with COVID-19 in Iran. DESIGN: This study was designed as a descriptive, cross-sectional, and correlational research. METHOD: A total of 211 nurses working in four hospitals affiliated with the Hamadan University of Medical Sciences in Iran from December 2021 to April 2022 were selected via the stratified proportional random sampling method. Demographic information, a moral sensitivity questionnaire, and the Good Nursing Care Scale were used for data collection. The data were analysed by SPSS 24 based on descriptive and inferential statistics (Pearson correlation coefficient and multiple regression). RESULTS: Results revealed that 188 of the nurses (89.1%) had a moderate level of moral sensitivity. Furthermore, 160 of the participants (75.8%) reported a relatively low level of the quality of nursing care. The results of the Pearson correlation coefficient test indicated that there was an inverse and significant relationship between the moral sensitivity of nurses and the quality of nursing care (r = -0.528, p < 0.001). The results of multiple regression indicated that the model of moral sensitivity components explained 27.9% of the variance in the quality of nursing care. The components of moral sensitivity, including relation (ß = -0.246, p < 0.001), meaning (ß = -0.188, p = 0.003), conflict (ß = -0.170, p = 0.008), benevolence (ß = -0.153, p = 0.012), and rules (ß = -0.144, p = 0.019) had inverse and significant effects on the quality of nursing care. CONCLUSION: Since higher mean scores of moral sensitivity reflect lower moral sensitivity, it can be stated that with the increase in moral sensitivity of nurses, the quality of nursing care for patients with COVID-19 grows.

Covid-19 pandemic and Brazilian Nursing: unveiling meanings of work.

The objective of this study was to reflect on the meanings of the work of Brazilian nursing care in the context of the Covid-19 pandemic. This is a theoretical study anchored in the definition of meanings of work, according to Estelle Morin's perspective. The work developed by nursing professionals became even more evident in pandemic times, with the precarious conditions of health services in Brazil coming to light. During the pandemic, the incorporation of meanings of work became more important, given that the society recognized the relevance of these professionals in dealing with the pandemic, and this allowed the discussion about their social, political, and economic recognition. The impacts of nursing performance during the Covid-19 pandemic are related to the economic issue, social values, autonomy in the exercise of the profession, recognition, and safety, reflecting on the sense of purpose of work. Thus, the work that makes sense for nursing professionals is related to professional appreciation, specifically, to salary recognition, while what makes no sense is what hinders intellectual, cognitive, and financial progress. Thus, conditions were imposed that give directions to ambivalent meanings to work.

Supporting Feeding of Late Preterm Infants in the Hospital: A Quality Improvement Project.

BACKGROUND: Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding. PROBLEM: At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice. METHODS: The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice. RESULTS: Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic. CONCLUSION: Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.

Establishment of infection prevention and control strategy in nursing managements during surgical operations in COVID-19 patients based on Delphi method.

AIM: The aim of this study was to establish an infection prevention and control strategy for nursing managements during surgical operations in coronavirus disease 2019 (COVID-19) patients. DESIGN: A Delphi method. METHODS: Between November 2021 and March 2022, we first formulated a preliminary infection prevention and control strategy based on the literature review and institutional experience. Then, we applied Delphi method and performed expert surveys to reach a final strategy for nursing managements during surgical operations in COVID-19 patients. RESULTS: The strategy included seven dimensions with 34 items. The positive coefficients of Delphi experts in both surveys were 100%, indicating a high coordination among experts. The degree of authority and expert coordination coefficient were 0.91 and 0.097-0.213. After the second expert survey, value assignments for importance of each dimension and item were 4.21-5.00 and 4.21-4.76 points, respectively. The coefficients of variation for dimension and item were 0.09-0.19 and 0.05-0.19, respectively. PATIENT OR PUBLIC CONTRIBUTION: Except the medical experts and research personnel, there was no other patient or public contribution involved in the study.

Patients' satisfaction with nursing care quality and associated factors: A cross-section study.

AIM: This research aimed to evaluate patients' satisfaction with the nursing care quality during their hospitalization. DESIGN: Quantitative cross-sectional descriptive design. METHODS: A convenience sample of 238 patients were recruited from hospitals in two provinces in Saudi Arabia. Patient satisfaction was measured by the Arabic version of the Patients' Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ-Ar). RESULTS: Significant differences were found between Saudi provinces regarding the overall quality of nursing care (M = 4.65, p < 0.001). The study revealed mean significant variations between patient satisfaction with nursing care and sociodemographic factors, including age (p = 0.002), education level (p = 0.047), marital status (p = 0.017), employment status (p = 0.038), urban vs. suburban residence (p = 0.006), length of hospitalization (p = 0.001), and accompaniment by a family member (p = 0.014). Improving patients' experience during their hospitalization requires regular examination of the quality of nursing care services. PATIENT CONTRIBUTION: This research enhances our understanding of patients satisfaction toward the quality of nursing care received during hospitalization.

Experience in the development of nurses' personal resilience: A meta-synthesis.

AIM: Nurses play roles in hospitals, families, society and other aspects and often face stress sources, such as heavy workload, doctor-patient conflict and medical accidents. Resilience can help the nurses to avoid or reduce various adverse consequences caused by stress sources; however, this phenomenon remains ill-defined and under-researched. The aim of this review was to summarize the experiences of development of nurses' resilience and explore the reasons for the formation of resilience by examining the findings of the existing qualitative studies. DESIGN: The review is a systematic review and meta-synthesis of qualitative studies. DATA SOURCES: PubMed, Cochrane Library, CINAHL, Web of Science, Embase, and Ovid and Chinese databases include the following: Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database and China Biomedical Database (CBM). REVIEW METHODS: Relevant publications were identified by systematic searches across 11 databases in June 2021. All qualitative and mixed-method studies in English and Chinese that explored the experiences of development of nurses' resilience were included. The qualitative meta-synthesis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected the studies and assessed the quality of each study. Meta-synthesis was performed to integrate the results. RESULTS: A total of nine studies revealed 10 sub-themes and three descriptive themes: being psychologically strong, physical positive coping and adoption of external support. CONCLUSION: Several factors contributed to the development of nurses' resilience, and various supporting strategies in the nursing management and education are helpful to their adaption ability. However, it is necessary to focus on the cultivation of nurses' resilience to improve the quality of clinical nursing. Leaders or organizations are required to establish and sustain multifaceted strategies to improve nurse' resilience through scientific resilience training programmes and improved organizational support.

Nursing Care of an Older Patient With Severe COVID-19 Receiving Prolonged Prone Ventilation: A Case Report.

INTRODUCTION: Prone positioning has been shown to improve ventilation status for patients with severe COVID-19 who are receiving mechanical ventilation. This case report describes the nursing care of a patient with severe COVID-19 who underwent prone ventilation for 72 hours. Relevant nursing management and operational considerations are also discussed. CLINICAL FINDINGS: An 83-year-old woman was admitted to the hospital with fatigue, dizziness, and positive tests for SARS-CoV-2 on nasopharyngeal swab specimens. The patient was intubated. DIAGNOSIS: The patient's positive tests for SARS-CoV-2, chest computed tomography findings, and clinical symptoms were consistent with a diagnosis of severe COVID-19. INTERVENTIONS: When the patient's condition did not improve with mechanical ventilation and intermittent prone positioning, she was placed in the prone position for 72 hours. She received sedation, analgesics, anti-infective medications, and enteral nutrition support in the intensive care unit. Nurses performed dynamic monitoring based on blood gas analysis results to guide lung rehabilitation. OUTCOMES: The patient was weaned from the ventilator on day 20 and successfully discharged home on day 28 of hospitalization. CONCLUSION: During prolonged prone ventilation of a patient with severe COVID-19, nursing strategies included airway management, early lung rehabilitation training guided by pulmonary ultrasonography, skin care, hierarchical management of nurses, hemodynamic support, and enteral nutrition. This report may assist critical care nurses caring for similar patients.

Description of COVID-19 patients and mapping nursing data to ICNP 2021 reference set in SNOMED CT.

AIM: To describe nursing care of COVID-19 patients with International Classification for Nursing Practice (ICNP) 2019, ICNP 2021 reference set, and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). BACKGROUND: From the beginning of the COVID-19 pandemic, nurses have realised the importance of documenting nursing care. INTRODUCTION: It is important to recognise how real nursing data match the ICNP reference set in SNOMED CT as that is the terminology to be used in Iceland. METHODS: A descriptive study with two methods: (a) statistical analysis of demographic and coded clinical data identified and retrieved from Electronic Health Record (EHR) and (b) mapping of documented nursing diagnoses and interventions in EHRs into ICNP 2019, ICNP 2021 and SNOMED CT 2021. RESULTS: The sample consisted of all (n = 91) adult COVID-19 patients admitted to the National University Hospital between 28 February and 30 June 2020. Nurses used 62 different diagnoses and 79 interventions to document nursing care. Diagnoses and interventions were best represented by SNOMED CT (85.4%; 100%), then by ICNP 2019 version (79.2%; 85%) and least by the ICNP 2021 reference set (70.8; 83.3%). Ten nursing diagnoses did not have a match in the ICNP 2021 reference set. DISCUSSION: Nurses need to keep up with the development of ICNP and submit to ICN new terms and concepts deemed necessary for nursing practice for inclusion in ICNP and SNOMED CT. CONCLUSION: Not all concepts in ICNP 2019 for COVID-19 patients were found to have equivalence in ICNP 2021. SNOMED CT-preferred terms cover the description of COVID-19 patients better than the ICNP 2021 reference set in SNOMED CT. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Through the use of ICNP, nurses can articulate the unique contribution made by the profession and make visible the specific role of nursing worldwide.

Leadership Science in Nursing: Creating New Solutions for New Challenges.

The Association for Leadership Science in Nursing (ALSN) November 2022 International Conference was held at the Frances Payne Bolton School of Nursing at Case Western University. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. One hundred fifty-one nurse leaders from the United States, Canada, and Oman gathered to discuss leadership as highlighted in this column.

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.

A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models.

The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].

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.

Quality management in the COVID-19 pandemic: nursing action plan.

OBJECTIVES: to describe the implementation of a nursing action plan to face the pandemic of COVID 19 in a University Hospital in the state of Rio de Janeiro. Methods: this is an experience report, in which two management tools were used: the Ishikawa Diagram to identify problems and the 5W2H spreadsheet to outline the actions according to the situations presented. RESULTS: four categories were listed in two groups: 1- Actions of the Nurse Manager in the Organization of Logistics, Infrastructure and Care: materials and environment; and 2- Nursing Human Resources Management and Continuing Education: method and human resources. FINAL CONSIDERATIONS: the plan developed showed the role of nursing management, with the search for best care practices, development of protocols, carrying out multi-professional training and management of supplies.