Professional nursing practice environment from students' perspective in COVID-19 / Ambiente de prática profissional em enfermagem na perspectiva de estudantes na COVID-19 / Ambiente de práctica profesional de enfermería por la perspectiva de estudiantes en el COVID-19

Resumo Objetivo Avaliar o ambiente da prática profissional em enfermagem na perspectiva de estudantes no contexto da pandemia da COVID-19. Métodos Estudo transversal, realizado com amostra por conveniência de 43 estudantes da última série do bacharelado em Enfermagem de uma universidade federal, localizada no município de São Paulo, SP, Brasil. Variáveis de caracterização: gênero, etnia, idade, local de estágio e um questionamento se já trabalharam e/ou realizam estágio extracurricular na área. Aplicou-se o Instrumento Practice Environment Scale - versão brasileira validada, composto de 24 itens e 5 subescalas. Os dados foram analisados com estatística descritiva e inferencial por meio dos testes: Kruskal Wallis, ANOVA, Tukey, t-student e Mann Whitney. Foi realizada a análise de regressão logística. Considerou-se como nível de significância de p<0,005. Resultados A Subescala 3 "adequação da equipe e de recursos" foi a única que apresentou média desfavorável (53,49%). A variável "ter trabalhado e/ou realizado estágio extracurricular" mostrou-se estatisticamente significante na Subescala 2 "habilidade, liderança e suporte dos coordenadores/supervisores de enfermagem aos enfermeiros/equipe de enfermagem" (p=0,003). Na média geral, os estudantes avaliaram o ambiente como favorável (p<0,001). Conclusão Apesar do contexto, a maioria dos estudantes avaliaram o ambiente como favorável. A variável "ter trabalhado e/ou realizado estágio extracurricular" foi estatisticamente significativa. A capacitação das lideranças, o fortalecimento de programas de educação continuada e o envolvimento dos enfermeiros nas atividades, resoluções de problemas e comissões internas da instituição, são considerados preâmbulos para ofertar uma assistência qualificada dentro de um ambiente de prática profissional próximo do favorável.

Resumen Objetivo Evaluar el ambiente de la práctica profesional de enfermería por la perspectiva de estudiantes en el contexto de la pandemia del COVID-19. Métodos Estudio transversal, realizado con muestra por conveniencia de 43 estudiantes del último año del grado de Enfermería de una universidad federal, ubicada en el municipio de São Paulo, São Paulo, Brasil. Variables de caracterización: género, etnia, edad, lugar de la pasantía y un interrogante sobre si ya trabajaron o realizan una pasantía extracurricular en el área. Se aplicó el Instrumento Practice Environment Scale - versión brasileña validada, compuesto por 24 ítems y 5 subescalas. Los datos fueron analizados con estadística descriptiva e inferencial por medio de las pruebas: Kruskal Wallis, ANOVA, Tukey, t-student y Mann Whitney. Se realizó el análisis de regresión logística. Se consideró un nivel de significación de p<0,005. Resultados La Subescala 3 "adecuación del equipo y de recursos" fue la única que presentó un promedio desfavorable (53,49 %). La variable "haber trabajado o realizado una pasantía extracurricular" se mostró estadísticamente significante en la Subescala 2 "habilidad, liderazgo y suporte de los coordinadores/supervisores de enfermería a los enfermeros/equipo de enfermería" (p=0,003). En el promedio general, los estudiantes evaluaron al ambiente como favorable (p<0,001). Conclusión Pese al contexto, la mayoría de los estudiantes evaluaron al ambiente como favorable. La variable "haber trabajado o realizado una pasantía extracurricular" fue estadísticamente significante. La capacitación de los liderazgos, el fortalecimiento de programas de educación continua y la participación de los enfermeros en las actividades, resoluciones de problemas y comisiones internas de la institución, son considerados preámbulos para brindar una asistencia calificada dentro de un ambiente de práctica profesional próxima a lo favorable.

Abstract Objective To assess the professional nursing practice environment from the perspective of students in the context of the COVID-19 pandemic. Methods Cross-sectional study conducted with a convenience sample of 43 students attending the last grade of the Nursing Undergraduate course at a federal university located in the city of São Paulo, SP, Brazil. Characterization variables: sex, ethnicity, age, place of internship and a question on whether they have worked and/or did an extracurricular internship in the area. The Practice Environment Scale - Brazilian validated version, consisting of 24 items and five subscales, was applied. Data were analyzed using descriptive and inferential statistics with the following tests: Kruskal Wallis, ANOVA, Tukey, t-student and Mann Whitney. Logistic regression analysis was performed. A significance level of p<0.005 was considered. Results Subscale 3 "Staffing and resource adequacy" was the only one with an unfavorable mean (53.49%). The variable "having worked and/or done an extracurricular internship" was statistically significant in Subscale 2 "Nurse manager ability, leadership and support of nurses" (p=0.003). On overall mean, students rated the environment as favorable (p<0.001). Conclusion Despite the context, most students rated the environment as favorable. The variable "having worked and/or done an extracurricular internship" was statistically significant. The training of leaders, the strengthening of continuing education programs and involvement of nurses in activities, problem solving and internal committees of the institution are considered preambles to offer qualified care within a close to favorable environment of professional practice.

Domains of professional practice: analysis of publications in the Journal of the Medical Library Association from 2010 to 2019.

The Medical Library Association (MLA) has defined 7 domain hubs aligning to different areas of information professional practice. To assess the extent to which content in the Journal of the Medical Library Association (JMLA) is reflective of these domains, we analyzed the magnitude of JMLA articles aligning to each domain hub over the last 10 years. Bibliographic records for 453 articles published in JMLA from 2010 to 2019 were downloaded from Web of Science and screened using Covidence software. Thirteen articles were excluded during the title and abstract review because they failed to meet the inclusion criteria, resulting in 440 articles included in this review. The title and abstract of each article were screened by two reviewers, each of whom assigned the article up to two tags corresponding to MLA domain hubs (i.e., information services, information management, education, professionalism and leadership, innovation and research practice, clinical support, and health equity & global health). These results inform the MLA community about our strengths in health information professional practice as reflected by articles published in JMLA.

Case Study: The Impact of Nursing Professional Practice during the COVID-19 Pandemic at a Large Community Hospital in Canada.

The COVID-19 pandemic posed numerous challenges experienced by healthcare organizations. Nursing professional practice plays a crucial leadership role in supporting nursing staff and leaders in developing policies, parameters and philosophical approaches for delivering safe patient care. The professional practice leadership at Humber River Hospital, a large Canadian community hospital, implemented three key interventions in this hospital-based case study: (1) proactive workforce planning, (2) increased nursing student placements and (3) novel "stretch model of care" in the intensive care unit (ICU). The overall results following the implementation of these interventions resulted in substantial improvements. For example, proactive nursing workforce planning supported both a 98% reduction in agency utilization and an accelerated ICU certification program with an 84% certificate completion rate. Through innovative strategies, there was a significant increase (33-67%) in the number of nursing student placements during the first two years of the pandemic compared with previous years. Within the ICU setting, we maintained optimum ICU capacity that resulted in stronger partnership-driven relationships between nurses and physicians through an interprofessional "stretch model of care." Finally, we avoided emergency department closures and Code Orange calls during peaks of the pandemic.

Design Thinking Like a Nurse: A Professional Practice Model for Nursing Innovation.

The COVID-19 pandemic made creative problem-solving, a skill that nurses have long possessed, more observable and valued. This article presents a new professional practice model for nursing innovation that facilitates practice improvements and leverages skills, strengths, and values that are integral to nursing. This model integrates the nursing process with Design Thinking and Theory U change management processes. A clinical case study illustrates the model's components in a pediatric oncology ambulatory center. Using this practice model, nurse leaders can leverage "design thinking like a nurse," to enhance innovation in health-care settings.

Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System.

Importance: Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents' prescription across racial and ethnic groups has not been well-evaluated. Objective: To investigate differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups. Design, Setting, and Participants: Cross-sectional analysis of data from the US Veterans Health Administration's Corporate Data Warehouse. The sample included adult patients with type 2 diabetes and at least 2 primary care clinic visits from January 1, 2019, to December 31, 2020. Exposures: Self-identified race and self-identified ethnicity. Main Outcomes and Measures: The primary outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active prescription during the study period. Results: Among 1 197 914 patients (mean age, 68 years; 96% men; 1% American Indian or Alaska Native, 2% Asian, Native Hawaiian, or Other Pacific Islander, 20% Black or African American, 71% White, and 7% of Hispanic or Latino ethnicity), 10.7% and 7.7% were prescribed an SGLT2i or a GLP-1 RA, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 8.4% among American Indian or Alaska Native patients; 11.8% and 8% among Asian, Native Hawaiian, or Other Pacific Islander patients; 8.8% and 6.1% among Black or African American patients; and 11.3% and 8.2% among White patients, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 7.1% among Hispanic or Latino patients and 10.7% and 7.8% among non-Hispanic or Latino patients. After accounting for patient- and system-level factors, all racial groups had significantly lower odds of SGLT2i and GLP-1 RA prescription compared with White patients. Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio, 0.72 [95% CI, 0.71-0.74] for SGLT2i and 0.64 [95% CI, 0.63-0.66] for GLP-1 RA). Patients of Hispanic or Latino ethnicity had significantly lower odds of prescription (0.90 [95% CI, 0.88-0.93] for SGLT2i and 0.88 [95% CI, 0.85-0.91] for GLP-1 RA) compared with non-Hispanic or Latino patients. Conclusions and Relevance: Among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.

Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are also nurses. PURPOSE AND METHODS: This qualitative descriptive study used a practice development approach to explore the intersection between academic and professional work experiences for undergraduate Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of Science in Nursing students and Master of Nursing graduate nursing students during the first wave of the COVID-19 pandemic. The study incorporated critical aesthetic reflections that focused on the personal and aesthetic ways of knowing, as a data collection approach and knowledge dissemination strategy. RESULTS: Analysis of the narrative component of participants' reflections revealed the following themes: sensing a "call to duty," experiencing a myriad of emotions, shifting societal and individual perceptions of nursing, and learning in an uncertain environment. CONCLUSIONS: The results of the study can inform educational strategies and academic policies to support this unique nursing population, who are frontline practitioners as well as student learners.

[COVID-19: Professional practices in closed institutional settings]. / COVID-19 et pratiques professionnelles dans les milieux institutionnels fermés.

INTRODUCTION: While governments have focused efforts on implementing health measures such as physical distancing and confinement to protect communities from the spread of COVID-19, some researchers focused on the significant impact of these measures on mental health and well-being. Persons with mental disorders who are both institutionalized and justice-involved in psychiatric and forensic hospitals find themselves more vulnerable to these measures and more limited in their movements and activities. AIMS: The purpose of this paper is to examine the changes in practice in response to the pandemic and their potential impact on individuals in institutional settings. RESULTS: A rapid review including 69 publications identified nine major themes in the literature, which will serve as a framework to analyze the experience of one forensic psychiatry institution in Canada. These themes are: 1) population-specific vulnerability factors; 2) staff management and training; 3) early discharge, parole, and community integration; 4) management of contagion in closed spaces; 5) sanitary measures and personal protective equipment; 6) care and service continuity; 7) use of technology to maintain social ties and services; 8) legal mechanisms and individual rights; and 9) post-pandemic realities. CONCLUSION: Although this is the first pandemic of such international magnitude, experts point to an increase in epidemics over the past decade and continued growth in the coming decades. It is thus essential to learn from this health crisis in order to be prepared and minimize their potential impact on vulnerable populations in the future. The reflections presented here could be contrasted with the lived-experiences of people in institutions in order to nuance the data and propose new strategies.

The lived experience of nurses transitioning to professional practice during the COVID-19 pandemic.

As a result of the COVID-19 pandemic, newly graduating nurses have entered into rapidly changing clinical environments, experiencing healthcare in a manner for which they were not fully prepared. The purpose of this study is to describe the lived experience of these newly graduated registered nurses (RNs) who transitioned to practice during the COVID-19 pandemic, and to gain understanding of how to better prepare future graduates for similar situations. A multisite qualitative phenomenological design was used in this study of 12 frontline nurses that graduated in the spring of 2020 and transitioned into their new role as RNs. A trained research team conducted semistructured interviews and completed a thematic analysis of the data. The results were six themes that emerged from the study participants' interviews: (1) fear, (2) emotional conflict, (3) self-doubt, (4) alone, (5) communication barriers, and (6) finding the positive.

Telenutrition: Changes in Professional Practice and in the Nutritional Assessments of Italian Dietitian Nutritionists in the COVID-19 Era.

The COVID-19 pandemic has brought about various restrictions around the world, and its impact on healthcare has been enormous: RDNs have had to shift from in-person interactions with clients to telenutrition consultations, encountering obstacles. We designed the first survey to investigate the changes in RDN practices related to telenutrition provision after the onset of the pandemic through an online survey in Italy. Four hundred and thirty-six responses were analyzed. Before the pandemic, only 16% of Italian RDNs provided telenutrition; this percentage increased significantly up to 63% (p < 0.001). Among patients, the lack of interest in accessing telenutrition (30.9%) and the Internet (16.7%) were the most frequently reported barriers. Among RDNs, one of the main obstacles was their inability to conduct nutritional evaluation or monitoring activities (24.4%). Our survey indicated that increased adoption of telenutrition can be a valid, safe alternative to face-to-face visits. Telenutrition was mainly used by young RDNs (20-39 years) with fewer years of professional experience (0-20 years) and master's degrees. Remote nutrition can enable RDNs to maintain normal workloads and provide patients with uninterrupted access to nutritional healthcare. It is important that RDNs using telemedicine resources possess the ability to provide high-quality, efficient, and secure services using evidence-based guidance.

Professional practice for COVID-19 risk reduction among health care workers: A cross-sectional study with matched case-control comparison.

BACKGROUND: Health care workers (HCWs) are particularly exposed to COVID-19 and therefore it is important to study preventive measures in this population. AIM: To investigate socio-demographic factors and professional practice associated with the risk of COVID-19 among HCWs in health establishments in Normandy, France. METHODS: A cross-sectional and 3 case-control studies using bootstrap methods were conducted in order to explore the possible risk factors that lead to SARS-CoV2 transmission within HCWs. Case-control studies focused on risk factors associated with (a) care of COVID-19 patients, (b) care of non COVID-19 patients and (c) contacts between colleagues. PARTICIPANTS: 2,058 respondents, respectively 1,363 (66.2%) and 695 (33.8%) in medical and medico-social establishments, including HCW with and without contact with patients. RESULTS: 301 participants (14.6%) reported having been infected by SARS-CoV2. When caring for COVID-19 patients, HCWs who declared wearing respirators, either for all patient care (ORa 0.39; 95% CI: 0.29-0.51) or only when exposed to aerosol-generating procedures (ORa 0.56; 95% CI: 0.43-0.70), had a lower risk of infection compared with HCWs who declared wearing mainly surgical masks. During care of non COVID-19 patients, wearing mainly a respirator was associated with a higher risk of infection (ORa 1.84; 95% CI: 1.06-3.37). An increased risk was also found for HCWs who changed uniform in workplace changing rooms (ORa 1.93; 95% CI: 1.63-2.29). CONCLUSION: Correct use of PPE adapted to the situation and risk level is essential in protecting HCWs against infection.

International professional practices in mental health, organization of psychiatric care, and COVID-19: A survey protocol.

OBJECTIVE: Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries;a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods;an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. METHODS: This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.

Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: A survey was conducted at the 2021 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to evaluate current practice management strategies among AAHKS members. METHODS: An application was used by AAHKS members to answer both multiple-choice and yes or no questions. Specific questions were asked regarding the impact of COVID-19 pandemic on practice patterns. RESULTS: There was a dramatic acceleration in same day total joint arthroplasty with 85% of AAHKS members performing same day total joint arthroplasty. More AAHKS members remain in private practice (46%) than other practice types, whereas fee for service (34%) and relative value units (26%) are the major form of compensation. At the present time, 93% of practices are experiencing staffing shortages, and these shortages are having an impact on surgical volume. CONCLUSION: This survey elucidates the current practice patterns of AAHKS members. The pandemic has had a significant impact on some aspects of practice activity. Future surveys need to monitor changes in practice patterns over time.

The professional autonomy of nursing in pandemic times.

OBJECTIVE: To reflect on the exercise of Nursing's professional autonomy in times of pandemic. METHOD: Theoretical reflection in the light of the Sociology of Professions proposed by Eliot Freidson. Using the author's main concepts, it was sought to understand the professional practice of Nursing in times when its protagonism in the care process becomes even more challenging. RESULTS: Although there are obstacles in the daily work, it is believed that an autonomous practice contributes satisfactorily to the performance of nurses, since by revealing all the potential and leadership they have, they allow their professional autonomy to be legitimized. FINAL CONSIDERATIONS: The reflection clarified the importance of nurses to put their professional autonomy into practice, in order to achieve greater recognition and social appreciation of their work in times of pandemic.

How Qualitative Case Study Methodology Informs Occupational Therapy Practice: A Scoping Review.

Qualitative case study methodology (QCSM) is a useful research approach that has grown in popularity within the social sciences; however, it has received less attention in the occupational therapy literature. The current scoping review aims to explore how studies utilizing a QCSM help inform occupational therapy knowledge and practice. Electronic searches were conducted in April 2017, and the resultant 388 publications were screened by three reviewers in Covidence. In all, 27 publications met the inclusion criteria and were included in the scoping review. Case studies in the occupational therapy literature have explored phenomena relating to the delivery of intervention, theoretical concepts, clinical reasoning, and education and research methods and were situated in a range of different practice areas and contexts. QCSM is a valuable approach in occupational therapy research that contributes to the body of knowledge and theory that informs occupational therapy practice.

Impact of the coronavirus pandemic (COVID-19) on the professional practice and personal well-being of community pharmacy teams in the UK.

OBJECTIVES: Community pharmacy teams (CPTs) were at the frontline of dealing with patients throughout the COVID-19 pandemic. This study aimed to explore the impact on professional practice and personal well-being of CPTs, in the UK. METHODS: A 25-item survey was designed including a range of open and closed questions. The survey was piloted before being published online via SurveyMonkey and distributed using social media platforms. A combination of opportunity and snowball sampling was employed to recruit participants who worked in community pharmacy (CP) during the pandemic. RESULTS: In total 758 participants (75% completion rate) including pharmacists, owners, managers, technicians, dispensers, healthcare assistants and pre-registration pharmacists took part. Increased workloads and working hours coupled with staff shortages compromised professional practice (n = 257, 35%). Some of the key challenges of working in CP during the pandemic included: a fear of contracting and passing the virus to others (n = 578, 78%), patients stockpiling medicines (n = 530, 71%) and doctors' surgeries being closed (n = 517, 70%) The impact on emotional well-being (n = 433, 76%) included stress, anxiety, depression and loneliness; physically (n = 322, 56%) it affected sleep, pain and weight. The effects of the pandemic left 45% (n = 258/569) of participants reconsidering their future in CP as they felt demotivated, unsupported and undervalued. CONCLUSION: Despite the enhanced pressures and lack of initial recognition CPTs played a vital role in caring for the population during the pandemic. Resources to better support pharmacy teams in the future not only rely on more funding for better provisions but also investing in CPTs' well-being.

[Evaluation of professional practice in the context of Covid-19]. / L'évaluation des pratiques professionnelles appliquée au contexte de la Covid-19.

An evaluation of professional practices was carried out in a cancer centre in the wake of the management of the health crisis linked to the severe acute respiratory syndrome coronavirus 2 pandemic. Hospital teams questioned the relevance of the measures adopted, internally and during home care, to manage suspected or confirmed Covid-19 patients and prevent contagion for all.