Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.

BACKGROUND: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. OBJECTIVE: The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. METHODS: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. RESULTS: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. CONCLUSIONS: RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

A multimodal sensor dataset for continuous stress detection of nurses in a hospital.

Advances in wearable technologies provide the opportunity to monitor many physiological variables continuously. Stress detection has gained increased attention in recent years, mainly because early stress detection can help individuals better manage health to minimize the negative impacts of long-term stress exposure. This paper provides a unique stress detection dataset created in a natural working environment in a hospital. This dataset is a collection of biometric data of nurses during the COVID-19 outbreak. Studying stress in a work environment is complex due to many social, cultural, and psychological factors in dealing with stressful conditions. Therefore, we captured both the physiological data and associated context pertaining to the stress events. We monitored specific physiological variables such as electrodermal activity, Heart Rate, and skin temperature of the nurse subjects. A periodic smartphone-administered survey also captured the contributing factors for the detected stress events. A database containing the signals, stress events, and survey responses is publicly available on Dryad.

Challenges faced by new nurses during the COVID-19 pandemic.

INTRODUCTION: COVID-19 can be considered a unique and complex form of trauma with potentially devastating consequences for nurses in general and new nurses specifically. Few studies have been published that explain how relatively new nurses were prepared for COVID-19 in terms of knowledge and skill and how these nurses fared physically and emotionally. DESIGN: A qualitative descriptive design utilizing purposive sampling to recruit a diverse group of nurses who were within 2 years post-graduation from nursing school. METHODS: In-depth interviews of 29 nurses were conducted using a semi-structured interview guide to elicit data, which was coded and analyzed using thematic analysis. RESULTS: Six main themes and multiple subthemes were identified in the data. The main themes were: "We were not prepared," "I was just thrown in," "Avoiding infection," "It was so sad," "We did the best we could," and "I learned so much." CONCLUSION: The nurses who participated in this study expressed fear, weariness, exhaustion, isolation, and distress, observations echoed by studies from other countries. Retention of new nurses in acute care settings has always been a concern. In the recent Current Population Survey, a 4% reduction in nurses under 35 years of age has been reported, imperiling the retention of an effective workforce for decades to come. CLINICAL RELEVANCE: A recent report suggests that a larger than expected number of young nurses have left the profession in the wake of the pandemic. Staff shortages threaten the ability of the remaining nurses to do their jobs. This is the time to listen to the needs of new nurses to retain them in the profession and to avoid an even greater shortage in the near future.

Reflections From the Middle: Exploring the Experience of Nurse Managers Across the United States During the COVID-19 Pandemic.

OBJECTIVE: The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic. BACKGROUND: NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic. METHODS: Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method. RESULTS: Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme. CONCLUSION: NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

Adequate PPE Is Finally Within Reach.

The challenge now is ensuring distribution and proper use.

A nurse staffing model for an unprecedented event.

Lessons learned from one hospital's COVID-19 experience.

Nurses step up to the challenge of working during the pandemic.

Chief Nursing Officers for Northern Ireland, Scotland, Wales and England Jean White, Charlotte McArdle, Fiona McQueen and Ruth May all agree that, although plans to mark International Nurses' Day are on hold, we must still find time to celebrate nurses across all specialties who have responded with speed and flexibility.

Global Integration of Palliative Nursing Education to Improve Health Crisis Preparedness.

BACKGROUND: COVID-19 has highlighted the need for universal palliative care access. Nurses require palliative care education throughout the trajectory of professional training to effectively achieve this vision. METHOD: Review of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and use of educational exemplars highlight opportunities for improving palliative nursing education in academic and clinical settings. RESULTS: Consistently applying palliative care principles affects nursing outcomes across myriad domains of person-centered services. All nurses are responsible for delivering primary palliative care, but they cannot practice what they do not know. The End-of-Life Nursing Education Consortium Project offers evidence-based education for nursing students and practicing nurses nationally and globally. CONCLUSION: Equipping both nurses and nursing students with palliative care education is critical to improve the overall quality of health care throughout the continuum during COVID-19 and in the face of future health crises. [J Contin Educ Nurs. 2021;52(3):130-135.].

Optimizing Nurse Staffing During a Pandemic.

This article describes how a health care organization optimized staffing during the COVID-19 crisis by capitalizing on the expertise of nursing professional development practitioners to create a rapid deployment onboarding plan. The rapid onboarding training plan provided Riley Hospital for Children at Indiana University Health with a sense of stability in an uncertain time. Designing a plan that easily could be modified allowed the organization to be prepared during the pandemic and at a point where staffing needs must meet surge capacity. [J Contin Educ Nurs. 2021;52(3):109-111.].

Personal reflections on navigating the COVID-19 pandemic: From vision to reality.

Transitioning from bedside nursing to public health nursing after graduating with my Master's in Public Health was a unique experience, particularly as I navigated the COVID-19 pandemic as a new public health and nursing leader. Personal reflection pieces can provide a meaningful review of the experiences of integrating clinical nursing practice and more broad public health practice. The purpose of this paper is to offer my reflection and synthesis of the lessons learned while leading a Federally Qualified Health Center (FQHC) through the COVID-19 pandemic. Additionally, I reflect on the future of FQHCs and the critical need to advance public health as a field and empower public health nurses.

Right Under Our Noses: Nursing Homes and COVID-19.

A medical mission volunteer bears witness to nightmarish inequalities.

A Nurse's Guide to COVID-19.

ABSTRACT: To assist nurses caring for hospitalized adults with coronavirus disease 2019 (COVID-19), the authors synthesize evidence-based information on the disease, providing background on the epidemiology and history of severe acute respiratory syndrome coronavirus 2, the causative virus. They also discuss the risks for severe effects of the illness, the multiple signs and symptoms hospitalized adults with COVID-19 may manifest, and the precautions hospitals should take to keep health care providers and patients safe during the course of this pandemic.

Coronavirus infections: health care planning based on Orem's Nursing Theory.

OBJECTIVE: to report the experience of professors and students of a graduate course on nursing care in coping with the new coronavirus (COVID-19) based on Self-Care Theory. METHOD: the active methodologies used were a literature search and seminar presentations, with an understanding of Orem's theoretical concepts: health; man; self-care; universal, developmental and health deviation requirements; self-care activities; self-care deficits; the required therapeutic demand; nursing systems. The pandemic was considered a health deviation that requires critical thinking and nursing care planning. Methodological frameworks to classify nursing diagnoses, interventions, and outcomes were used. RESULTS: for each health deviation, nursing systems were identified; self-care deficits, diagnoses; actions, interventions; and the form of assessment, outcomes. FINAL CONSIDERATIONS: theoretical-practical reflections of the academic context support nursing care planning.