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Gerontologist ; 60(3): e200-e217, 2020 04 02.
Article in English | MEDLINE | ID: covidwho-1455299


BACKGROUND AND OBJECTIVES: In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS: A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS: The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS: Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.

Homes for the Aged/standards , Nursing Homes/standards , Nursing Staff/statistics & numerical data , Personnel Staffing and Scheduling/statistics & numerical data , Quality of Health Care , Aged , Delivery of Health Care/standards , Humans , Long-Term Care , Workforce
J Clin Nurs ; 30(3-4): 397-405, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1093760


AIMS AND OBJECTIVES: We aimed to investigate the anxiety of nurses who are supporting Wuhan in fighting against coronavirus disease 2019 (COVID-19) infection and explore relevant influencing factors. BACKGROUND: The COVID-19 outbreak poses a major threat to public health worldwide. Nurses play an important role in this epidemic. However, available data on the mental health among these nurses are limited. DESIGN: A descriptive, cross-sectional survey was performed. METHODS: An online questionnaire was completed by 200 nurses who went to Wuhan to help to fight against COVID-19 from another province. Data collection tools include the Chinese version of the Stress Overload Scale (SOS), the Self-Rating Anxiety Scale (SAS) and General Self-Efficacy Scale (GSES). Descriptive, single-factor correlation and multiple regression analyses were used in exploring related influencing factors. Reporting followed the STROBE guidelines. RESULTS: The scores of SAS, SOS and GSES range from 20 to 80, 22 to 110 and 10 to 40, respectively, and the SAS (31.79 ± 7.32) and SOS (40.19 ± 12.92) and GSES scores (24.83 ± 6.60) were obtained. Anxiety was positively correlated with stress (r = .679, p < .001) but negatively correlated with self-efficacy (r = -.326, p < .001). Multiple regression analysis showed that professional qualification, sleep, stress and self-efficacy were the main factors affecting nurse anxiety (p = .006, <.001, <.001, .039, respectively). CONCLUSIONS: Nurses who are supporting Wuhan in fighting against COVID-19 were under a low level of anxiety. RELEVANCE TO CLINICAL PRACTICE: The current study suggests work stress reduction might be a key factor in reducing anxiety and maintaining mental health to support nurses who are fighting against COVID-19 infection.

COVID-19/psychology , Mental Health/statistics & numerical data , Nursing Staff/psychology , Occupational Stress/psychology , Self Efficacy , Adult , Anxiety/psychology , COVID-19/nursing , China/epidemiology , Cross-Sectional Studies , Epidemics , Female , Humans , Male , Nursing Staff/statistics & numerical data , Surveys and Questionnaires
Front Public Health ; 8: 560606, 2020.
Article in English | MEDLINE | ID: covidwho-1063365


The aim of this study is to investigate the knowledge, attitude, and practice (KAP) on Coronavirus Disease 2019 (COVID-19) care among nursing staff and analyze its influencing factors. The survey was conducted on February 18, 2020, among 7,716 voluntary participants from 143 medical institutions in Zhejiang, China. The findings indicated that KAP of nursing staff scored well. However, the accuracy of psychological nursing knowledge was much lower, 14.3% only. Nursing staff working in isolation wards have higher knowledge (OR = 1.776, 95% CI: 1.491-2.116), attitude (OR = 1.542, 95% CI: 1.298-1.832), and practice (OR = 1.902, 95% CI: 1.590-2.274) scores than those in general wards. In terms of KAP, nursing staff with working experience ≤ 10 years scored lower than those with working experience ≥ 20 years, with OR values of 0.490 (95% CI: 0.412-0.583), 0.654 (95% CI: 0.551-0.775), and 0.747 (95% CI: 0.629-0.886), respectively. It is necessary to take measures to enhance the training on COVID-19, especially for KAP of junior nurses in general wards.

COVID-19/prevention & control , COVID-19/therapy , Health Knowledge, Attitudes, Practice , Nursing Care/standards , Nursing Staff/statistics & numerical data , Adult , COVID-19/psychology , China , Female , Humans , Middle Aged , Nursing Staff/education , Surveys and Questionnaires
J Am Med Dir Assoc ; 22(1): 204-208.e1, 2021 01.
Article in English | MEDLINE | ID: covidwho-947264


OBJECTIVES: To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana. MEASURES: Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000. RESULTS: The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601‒0.696) and 0.649 (95% confidence interval 0.601‒0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases. CONCLUSIONS AND IMPLICATIONS: We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity.

COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Nursing Staff/statistics & numerical data , Skilled Nursing Facilities/organization & administration , Aged , Area Under Curve , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Indiana , Male , SARS-CoV-2/isolation & purification
J Aging Soc Policy ; 33(4-5): 414-430, 2021.
Article in English | MEDLINE | ID: covidwho-843234


With nursing homes being hit hard by the COVID-19 pandemic, it is important to know whether facilities that have any cases, or those with particularly high caseloads, are different from nursing homes that do not have any reported cases. Our analysis found that through mid-June, just under one-third of nursing homes in Ohio had at least one resident with COVID-19, with over 82% of all cases in the state coming from 37% of nursing homes. Overall findings on the association between facility quality and the prevalence of COVID-19 showed that having any resident case of the virus or even having a high caseload of residents with the virus is not more likely in nursing homes with lower quality ratings.

COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , Nursing Homes/statistics & numerical data , Nursing Staff/statistics & numerical data , Quality of Health Care/statistics & numerical data , Humans , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Ohio/epidemiology , Prevalence , United States
J Nurs Manag ; 28(5): 1002-1009, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-668308


AIMS: To investigate the work stress among Chinese nurses who are supporting Wuhan in fighting against Coronavirus Disease 2019 (COVID-19) infection and to explore the relevant influencing factors. BACKGROUND: The COVID-19 epidemic has posed a major threat to public health. Nurses have always played an important role in infection prevention, infection control, isolation, containment and public health. However, available data on the work stress among these nurses are limited. METHODS: A cross-sectional survey. An online questionnaire was completed by 180 anti-epidemic nurses from Guangxi. Data collection tools, including the Chinese version of the Stress Overload Scale (SOS) and the Self-rating Anxiety Scale (SAS), were used. Descriptive single factor correlation and multiple regression analyses were used in exploring the related influencing factors. RESULTS: The SOS (39.91 ± 12.92) and SAS (32.19 ± 7.56) scores of this nurse group were positively correlated (r = 0.676, p < .05). Multiple regression analysis showed that only children, working hours per week and anxiety were the main factors affecting nurse stress (p = .000, .048, .000, respectively). CONCLUSIONS: Nurses who fight against COVID-19 were generally under pressure. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should pay attention to the work stress and the influencing factors of the nurses who are fighting against COVID-19 infection, and offer solutions to retain mental health among these nurses.

Coronavirus Infections/epidemiology , Coronavirus Infections/nursing , Epidemics/prevention & control , Nursing Staff/psychology , Occupational Stress/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/nursing , Adult , COVID-19 , China/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Nursing Staff/statistics & numerical data , Pandemics , Risk Factors , Young Adult
J Am Geriatr Soc ; 68(10): 2167-2173, 2020 10.
Article in English | MEDLINE | ID: covidwho-648533


OBJECTIVE: To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in skilled nursing facilities (SNFs). DESIGN: Cross-sectional study linking county SARS-CoV-2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post-acute and long-term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS: The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non-Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS: For Genesis and non-Genesis SNFs: any outbreak (one or more residents testing positive for SARS-CoV-2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing. RESULTS: One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non-Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6-57.7 percentage point; P = .008) difference in the probability of an outbreak for Genesis and non-Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4-20.8 cases; P = .003) for Genesis SNFs. A 10-bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6-1.2 percentage point; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five-Star ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167-2173, 2020.

COVID-19/epidemiology , Skilled Nursing Facilities/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/transmission , Case-Control Studies , Cross-Sectional Studies , Humans , Infection Control/standards , Nursing Staff/statistics & numerical data , Pandemics , Prevalence , Risk Assessment , SARS-CoV-2 , Skilled Nursing Facilities/organization & administration , United States/epidemiology
Rev. bras. enferm ; 73(supl.2): e20200225, 2020. graf
Article in English | LILACS (Americas) | ID: covidwho-646371


ABSTRACT Objective: to know and analyze the nursing appeals on social media during the COVID-19 pandemic. Method: it is a documentary, qualitative, descriptive, and exploratory research with data collected in publications in two social media. Two hundred ninety-five publications of nursing professionals published on Twitter and Instagram between March 11 and 20, 2020 were submitted to content analysis using ATLAS.ti resources. Results: four thematic categories emerged: #stayathome, #whereismyPPE, #nowweareheroes, #nothingnewinthefrontline, according to frequency of communications. The appeals show a relationship with the social relevance of nursing professional work and with the conditions required for its exercise. Final considerations: old and new challenges of the profession were placed on the agenda in social media, especially related to the workforce and instruments of labor. These speeches can serve as a foundation for policies to improve working conditions and promote appreciation of the profession.

RESUMEN Objetivo: conocer y analizar las llamadas de enfermería en las redes sociales durante la pandemia de COVID-19. Método: investigación documental, cualitativa, descriptiva y exploratoria, con datos recopilados en publicaciones en dos redes sociales, sometidos a análisis de contenido utilizando recursos del software ATLAS.ti. Se analizaron 295 publicaciones de profesionales de enfermería publicadas en Twitter e Instagram entre el 11 y el 20 de marzo de 2020. Resultados: fue organizado en cuatro categorías temáticas: #quédeseencasa, #dóndeestámiEPP, #ahorasomoshéroes, #nadanuevoenlalíneadefrente, según la frecuencia en las comunicaciones. Las apelaciones muestran una relación con la utilidad social del trabajo profesional y las condiciones requeridas para su ejercicio. Consideraciones finales: los viejos y nuevos desafíos de la profesión se colocaron en la agenda de las redes sociales, especialmente en relación con las herramientas de trabajo y la propia fuerza laboral. Estos discursos pueden servir de base para políticas que mejoren las condiciones de trabajo y promuevan la apreciación de la profesión.

RESUMO Objetivo: conhecer e analisar os apelos da Enfermagem nas mídias sociais durante a pandemia de COVID-19. Método: pesquisa documental, qualitativa, descritiva e exploratória, com dados coletados em publicações em duas mídias sociais, submetidos à análise de conteúdo utilizando recursos do software ATLAS.ti. Foram analisadas 295 publicações de profissionais de enfermagem veiculadas no Twitter e no Instagram entre os dias 11 e 20 de março de 2020. Resultados: organizados em quatro categorias temáticas: #fiqueemcasa, #cadêmeuEPI, #agorasomosheróis, #nadadenovonofront, segundo frequência nas comunicações. Os apelos mostram relação com a utilidade social do trabalho profissional e com condições requeridas para seu exercício. Considerações finais: antigos e novos desafios da profissão foram colocados em pauta nas mídias sociais, especialmente relacionados aos instrumentos de trabalho e à própria força de trabalho. Esses discursos podem servir de alicerce para políticas de melhoria das condições trabalho e fomentar a valorização da profissão.

Humans , Male , Female , Adult , Personnel Selection/methods , Personnel Selection/statistics & numerical data , Pneumonia, Viral/nursing , Coronavirus Infections , Workforce/statistics & numerical data , Social Media/statistics & numerical data , Nursing Staff/supply & distribution , Nursing Staff/statistics & numerical data , Pandemics , Betacoronavirus , Middle Aged
J Am Geriatr Soc ; 68(9): 1899-1906, 2020 09.
Article in English | MEDLINE | ID: covidwho-603642


BACKGROUND/OBJECTIVES: To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID-19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents. DESIGN: Cross-sectional analysis on Connecticut nursing home (n = 215) COVID-19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two-part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death). SETTING: All Connecticut nursing homes (n = 215). PARTICIPANTS: None. INTERVENTION: None. MEASUREMENTS: Numbers of COVID-19 confirmed cases and deaths among residents. RESULTS: The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20-minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68-.89; P < .001); compared with one- to three-star facilities, four- or five-star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78-.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02-1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03-1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20-minute increase in RN staffing significantly predicted 26% fewer COVID-19 deaths (IRR = .74; 95% CI = I .55-1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSION: Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.

COVID-19/mortality , Nursing Homes , Aged , COVID-19/epidemiology , Connecticut/epidemiology , Correlation of Data , Cross-Sectional Studies , Humans , Minority Groups/statistics & numerical data , Nursing Homes/standards , Nursing Staff/statistics & numerical data , /statistics & numerical data