Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China.

AIM: To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China. DESIGN: A nationwide cross-sectional online survey. METHODS: A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation. RESULTS: The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.

Perspectives of nursing directors on emergency nurse deployment during the pandemic of COVID-19: A nationwide cross-sectional survey in mainland China.

AIMS: The aim of this study is to investigate the situation and perceptions of nursing directors about emergency nursing staff deployment in designated hospitals during the pandemic of COVID-19 in mainland China. BACKGROUND: The pandemic of COVID-19 has significantly depleted health care resources, leading to increased burden of nursing care and staffing and exacerbating the crisis in health care facilities. Currently, how to effectively plan and schedule nursing staffing in the pandemic still remains unknown. METHODS: From 14 July 2020 to 8 September 2020, 62 nursing directors of designated hospitals in mainland China were invited to participate in a cross-sectional online survey for their perceptions of nursing human-resource allocation during the pandemic of COVID-19. RESULTS: A total of 55 valid questionnaires were collected, showing that 96.36% of the hospitals had emergency nursing organizations and management systems during the pandemic, 96.36% had well-established scheduling principles for nursing human resources and 54.55% of hospitals had human-resource scheduling platforms. All the hospitals had trained emergency nursing staff in infection control (55, 100%), work process (51, 92.73%) and emergency skills (50, 90.91%). Most of the participants were satisfied with the nursing staffing deployments at their institutions (52, 94.55%). However, more than two thirds of them believed that their human-resource deployment plans need further improvements (39, 70.91%). CONCLUSIONS: Most of the designated hospitals investigated had established emergency nursing organizations, and management systems, and related regulations for the epidemic. However, the contents mentioned above still need to be further standardized. IMPLICATIONS FOR NURSING MANAGEMENT: The surge of patients in the epidemic was considerable challenge for the emergency capacity of hospitals. In the future, we should pay more attention to the following aspects: building emergency nursing staffing platforms, increasing emergency human-resource reserves, establishing reliable communication channels for emergency response teams, improving the rules and regulations of emergency human-resource management, offering more training and drills for emergency-related knowledge and skills and giving more focus on bio-psycho-social wellbeing of nurses.

Nursing allocation in isolation wards of COVID-19 designated hospitals: a nationwide study in China.

BACKGROUND: Appropriate allocation of nursing staff is key to ensuring efficient nursing in hospitals, and is significantly correlated with patient safety, nursing quality, and nurse job satisfaction. However, there are few studies on nursing workforce allocation in the isolation wards of COVID-19 designated hospitals globally. This study aims to better understand the nursing workforce allocation in the isolation wards of COVID-19 designated hospitals in China, and provide a theoretical basis for efficiently deploying first-line nurses in China and across the world in the future. METHODS: An online survey was conducted among the head nurses (n = 229) and nurses (n = 1378) in the isolation wards of 117 hospitals (selected by stratified sampling), using a self-reported human resource allocation questionnaire. RESULTS: The average bed-to-nurse ratios of different isolation wards were different (Z = 36.742, P = 0.000). The bed-to-nurse ratios of the ICU, suspected COVID-19 cases ward, and confirmed COVID-19 cases ward, were 1:1.88, 1:0.56, and 1:0.45, respectively. The nurse work hours per shift in different isolation wards were also different (Z = 8.468, P = 0.014), with the specific values of the ICU, suspected COVID-19 cases ward, and confirmed COVID-19 cases ward, being 5, 6, and 6 h, respectively. A correlation analysis showed that the average work hours per shift was proportional to the overtime work of nurses (rs = 0.146), the proportion of nurse practitioners was proportional to the overall utilization rate of nursing human resources in the wards (rs = 0.136), and the proportion of nurses with college degrees was proportional to teamwork (rs = 0.142). The proportion of nurses above grade 10 was inversely proportional to teamwork and psychological problems (rs = 0.135, rs = 0.203). The results of multiple stepwise regression analyses showed that the work hours of nurses per shift was the main factor affecting nurse satisfaction and that the proportion of nurses and the work hours of nurses per shift were both independent factors affecting the length of stay (LOS) of patients. CONCLUSION: Hospitals in China have made good nursing workforce allocations during the COVID-19 pandemic, but there are certain shortcomings. Therefore, scientific and efficient nursing workforce allocation practice plans should be established to improve the ability of hospitals to deal with public health emergencies and are urgent problems that need to be addressed soon.

MLK3 Is Associated With Poor Prognosis in Patients With Glioblastomas and Actin Cytoskeleton Remodeling in Glioblastoma Cells.

Mixed lineage kinase 3 (MLK3) has been implicated in human melanoma and breast cancers. However, the clinical significance of MLK3 in human gliomas and the underlying cellular and molecular mechanisms remain unclear. We found that MLK3 proteins were highly expressed in high-grade human glioma specimens and especially prevalent in primary and recurrent glioblastoma multiforme (GBM). High levels of MLK3 mRNA were correlated with poor prognosis in patients with isocitrate dehydrogenase (IDH)-wild-type (wt) gliomas. Furthermore, genetic ablation of MLK3 significantly suppressed the migration and invasion abilities of GBM cells and disrupted actin cytoskeleton organization. Importantly, MLK3 directly bound to epidermal growth factor receptor kinase substrate 8 (EPS8) and regulated the cellular location of EPS8, which is essential for actin cytoskeleton rearrangement. Overall, these findings provide evidence that MLK3 upregulation predicts progression and poor prognosis in human IDH-wt gliomas and suggest that MLK3 promotes the migration and invasion of GBM cells by remodeling the actin cytoskeleton via MLK3-EPS8 signaling.

Ischemic postconditioning confers cerebroprotection by stabilizing VDACs after brain ischemia.

Ischemic postconditioning provides robust neuroprotection, therefore, determining the molecular events may provide promising targets for stroke treatment. Here, we showed that the expression of functional mitochondrial voltage-dependent anion channel proteins (VDAC1, VDAC2, and VDAC3) reduced in rat vulnerable hippocampal CA1 subfield after global ischemia. Ischemic postconditioning restored VDACs to physiological levels. Stabilized VDACs contributed to the benefits of postconditioning. VDAC1 was required for maintaining neuronal Ca2+ buffering capacity. We found that microRNA-7 (miR-7) was responsible for postischemic decline of VDAC1 and VDAC3. Notably, miR-7 was more highly expressed in the peripheral blood of patients with acute ischemic stroke compared to healthy controls. Inhibition of miR-7 attenuated neuronal loss and ATP decline after global ischemia, but also diminished the infarct volume with improved neurological functions after focal ischemia. Thus, ischemic postconditioning protects against mitochondrial damage by stabilizing VDACs. MiR-7 may be a potential therapeutic target for ischemic stroke.

Impact of nurse-initiated preoperative education on postoperative anxiety symptoms and complications after coronary artery bypass grafting.

BACKGROUND: Coronary artery bypass grafting (CABG) in high-risk patients is associated with significant perioperative complications and anxiety. Prevention of these postoperative complications and anxiety is important in the improvement of clinical outcomes following CABG. OBJECTIVE: The objective of the study was to evaluate the effect of nurse-initiated preoperative education and counseling on postoperative complications and anxiety symptoms following CABG. METHODS: In this prospective and randomized trial, 40 patients were divided into the study and control groups. All patients received standard preoperative and postoperative care, but the study group patients also completed a structured education and counseling course supervised by designated nurses 3 days before the surgery. Anxiety symptoms were assessed by Zung's self-rating anxiety scale (SAS) on the day of admission and at 3 days after the surgery. RESULTS: There was no statistically significant difference in the baseline characteristics or operational data between the 2 groups (P > .05). Following the surgery, the rate of complications such as lower extremity edema, urinary retention, constipation, respiratory infection, and deep venous thrombosis in the study group was lower than in the control group (P < .05). The mean postoperative SAS scores in the study group was lower than in the control group (40.1 [SD, 6.5] vs 48.9 [SD, 7.3]; P = .01), and the proportion of patients with a SAS score greater than 40 in the study group was also lower than in the control group (15% vs 45%, P = .041). CONCLUSIONS: Nurse-initiated preoperational education and counseling were associated with a reduced rate of perioperative complications and a reduced level of anxiety following CABG.