Digital capability: An essential nursing skill for proficiency in a post-COVID-19 world.

AIM: We explored the importance of digital technologies to health responses during the COVID-19 pandemic. The benefits, challenges and barriers to developing digital capabilities are identified, and strategies to establish enduring digital proficiency among nurses and healthcare colleagues gained during the pandemic are canvassed. BACKGROUND: Since the mid-20th century, technology uptake by health practitioners has prioritised digital information and communication technology. The COVID-19 pandemic accelerated the need to adapt digital communication to dangerous clinical workplaces. Organisational policies enabled digital capabilities to replace in-person processes while preserving regulatory compliance, safety and security of patient information and staff deployment. SOURCES OF EVIDENCE: All evidence was accessed from publicly available sources. DISCUSSION: The COVID-19 pandemic was a catalyst for implementing Technology Enhanced Care Services. Health practitioners need appropriate digital capabilities for their roles and scope of practice. Nursing proficiency includes technological skills. Combining the Jisc Digital Capability Framework and the Health and Care Digital Capabilities Framework helps nurses achieve the technical expertise needed for clinical proficiency in contemporary healthcare environments. CONCLUSION: Healthcare workforce digital capability requires policies that resource digital technologies and individual user skills in dangerous COVID-19 workplaces. All involved must be abreast of technological changes and monitor technology effectiveness in innovation in patient care, professional education and evidence-based infectious disease management of healthcare systems. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Nurses and other practitioners in COVID-19-compromised settings must be able to use the embedded digital technologies in patient care, clinical management and education. Policies securing resources for nurses to learn to use digital technologies will ensure that digital systems are regularly upgraded and that nurses develop proficiency in using technology in their clinical practice. Work and workplace redesign needs compatible computer systems and software to support nursing innovation and digital proficiency.

Are we there yet? A guide to achieving endemic status for COVID-19 and variants.

AIM: To clarify factors that support a policy change from pandemic to endemic status and to examine options for non-medical responses to reduce COVID-19 transmission. BACKGROUND: Critical factors to be considered in pandemic response decisions are not limited to medical options or public health orders, although these are important. SOURCES OF EVIDENCE: All evidence drawn from publicly available sources is presented through the lens of the authors' nursing, management, education, policy and research experience. DISCUSSION: As COVID-19 variants cause infections to surge nurses and other health practitioners, who are the de facto implementers of public and health policy, need to consider the evidence supporting a pandemic policy change to endemic status. Non-medical options for reducing transmission and variant mutations are needed to enable at-risk populations to avoid infection. CONCLUSION: Public policy that shifts infection risks onto the general population requires close scrutiny of the evidence base for such decisions and warrants open debate and review. If people are to manage risks arising from policy decisions, they need access to non-medical virus detection options as well as access to effective medicines and treatment. IMPLICATIONS FOR NURSING PRACTICE: Nurses have an extension to their advocacy role when policy changes about infectious disease status are declared. Evaluation of policy in terms of validity, equity and scientific basis is part of nursing's public responsibility. Policies that fail to reflect what is happening at the patient care level need to be questioned and modified where necessary. Only policies deemed 'good' policy by nurses should be implemented without challenge. Access to devices for environmental detection of the virus would enable real-time estimation of infection risks and inform individual decisions about the real risk of participating in work or other activities. IMPLICATIONS FOR HEALTH AND SOCIAL POLICY: Policy decisions to transition from pandemic to endemic status must be evidence based. Clear messaging about risks and options assists policy implementation. Terminologies describing stages of infectious disease spread from 'outbreak, epidemic, endemic and pandemic' are not interchangeable, although they will expand and contract across the range in response to interventions such as public health safety measures (PHSM), quarantine, vaccinations, antivirals and fatalities that alter the case count in defined locations for those who avoid or survive an infection.

Speak truth to power and consolidate the nursing visibility gained during COVID-19.

AIM: To provide a perspective on the visibility of nursing gained during the COVID-19 pandemic and propose strategic options for nurses to consolidate their expanded roles and influence. BACKGROUND: The COVID-19 pandemic has exposed long-standing inequities across the world. Factors preserving discrimination weakened during the emergency are now being re-established by neo-liberalist influences that dismiss the true scale of the disaster and shape the narrative in ways that increase public risk and render nurses invisible. SOURCES OF EVIDENCE: All evidence drawn from publicly available sources is presented through the lens of the authors' nursing, management, education, policy and research experience. DISCUSSION: Nurse advocacy will be needed during future decades of pandemic control and recovery and be in a position to deliver appropriate care and services. CONCLUSION: For nurses at all levels to remain visible, important, valued and respected, they need to be informed, engaged and willing to make a stand to preserve the hard-won reputational gains of the last 30 months of the COVID-19 pandemic. IMPLICATIONS FOR NURSING PRACTICE: Nurse advocacy and engagement are needed to maintain public awareness of the ongoing risks and safety options associated with the pandemic. IMPLICATIONS FOR HEALTH AND SOCIAL POLICY: Nurses and other health practitioners need to reveal the true level of devastation that continues to occur and guide the focus of political and administrative strategies in response to COVID-19 impacts on services and public health orders.

Appetite for risk in the C-19 policy environment.

AIM: Leadership deficits and poor communication about COVID-19 (C-19) science connect risk-shifting and vaccination hesitancy to safety issues for nurses and the general public. BACKGROUND: Nurses can be trusted, especially in these chaotic times, to provide trustworthy information on C-19. Publicly expressed gratitude to nurses does little to improve work environments made more precarious by C-19. Practical support may help retain nurses in the health system. DISCUSSION: Public trust in governments has dissipated during the pandemic. People are confused by inconsistent and contentious information and services. Publishing practices that produce low-quality publications undermine scientific information and impede the flow of high-quality research information. CONCLUSION: Science can advise on a pathway through the risks of C-19 but it is politicians and government officials who decide policy on whether to accept the science and set the level of acceptable risk to the general public. Problematic publishing and communication pathways for essential information contribute to public uncertainty and undermine trust in vaccines, public health strategies, and immigration and quarantine policies. IMPLICATIONS: Nurse safety needs to be central to policy deliberations that affect transmission or spending on infection risk reduction. Policies that put nurses at increased risk encourage those with a choice, to abandon unsafe health system employment. Research quality systems that improve research communication pathways to support practice are urgently needed. Nurses rely on research information sources for credible evidence to support their clinical practice. Risk-shifting is the unintended consequence of government policy on vaccination, immigration, international travel, quarantine and screening for C-19. Governments must accept their role in generating public mistrust of vaccines and not judge people's decisions made on the basis of information available. Political manipulation of C-19 data needs to be exposed to enable recovery planning.

Lethal ageism in the shadow of pandemic response tactics.

AIM: This paper examines aspects of pandemic policy responses to the COVID-19 and SARS-CoV-2 variants and presents an integrated view of the consequences of response tactics at national and health service levels for older adults. BACKGROUND: Nurses are positioned at the intersection of health service and policy implementation; therefore, their influence on clinical protocols and health policy directions post pandemic is crucial to preventing further premature deaths in the 65+ years age group and others. SOURCES OF EVIDENCE: Perspectives presented here are based on a critical evaluation of the many published reports, comments, research and insights concerning the pandemic. That evidence, combined with my experience in various fields of study and professional service, enables me to envisage what some decisions and policies may mean for older people, nurses and societies worldwide. DISCUSSION: Established information on world population patterns and the location and health of national groups has been made less reliable by population shifts caused by years of geo-political conflicts and now the impact of the pandemic. Added to this already chaotic context, the pandemic has further disrupted societies, health services and economies. Ageist responses by these systems have further disadvantaged older people and generated trust deficits that need to be resolved. CONCLUSION: When the pandemic recedes, policy and management decisions taken by governments and hospital administrators will be a telling indicator of whether the established systematic ageism exposed during the pandemic will continue to compromise the health and longevity of older adults. IMPLICATIONS FOR NURSING, HEALTH AND SOCIAL POLICY: The ascendency of nursing influence within the health and social policy environment must be further strengthened to enable nurses to champion equity and fairness in the pandemic recovery effort.

Getting the COVID-19 pandemic into perspective: a nursing imperative.

As we approach the seventh month of the latest pandemic to wreak havoc and death across all societies, it beggars belief that many world and national leaders have acted surprised at the speed and destructive efficiency of COVID-19. Nurses are not surprised by the level of misery and devastation that infectious diseases can cause. We have seen it all before. In every outbreak through history, nurses have responded to the dangers that direct engagement with such crises entails. The inherent risks nurses face in controlling potentially fatal pathogens are compounded by flaccid public policy and incompetent management, resulting in poorly resourced preparedness for the epidemics and pandemics that routinely punctuate our history. That nurses are repeatedly placed in such precarious work environments is an indictment on all involved. Over time, nurses responding to populations in crisis have learned not to rely too heavily on those occupying leadership positions for front-line resources and protection or even early warnings or open disclosure about contagion risk, case numbers and outcomes. Once the danger has passed, the usual public expressions of gratitude for nurses who put themselves in harm's way to help victims of these catastrophes seem to fade, amid hasty efforts to consolidate policies, processes and hierarchies back to the same settings that allowed the current crisis to flourish. So far in this pandemic, an unconfirmed number of nurses and other health workers have either died usually as a result of their involvement with infectious patients or become infected themselves. Data collection on this is haphazard at best, with nurse deaths absorbed within the aggregated morbidity data reported on during pandemics. This is despite nurses being the prominent professional workforce providing crucial front-line interventions to protect public health. It is time nurses involved themselves with the overdue reformation of public health policies, information management and health systems that would seek to return nurses to precarious work environments and trivialize foreseeable risks to us, our communities and patients.

Watching the Glass: Policy Hurdles for 21st Century Nurses.

Our nursing clinical identity is being neglected as it dwindles into a support role for other clinicians. Underlying this process is a web of policies involving health practitioner licensure and credentialling, standardizing of nursing undergraduate preparation, hospital staffing models and nursing work design, nurse authorization limitations, government funding of nursing services and client access to insurance items and other subsidies in the private nursing market. Constraints placed on clinical nurses working in institutional services result in systematic deskilling and dismissal of the comprehensive knowledge and contribution of nurses. Nurses of the 21st century need to be savvy and earnest in reforming policy if they are to rescue the profession from the relentless contraction of clinical nursing status and profile that is happening worldwide. If a revival of clinical nursing as a professional role by 2030 is the goal, the process of reform needs to start now.

Long-Term Care Quality-of-Life Scale utility in community home care.

This study aimed to test the utility of the Long-Term Care Quality-of-Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality-of-Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long-Term Care Quality-of-Life scale to have good test-retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long-Term Care Quality-of-Life and World Health Organization Quality-of-Life scales' scores suggesting moderate-to-strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long-Term Care Quality-of-Life scale monitoring in home and residential care can identify opportunities for quality-of-life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality-of-life assessment scale that can be used across care contexts to support evidence-based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.

Benchmarking life quality support interventions in long-term care using the Long-Term Care Quality of Life scale.

We aimed to develop a graphical procedure for benchmarking quality of life care results using the Long-Term Care Quality of Life (LTC-QoL) scale. While clinical care quality benchmarking is now well established, similar research for quality of life (QOL) aged care benchmarking has received scant attention. Data from 10 facilities utilizing the LTC-QoL scale were analysed to establish baseline statistics for developing a graphical procedure for QOL benchmarking. Client LTC-QoL records were tested with varimax rotation factor analysis revealing three viable benchmarking themes: B1 (Self-efficacy), B2 (supporting relationships), and B3 (outlook on life) were selected for benchmark development utilizing Analysis of Means to generate graphical outputs using Minitab version 17.3.1. In this way, in the absence of verified industry standards, it is possible to compare organizations providing similar services using the same indicators, against group averages. In conclusion, the benchmarking protocol produced comparative information on three benchmarks for 10 facilities. Similar analysis is feasible for a single facility over time. The results of these analyses provide evidence for on-site discussion of quality of life care quality performance.

Management capacity to promote nurse workplace health and safety.

PURPOSE: To investigate regarding workplace health and safety factors, and to identify strategies to preserve and promote a healthy nursing workplace. METHODS: Data collected using the Delphi technique with input from 41 key informants across four participant categories drawn from a Chinese university and four hospitals were thematically analysed. RESULTS: Most respondents agreed on the importance of nurses' health and safety, and that nurse managers should act to protect nurses, but not enough on workplace safety. Hospital policies, staff disempowerment, workload and workplace conflicts are major obstacles. CONCLUSION: The reality of Chinese nurses' workplaces is that health and safety risks abound and relate to socio-cultural expectations of women. Self-management of risks is neccessary, gaps exist in understanding of workplace risks among different nursing groups and their perceptions of the professional status, and the value of nurses' contribution to ongoing risks in the hospital workplace. The Chinese hospital system must make these changes to produce a safer working environment for nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This research, based in China, presents an instructive tale for all countries that need support on the types and amounts of management for nurses working at the clinical interface, and on the consequences of management neglect of relevant policies and procedures.

Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males.

BACKGROUND: Evaluation of sensitive myocardial mechanics with speckle tracking echocardiography (STE) across the lifespan may reveal early indicators of cardiovascular disease (CVD) risk. Epicardial adipose tissue (EAT) and left ventricular (LV) myocardial dyssynchrony; subclinical risk-factors of CVD, are of particular clinical interest. However, the evolution of EAT and LV-dyssynchrony across the lifespan, and their influence on myocardial dysfunction remains unclear. We aimed to establish a profile of the healthy aging-heart using conventional, tissue-Doppler imaging (TDI) and speckle-tracking echocardiography (STE), while also exploring underlying contributions from EAT and LV-dyssynchrony towards LV myocardial mechanics, independent of blood biology. METHODS: Healthy males aged 19-94 years were recruited through University-wide advertisements in Victoria and New-South Wales, Australia. Following strict exclusion criteria, basic clinical and comprehensive echocardiographic profiles (conventional, TDI and STE) were established. LV-dyssynchrony was calculated from the maximum-delay of time-to-peak velocity/strain in the four LV-annulus sites (TDI), and six LV-segments (STE longitudinal and circumferential axes). Epicardial fat diameter was obtained from two-dimensional grey-scale images in the parasternal long-axis. Blood biological measures included glycemia, hsCRP, triglycerides, total cholesterol, high-density and low-density lipoprotein levels. RESULTS: Three groups of 15 were assigned to young (<40 years), middle (40-65 years), and older (>65) aged categories. Five participants were excluded from STE analyses due to inadequate image quality. Decreased longitudinal strain, increased circumferential apical strain and LV twist were age-related. Moreover, independent of blood biology, significant increases were observed across age categories for EAT (young: 2.5 ± 0.9 mm, middle: 3.9 ± 1.0 mm, older 5.7 ± 2.4 mm; p < 0.01), longitudinal STE-dyssynchrony (young: 42 ± 7.7 ms, middle: 58.8 ± 18.9 ms, older 88.6 ± 18.2 ms; p < 0.05), and circumferential-basal STE-dyssynchrony (young: 50.2 ± 20.5 ms, middle: 75.9 ± 20.6 ms, older 97.9 ± 20.2 ms; p < 0.05). These variables collectively explained 37% and 31% (p < 0.01) of longitudinal strain and LV twist, respectively. CONCLUSIONS: This study enabled comprehensive profiling of LV mechanics at different stages of aging using sensitive echocardiographic technology. Novel findings included increased epicardial fat, and both longitudinal and circumferential LV-dyssynchrony across the healthy age groups. These factors may be key underlying contributors to myocardial dysfunction during aging, and their recognition may promote an advanced understanding of early signs of cardiovascular disease.

Impact of technology-based care and management systems on aged care outcomes in Australia.

This study determined the impact of a computerized care documentation system on client outcomes, regulatory compliance, and staff workloads after 3 years of use. The survey was conducted at an 800-bed aged care facility, and staff using the computerized care system were invited to participate (n = 112). The survey was an adapted version of the Nurses Computer Attitudes to Technology Inventory, which was refined to make it relevant to the aged care workplace. Four multiple regression models were produced, assessing the impact of the computerized care management system on staff and workload; time; accuracy, and regulatory data; and resident care. The analysis showed that the perceived benefits of the computerized system were influenced by personal attitudes towards computer use and feelings of empowerment related to the computer system. Even those with poor computer skills and feelings of insecurity about using computers believed that there were significant benefits to be gained by using the system. This result has implications with regards to the training and recruitment of staff in the aged care sector, as facilities introduce computerized care systems.