Valuing tacit nursing knowledge during the COVID-19 pandemic

Public health nurses in Ontario, Canada, support the healthy growth and development of children across the province through a variety of programs including home visits for pregnant individuals and families with young children. During the COVID-19 global pandemic the needs of families increased while access to health and social services decreased. During this time, home visiting teams closely involved in supporting families also experienced staff redeployment to support pandemic efforts (e.g., case and contact management, vaccinations) and changes to the nature of home visiting work, including shifts to remote or virtual service delivery. To support nursing practice in this new and evolving context, a framework for capturing and sharing the tacit or how-to knowledge of public health nurses was developed. A valuing of this type of knowledge for informing future public health nursing practice – well beyond the pandemic response – was recognized as a pandemic silver lining when reflecting on two years of supporting home visiting teams in our province.     

Exploring student perceptions of their learning adaptions during the COVID-19 pandemic

ObjectiveWith the shelter-in-place orders implemented during the COVID-19 pandemic, learning experiences abruptly changed from on campus to wholly online. This qualitative study explores the perceptions and attitudes of students as they adapted their study space, study time, and approach to learning.MethodsOne hundred five students enrolled in a doctor of chiropractic program were invited to participate in a survey to understand how shelter-in-place orders during the COVID-19 pandemic influenced their approach to learning. Fifty-two of 105 (49.5%) students completed the survey. The survey asked students to select their primary study strategy from a list of options and then prompted students to explain how the COVID-19 pandemic influenced their study space, use of technology, study time, and metacognitive cycle of planning, monitoring, and evaluating their approach to learning. A Thematic analysis of the participants'' responses was performed.ResultsNearly all study participants described a challenge in adapting their study space, study time, or approach to learning. Respondents reported that the use of technology did not change because assessments and resources were electronic before the pandemic. Respondents who selected high-impact study strategies such as self-quizzing or who demonstrated evidence of well-developed metacognition described a positive approach to learning more frequently than did respondents who selected low-impact study strategies such as repeated reading or who did not show evidence of metacognitive development.ConclusionThis study presents student perceptions related to promoting and developing self-regulated learning skills. Educators can use this information to understand the adaptations to changes in learning experiences that may promote successful learning.     

Medical research during the COVID-19 pandemic

The current pandemic of coronavirus disease 2019 (COVID-19) which was first detected in Wuhan, China in December 2019 is caused by the novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus has quickly spread to a large number of countries leading to a great number of deaths. Unfortunately, till today there is no specific treatment or vaccination for SARS-CoV-2. Most of the suggested treatment medications are based on in vitro laboratory investigations, experimental animal models, or previous clinical experience in treating similar viruses such as SARS-CoV-1 or other retroviral infections. The running of any clinical trial during a pandemic is affected at multiple levels. Reasons for this include patient hesitancy or inability to continue investigative treatments due to self-isolation/quarantine, or limited access to public places (including hospitals). Additional barriers relate to health care professionals being committed to other critical tasks or quarantining themselves due to contact with COVID-19 positive patients. The best research approaches are those that adapt to such external unplanned obstacles. Ongoing clinical trials before COVID-19 pandemic have the potential for identifying important therapies in the long-term if they can be completed as planned. However, these clinical trials may require modifications due a pandemic such as this one to ensure the rights, safety, and wellbeing of participants as well as medical staff involved in the conduction of clinical trials. Clinical trials initiated during the pandemic must be time-efficient and flexible due to high contagiousness of severe acute respiratory syndrome coronavirus 2, the significant number of reported deaths, and time constraints needed to perform high quality clinical trials, enrolling adequate sample sizes. Collaboration between different countries as well as implementation of innovative clinical trial designs are essential to successfully complete such initiatives during the current pandemic. Studies looking at the long term sequalae of COVID-19 are also of importance as recent publications describe multi-organ involvement. Long term follow-up of COVID-19 survivors is thus also important to identify possible physical and mental health sequellae.     

Adapting NCLEX-RN remediation during the COVID-19 pandemic

AimRemediation is used by nursing programs to promote success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Evidence related to distance learning as a strategy for NCLEX-RN remediation is non-existent. The aim of this paper is to report the results of a remediation course converted to a virtual format from a traditional format due to the COVID-19 pandemic.MethodUsing an on-line meeting platform, at-risk students enrolled in a pre-licensure nursing program in the Midwest, United States, actively participated in a remediation course. Students met as a group and answered NCLEX-RN questions. The on-line platform allowed discussion among the instructor and students that promoted critical thinking related to nursing content and test-taking strategies. Students were also encouraged to complete NCLEX-RN questions outside of meeting times.ResultsStudents voiced satisfaction with the method of course delivery and felt the course increased their knowledge and confidence in answering questions. The NCLEX-RN pass rate for remediating students was 77.8%.ConclusionA remediation course offered through distance learning proved to be effective in promoting NCLEX-RN success among at-risk students.     

Pediatric kidney transplantation during the COVID-19 pandemic

A waiting list for non-emergency transplant medical care was recommended in the first half of 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Hence, the number of kidney transplants temporarily declined. However, the waiting list for transplant medical care was lifted in the latter half of 2020 with the establishment of a polymerase chain reaction test system and the spread of infection prevention. The basic stance is to recommend vaccination to post-transplant recipients, recipients, and donors who are scheduled to undergo transplantation, and their families, with the start of vaccine therapy in 2021. The mortality rate of patients undergoing kidney transplants who had COVID-19 is slightly higher than healthy persons, and acute kidney injury was reported to lead to graft loss. However, pediatric cases of severe disease are rare and without deaths. Kidney transplantation medical care will be continuously provided by implementing infection prevention and treatments based on the latest evidence, promoting donated kidney transplantation, and hoping that pediatric patients with renal failure will grow up healthy, both physically and mentally, and become independent members of society, just like healthy children.     

Liver transplantation during global COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally. Liver transplantation (LT) has faced an unequivocal challenge during this unprecedented time. This targeted review aims to cover most of the clinical issues, challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.     

Nursing student challenges during the COVID-19 pandemic from 2020 to 2021: A thematic analysis

As part of program evaluation, the New Mexico Nursing Education Consortium, a consortium of 11 state-funded nursing schools, asks that students complete end-of-term surveys. In Spring 2020, a question was added to the survey to elicit challenges experienced by students during the COVID-19 pandemic: “What was the biggest challenge that you had in completing the semester/term?” This question again was asked of students in Spring 2021. Students belonging to schools in the New Mexico Nursing Education Consortium participated in the study. Eight themes were identified for each of the two years. Nursing faculty must anticipate respond to student feedback while maintaining proficiency in face-to-face and online teaching-learning strategies. Waiting until emergencies arise that require different types of pedagogy is not sufficient to ensure instructor proficiency with online pedagogies.     

EMS responses and non-transports during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic may affect both use of 9–1-1 systems and prehospital treatment and transport practices. We evaluated EMS responses in an EMS region when it experienced low to moderate burden of COVID-19 disease to assess overall trends, response and management characteristics, and non-transport rates. Our goal is to inform current and future pandemic response in similar regions.MethodsWe performed a retrospective review of prehospital EMS responses from 22 urban, suburban, and rural EMS agencies in Western Pennsylvania. To account for seasonal variation, we compared demographic, response, and management characteristics for the 2-month period of March 15 to May 15, 2020 with the corresponding 2-month periods in 2016–2019. We then tested for an association between study period (pandemic vs historical control) and incidence of non-transport in unadjusted and adjusted regression. Finally, we described the continuous trends in responses and non-transports that occurred during the year before and initial phase of the COVID-19 pandemic from January 1, 2019 to May 31, 2020.ResultsAmong 103,607 EMS responses in the 2-month comparative periods of March 15 to May 15, 2016–2020, we found a 26.5% [95% CI 26.9%, 27.1%] decrease in responses in 2020 compared to the same months from the four prior years. There was a small increase in respiratory cases (0.6% [95%CI 0.1%, 1.1%]) and greater frequency of abnormal vital signs suggesting a sicker patient cohort. There was a relative increase (46.6%) in non-transports between periods. The pandemic period was independently associated with an increase in non-transport (adjusted OR 1.68; 95%CI 1.59, 1.78). Among 177,194 EMS responses occurring in the year before and during the early period of the pandemic, between January 1, 2019, and May 31, 2020, we identified a 31% decrease in responses and a 48% relative increase in non-transports for April 2020 compared to the previous year's monthly averages.ConclusionDespite a low to moderate burden of infection during the initial period of the COVID-19 pandemic, we found a decline in overall EMS response volumes and an increase in the rate of non-transports independent of patient demographics and other response characteristics.     

Neonatal nursing during the COVID-19 global pandemic: A thematic analysis of personal reflections

BackgroundThe COVID-19 pandemic has resulted in significant changes and restrictions to neonatal care. The aim of this study was to explore the impact of these changes on neonatal nurses globally.MethodsWe conducted a thematic analysis on written reflections by neonatal nurses worldwide, exploring their experiences of COVID-19. Twenty-two reflections were analysed from eleven countries.ResultsThematic analysis revealed 4 main themes relating to the nurses’ role: 1) protector 2) challenges to human quality of care 3) vulnerability and 4) resilience. The measures taken as protector were described as compromising the human qualities of care fundamental to their role. This tension, together with other new challenges, heightened feelings of vulnerability. Concurrently, nurses identified role resilience, including resourcefulness and peer support, which allowed them to navigate the global pandemic.ConclusionBy identifying global challenges and strategies to overcome these, neonatal nurses may be better equipped as the pandemic continues. The reflections underscore the importance of family integrated care and the tension created when it is compromised.     

Missed nursing care before and during the COVID-19 pandemic: A comparative cross-sectional study

Aim

This study aimed to compare perception of nurses about missed care for the patients before and during the coronavirus disease 2019 (COVID-19) in Jordan. It also examined how nurses differed in terms of the type of missed care and the factors that contributed to it before and during the COVID-19 pandemic. Additionally, socio-demographic factors, including gender, educational level, length of clinical experience, work position, age, and type of shift, were examined to evaluate their association with missed nursing care.

Background

Missed nursing care refers to omission of any aspect of required patient care. Missed care lowers patient satisfaction and also leads to adverse hospital outcomes.

Methods

We adopted a cross-sectional design among 260 nurses working in medical/surgical wards and intensive care units. Views of 130 nurses before COVID-19 were compared with views of 130 nurses during the COVID-19 pandemic. We used the Arabic version of the MISSCARE survey. Data were collected between November 2019 and May 2020.

Results

During COVID-19, nurses had significantly higher satisfaction levels and lower levels of absence and intention to leave than nurses before the COVID-19 pandemic. Differences were observed between nurses’ perceptions of missed care before and during the COVID-19 pandemic. It was observed that missed nursing care increased during COVID-19. The inadequate number of staff nurses was the main reason for missed care activities among both groups. Additionally, age and shift type were significantly associated with an increased reason for missed nursing care among both groups.

Conclusion and implications for nursing

Nurses reported higher satisfaction levels and fewer absences and planned departures during this period. Nurse managers should pay attention by maintaining high satisfaction levels and formulating appropriate policies to reduce missed care levels and thus improve patient care quality.     

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.     

Navigating nursing curriculum change during COVID-19 pandemic: A systematic review and meta-synthesis

AimTo consolidate the evidence around the experiences of nursing undergraduates and faculty members navigating through remote and online education during the COVID-19 pandemic.BackgroundThe Coronavirus disease 2019 caused by the SARS-CoV-2 Virus (COVID-19) has placed massive pressure on healthcare, economic and education systems globally. Restrictive social distancing policies and public health measures necessitated educational institutions to switch from face-to-face to remote and online education to sustain the learning process. These changes have created an uncertain path and undue stress for healthcare learners and faculty, especially for professional roles that traditionally require more hands-on and access to clinical practice particularly pre-licensure nursing students. As such, there is an urgent need to consolidate evidence on the experiences of nursing undergraduates and faculty members as they navigate the rapid transition from face-to-face to remote and online education to ensure continuity of learning in achieving optimal learning outcomes and to support them during current and future public health crises.DesignA systematic review and meta-synthesis of the qualitative literature was undertaken using Sandelowski and Barroso’s approach.MethodsSix electronic databases, CINAHL, Embase, ERIC, PsycINFO, PubMed and Scopus, were searched systematically using the eligibility criteria from December 2019 to September 2022. The Critical Appraisal Skills Program checklist for qualitative studies was used to conduct the critical appraisal of the selected articles.ResultsForty-seven studies were included in this review, which encapsulates the experiences of 3052 undergraduates and 241 faculty members. An overarching meta-theme ‘Remote and online education: a rollercoaster ride’, emerged along with three main meta-themes: (1) Transition to remote and online education: A turbulent road, (2) Acceptance of the untravelled road, (3) Hopes and recommendations for the road ahead.ConclusionTo improve nursing undergraduates’ and faculty member’s navigation of remote and online education, more institutions should move towards establishing hybrid education as the new ‘normal’ and exercise prudence in the organisation and delivery of curriculum, teaching, well-being and clinical attachment contingencies of their healthcare courses.     

Building coalitions: A statewide nursing organization's role in changing nursing education regulation during the COVID-19 pandemic

The California Association of Colleges of Nursing (CACN), representing California's baccalaureate and higher degree nursing education programs, has raised concerns for over two-years about the number, relevance, and legitimacy of nursing education regulations. Formal CACN letters to state regulators did not affect change. While California nursing education regulations require 75% direct patient contact for all clinical courses, meeting this requirement became impossible as clinical agencies closed to nursing students during the beginning of the COVID-19 pandemic. Nursing regulatory change was urgently needed to provide greater flexibility in meeting clinical course objectives using simulation and other online learning modalities. At stake was the graduation of over 14,971 RN students from public and private nursing programs. While state regulators opposed a legislative approach, CACN collaborated with stakeholders to support legislation that led to a reduction in direct patient care hours, allowing nursing students to progress and graduate. This longstanding advocacy work was accelerated by the pandemic and required leadership and knowledge about the legislative process for nurse educators to succeed. The ultimate goal for CACN is to forge a more respectful relationship and greater collaboration between educators and regulators to enhance quality, reduce costs, and redundancies in nursing education in this state.     

Challenging times: ethics,nursing and the COVID-19 pandemic

Globally nurses and midwives are working hard to detect cases of COVID-19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS-CoV-2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.