The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses.
We conducted a secondary thematic qualitative analysis using grounded theory methodology.
Data collection occurred through semi-structured, in-depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.’s Public Health Emergency Preparedness Framework and inductively for emergent themes.
Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need.
From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.
This study aimed to identify and understand challenges to inform new strategies to increase the COVID-19 vaccination rate according to involved vaccinators' perspectives in Belitung, Indonesia.
A qualitative descriptive study design was used.
Online interviews and chatting were done among 11 vaccinators for data collection between August 2021 and January 2022. Data were analyzed using a content analysis model.
Four main themes emerged, including (1) communication strategies (evidence-based, electronic-based, and culturally based communication), (2) cross-sectoral strategies (collaboration with police, religious leaders, customary leaders, heads of village divisions, and non-governmental organizations), (3) “picking-up the ball” system (home visits for elderly and people with disability and school visits for children), and (4) setting-up priorities (between mandatory vaccines and boosters).
Despite making vaccination mandatory, the roles of communication, cross-sectoral innovations, “picking-up the ball” system, and priority setting may have useful potential to improve vaccination rates.
The findings may serve as an input to overcome challenges and accelerate the vaccination coverage in Indonesia and beyond. However, further research is needed.
Hypertension is a major risk factor for cardiovascular diseases, which contributes to the worldwide mortality rate. Successful blood pressure control requires adherence to medications and lifestyle modifications. However, motivating patients with primary hypertension to change and sustain behaviors long-term is challenging. A web-based self-care program centered on self-efficacy theory could provide feedback for effective control of blood pressure.
To examine the effect of a web-based self-care program for patients with primary hypertension on cardiovascular risk-factors (pulse pressure and lipids), self-efficacy, and self-care behaviors (medication adherence and lifestyle).
A two-armed randomized controlled trial with 3-month and 6-month follow-ups.
A total of 222 patients with primary hypertension were recruited between February 2017 and August 2018 at a cardiology clinic of a medical center in Taipei, Taiwan.
Eligible patients were randomized by permuted block randomization into the intervention group (n = 111) and control group (n = 111). Patients in the intervention group received a 6-month web-based self-care program, based on the theory of self-efficacy, while patients in the control group received usual care. Baseline and outcome measures (3 and 6 months) included self-efficacy, evaluated with the Chinese version of the 6-item Self-Efficacy for Managing Chronic Diseases (SEMC6), self-care, using subscales of the Hypertension Self-Care Activity Level Effects Scale (H-SCALE) for lifestyle and medication adherence, and blood pressure and serum lipid data, collected through web-based self-reports and chart review. Generalized estimating equations evaluated the effects of the intervention.
At baseline, the control group had higher scores on the SEMC6, and lower cholesterol (HDL) compared with the intervention group (t = −2.70, p < 0.05; and t = 1.76, p < 0.05, respectively). Pulse pressure decreased significantly (β = −20.30, 95% CI −23.76, −16.83), and serum triglycerides and low-density lipoprotein cholesterol levels were significantly lower compared with controls at 6 months (all p < 0.001).
At 6 months, the intervention group had significantly higher mean scores for the SEMC6 compared with the control group (β = 21.84, 95% confidence interval [CI] 19.25, 24.42) and H-SCALE subscale for medication adherence, diet, weight management, and physical activity compared with controls at 6 months (all, p < 0.001).
The greatest benefit of this program was allowing participants to immediately consult with the researchers about self-care issues via the website. Lifestyles vary from person to person; therefore, the individuality of each participant was considered when providing feedback. We provided devising interventions for participants that would increase their confidence in self-care for hypertension and ultimately achieve home blood pressure control. We encourage incorporating this program into standard clinical care for patients with hypertension.
An occupational stress was reported as an inhibitor of optimal performance among nurses. Emotional intelligence (EI) has emerged as a successful behavioral buffer against occupational stress and as a facilitator for better performance. This study aimed to investigate the potential relationship between nurses' EI and their work performance; and to examine the mediating role of occupational stress.
A predictive correlational design was adopted.
Self-reported questionnaires were administered to 391 full-time bedside nurses recruited from one of the big hospitals in Saudi Arabia, between April and June 2021. Data were coded and analyzed using IBM SPSS version 25.0. Simple and multiple linear regression analyses were used to test the hypotheses. The significance level for all tests was set at p ≤ 0.05. Bonferroni correction method was used to control the family-wise error rate.
The findings revealed an affirmative association between nurses' EI and work performance (β = 0.69, p < 0.001; r 2 = 0.483). Additionally, an inverse association was established between nurses' EI and their perception of occupational stress (β = −0.54, p < 0.001; r 2 = 0.286), and between nurses' perception of occupational stress and work performance (β = −0.52; p < 0.001; r 2 = 0.226). Additionally, our results showed that occupational stress played a mediating role in the relationship between nurses' EI and work performance.
This study presented a novel framework that includes two factors affecting work performance among nurses in Saudi Arabia. Our results suggest that EI is vital for effective work performance among nurses. Additionally, EI was found to be a useful coping strategy against occupational stress.
EI has been described as a valuable asset for better performance and effective group cohesiveness among nurses. Optimal nurses᾽ performance leads to meeting patients᾽ needs and organizational goals.
This study aimed to reveal the experiences of healthcare professionals regarding a structured Virtual Patient Visit (sVPV) program implemented in an ICU during the coronavirus disease 2019 (COVID-19) pandemic and to share the process of establishing the program.
This qualitative, exploratory study was conducted using a semi-structured, in-depth interview method.
The study was conducted in a university hospital ICU in Turkey (where a sVPV program was implemented) and comprised one physician, eight nurses, and one clerk who volunteered to participate in the study. The data were evaluated with content analysis, and themes and sub-themes were determined.
Five themes and 13 subthemes were obtained: (1) an essential program during the pandemic, (2) contributing to patient's recovery, (3) family-centered care, (4) innovativeness, and (5) sustainability.
The results show that the sVPV program is highly innovative and effective and contributed to positive patient outcomes and family-centered care practices during the COVID-19 pandemic. In addition, it was revealed that in order to conduct sVPVs effectively, organizational planning, such as legal processes, and the employment of experienced and competent healthcare professionals, should be well managed.
A well-designed sVPV program specific to the setting alleviates anxiety among patients and family members, increases patient motivation and healing, and decreases the workloads of healthcare professionals. It is recommended that the sVPV program, which can be easily used during not only COVID-19 pandemics but also during other crises, be adopted in all ICUs and carried out by a dedicated nurse or healthcare provider.
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.
A qualitative descriptive design utilizing purposive sampling to recruit a diverse group of nurses who were within 2 years post-graduation from nursing school.
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.
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.”
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.
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.
In Ireland, there is a regulatory focus on restraint minimisation in elderly residential care facilities. Consistent with this focus, this study aimed to explore and identify the relationship between nurses' knowledge levels, attitudes and intentions regarding physical restraint use in two large Irish elderly residential care facilities.
A correlational and cross-sectional survey design was used to collect data on variables including nurses' education levels, years of experience and intentions toward restraint utilization.
Data was obtained from a sample of 83 nurses in early 2020 via an anonymous, adapted survey measuring knowledge, attitude and intentions.
Results showed high knowledge levels, negative attitudes toward restraint implementation, and moderate mean intention scores. A significant positive relationship existed between knowledge and attitudes, with both variables negatively predicting intentions regarding restraint. Education was significant in predicting knowledge and attitudes; however, years of experience reported no such findings.
Knowledge and attitudes negatively predict nurses' intentions toward restraint, with attitude being the stronger predictor of intentions. Falls risk caused the greatest variation in intention scores.
This research offered a seminal study providing insight into the use of restraints in an Irish context with findings that are in line with international research. It highlights the importance of knowledge and attitudes along with education with understanding intentions to use restraints. Furthermore this research demonstrates a useful instrument in the assessment of nurses' knowledge, attitudes, and intentions in Irish elderly residential care facilities, which can possibly be used in other settings.
Demographic changes and the increased chronical diseases burden are global challenges that cannot go unnoticed by healthcare systems, which must be organized without losing sight of the increasing influence of social determinants.
To evaluate the results of a primary care program implemented to reduce health inequalities associated with social determinants in patients with type 2 diabetes.
An exploratory pilot retrospective cross-sectional study that includes secondary data of 404 nonrandomized patients belonging to socially depressed areas and conventional areas. Descriptive, bivariate, and multivariate analyses were performed.
The age of the subjects included in the study was 66.80 ± 9.7 years with a proportion of 56.7% men. Proportions of patients from socially depressed areas and adherence to the Nursing Follow-up Program were around 33% and 60%, respectively. The obesity rate was 51%, percentage of patients with HbA1c<7% was 59%. No significant differences were found between patients belonging to socially depressed areas and those who do not, except for greater adherence to nursing follow-up programs. Multivariate models assessed chronical complications as health outcomes (cardiovascular diseases, retinopathy, and nephropathy) as health outcomes showing the influence of previously described risk factors. However, in none of the models did belonging to a socially depressed area or adherence to the Nursing Follow-up Program were predictors.
The program has proven to be efficient in equating the health outcomes related with cardiovascular risk of patients from both types of areas. Well-directed health policies could bring primary care systems closer to sustainable development goals through the reduction of health disparities that affect socially vulnerable groups.
To introduce a risk strategy and to adopt a family approach, contemplating the sociocultural and educational differences that diversely affect men and women in their health status has proven to be useful in reducing health disparities due to social determinants in patients with type 2 diabetes.
The purpose of this study is to examine compassion satisfaction, compassion fatigue, and burnout in nurses at a large nonprofit, Catholic-based health-care system in southern Texas.
This is a cross-sectional, exploratory study using a self-report survey. The survey included a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5). It was emailed to 1000 nurses at a large health-care system in Texas, USA. Three hundred and eighteen nurses completed the survey for a response rate of 31.8%.
The results find low mean levels of compassion fatigue (CF) and burnout and high mean levels of compassion satisfaction (CS) among the nurses. Hours worked and nursing specialty emerged as factors in whether the nurses experienced CF or CS. The nurses with less than 10 years of experience have lower levels of CS and higher levels of burnout than those with over 10 years of experience. Finally, nurses who hold professional certification have statistically significant higher CF scores than those who do not.
Health-care settings may need to take into consideration the number of hours worked and nursing specialty as significant factors in whether nurses experience CF or CS.
Three key elements in CF prevention are education, awareness, and self-care. Often the climate in health-care settings discourages medical professionals from practicing effective self-care. The strategies for combating burnout are linked to changing health-care systems so that nurses are supported. Hospitals may explore alternative work schedules and lower patient loads to prevent CF and burnout.
The study aims to examine the factors that impact vaccination uptake and additional protective behavior during the fourth wave of the pandemic in Israel, whereas the “pandemic fatigue” phenomenon has been identified as a hurdle to adherence to protective health behaviors against coronavirus disease 2019 (COVID-19).
A cross-sectional, structured questionnaire was utilized for this investigation in September 2021, during the fourth wave of the pandemic.
A sample of the adult (18+) Israeli population was employed for the study. Recruiting participants for the study was conducted through an online internet panel company that consists of over 100,000 members, representing all geographic and demographic sectors of the Israeli population.
Our findings indicate that pandemic fatigue has begun to have cascading effects on vaccination efforts. In particular, this study found that at this stage of the COVID-19 pandemic, trust in authorities, and even threat perception components, such as concern and fear of contracting the disease, are incapable of predicting vaccination uptake. Instead, perception of the importance of the vaccine and its effectiveness are predictive of vaccination uptake.
The findings indicate that at this stage of the pandemic, focusing on the robustness of the science behind the vaccine is more important than trying to regain public trust. The findings also suggest that risk communication employing fear tactics is losing its capacity to generate motivation for vaccination.
The findings of this study reveal lessons learned from the COVID-19 global pandemic. Specifically, the study reveals how in times of prolonged crisis, we can currently and, in the future, prepare improved strategies for public communication in order to promote uptake of protective health behavior, such as vaccination.
Psychotropic medications are used to manage behavioral symptoms of dementia in nursing homes despite limited efficacy and the risk of adverse effects, and may be considered an easier solution for the treatment of behavioral symptoms. However, non-pharmacologic interventions are preferable but are most effective with consistent staffing. To address this, the Centers for Medicare and Medicaid Services implemented additional regulatory scrutiny through F-tag for deficiencies of care, targeting inappropriate psychotropic medication use (F-758 tag). The purpose of this study was to examine associations between nurse staffing levels and the occurrence of deficiency citations for inappropriate psychotropic medication use in residents with dementia symptoms.
This was secondary data analysis of a cross-sectional study using CASPER (Certification and Survey Provider Enhanced Reporting) and PBJ (Payroll-Based Journal) data from 14,548 Medicare or Medicaid-certified facilities surveyed between December 1, 2017 and December 31, 2018.
Staffing measures included nursing hours per resident day and registered nurse skill-mix. Generalized linear mixed models with facilities nested within states, were used to estimate the magnitude of the associations between the occurrence of inappropriate psychotropics use deficiency citations and nurse staffing levels. Covariates included facility location, size, ownership, the presence of dementia special care units, and the proportion of residents with dementia, depression, psychiatric disorders, mental behavioral symptoms, and residents with Medicare/Medicaid.
There were 1875 facilities with deficiency citations regarding inappropriate psychotropics use for residents with dementia. When controlling for covariates, facilities with greater hours per resident day for registered nurses (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.44–0.67), certified nursing assistants (OR = 0.87, 95% CI = 0.77–0.99) and total nurse staff (OR = 0.87, 95% CI = 0.79–0.96) had significantly lower odds of inappropriate psychotropics use deficiency citations. Nursing homes with greater registered nurse skill-mix had significantly lower odds of receiving the deficiency tags (OR = 0.10, 95% CI = 0.04–0.26).
Citations for inappropriate psychotropic medication use among residents with dementia were less likely to occur in facilities with higher staffing levels for registered nurses, certified nursing assistants, total nurse staff, and greater registered nurse skill-mix. Facilities need to be equipped with adequate nurse staffing levels to facilitate the use of non-pharmacological interventions and reduce inappropriate psychotropic medication use.
Adequate nursing staffing is associated with fewer deficiencies related to the use of psychotropic medications to treat behavioral symptoms. Nursing home administrators and policymakers need to focus on assuring adequate nurse staffing levels to provide safe and high-quality dementia care.
Twitter is being increasingly used by nursing professionals to share ideas, information, and opinions about the global pandemic, yet there continues to be a lack of research on how nurse sentiment is associated with major events happening on the frontline. The purpose of the study was to quantitatively identify sentiments, emotions, and trends in nurses' tweets and to explore the variations in sentiments and emotions over a period in 2020 with respect to the number of cases and deaths of COVID-19 worldwide.
A cross-sectional data mining study was held from March 3, 2020 through December 3, 2020. The tweets related to COVID-19 were downloaded using the tweet IDs available from a public website. Data were processed and filtered by searching for keywords related to nursing in the profile description field using the R software and JMP Pro Version 16 and the sentiment analysis of each tweet was done using AFINN, Bing, and NRC lexicon.
A total of 13,868 tweets from the Twitter accounts of self-identified nurses were included in the final analysis. The sentiment scores of nurses' tweets fluctuated over time and some clear patterns emerged related to the number of COVID-19 cases and deaths. Joy decreased and sadness increased over time as the pandemic impacts increased.
Our study shows that Twitter data can be leveraged to study the emotions and sentiments of nurses, and the findings suggest that the emotional realm of nurses was affected during the COVID-19 pandemic according to the emotional trends observed in tweets.
The study provides insight into what nurses are feeling, and findings from this study highlight the importance of developing and implementing interventions targeted at nurses at the workplace to prevent mental health consequences.
This study is conducted to synthesize the effects of web-based self-management intervention on patients with cancer.
We searched Web of Science, PubMed, Embase and Cochrane library databases for related randomized controlled trials from inception through 2021. Reference lists of included studies were also searched for additional qualified studies. For quantitative data synthesis, standardized mean differences were used to eliminate the influence caused by different scales. Narrative synthesis was also performed.
Nine in 1149 studies were included for narrative and quantitative analysis. The pooled data suggested that patients in the intervention group had better quality of life (standardized mean difference = 1.091, 95% confidence interval: 0.155–2.028) and lower depression (standardized mean difference = −1.634, 95% confidence interval: −2.980 to −0.287) than those in the control group. The result of narrative synthesis is that patients receiving intervention had lower cancer or symptom distress and higher self-efficacy than those in the control group.
Web-based self-management intervention improved lives of cancer survivors.
Purpose: To examine the trajectory of decisional conflict and anxiety experienced by adolescents after the cancer diagnosis, and explore their perceptions on participation in shared decision-making (SDM). Design: This longitudinal study used incorporated data from questionnaires and interviews. Methods: Participants recruited from an academic hospital in southern Taiwan ranged in age from 13 to 20 years with a cancer diagnosis within 1 month and received cancer treatment. Each participant completed questionnaires on decisional conflict and anxiety at diagnosis, 1, 3, and 6 months later. Individual interviews were to gain an in-depth understanding of SDM. Findings: Total scores on decisional conflict changed significantly over time (F = 2.98, p = 0.039); the scores at 1 month were higher than 3 months (t = 2.18, p = 0.04) and 6 months (t = 2.97, p = 0.008). Participants perceived significantly different levels of values clarify (F = 9.49, p < 0.01) and support (F = 8.46, p < 0.01) over time. Only 27.3% of participants were anxiety-free. No significant differences were found in anxiety over time. The perception of SDM was a situational involvement. Conclusions: Decisional conflict changed over time. Participants experienced greater decisional conflict at 4–8 weeks after diagnosis and their anxiety did not decrease over time. The different levels of participation in SDM during their treatment trajectory were found. Clinical Relevance: Participants experienced the highest decisional conflict during diagnosis, and highlighted how their roles in healthcare discussions varied from direct participation to indirect involvement. Further research is needed to develop an SDM model which accommodates different levels of needs and implements timely support.
To identify factors responsible for hospital health care workers' intention to leave their job during the COVID-19 pandemic.
A cross-sectional study was performed.
A self-administered questionnaire was delivered to solicit hospital health care workers' demographics, intention to leave, workplace environment, and changes related to COVID-19 from July to November 2020 in Taiwan. Principal component analysis was performed to compare group-related factors. Multiple logistic regression was used to determine the risk factors for the intention of health care workers to leave their job.
Among the 1209 health care workers (mean age, 36.3 years) who participated in the study, intention to leave the job was found to be related to factors relating to COVID-19, including perceived risk, affected social relationships, and increased workload and job stress, after adjustment for demographic and work factors. Supportive administration/management were protective factors against leaving the job. These results were supported by sensitivity analyses.
Our findings suggest that the intention of health care workers to leave their job during a pandemic is related to potentially modifiable factors relating to the infection itself and work environment.
High perceived risk of COVID-19, affected social relationaops, and increased workload and job stress were positively associated with the intention of health care workers to leave their job, whereas supportive administration and management were protective factors against leaving the job. Development of workplace strategies is important to help mitigate these above factors, improve psychological wellbeing, and promote workforce stability.
This study aimed to investigate the effectiveness and understand the process of a nurse-led social media intervention for health behavior and glucose control for diabetes self-management among patients with type 2 diabetes mellitus.
This study had an explanatory sequential mixed methods design, with a randomized controlled trial and qualitative interviews.
A total of 89 patients diagnosed with type 2 diabetes mellitus were randomly assigned to an intervention or a control group. Patients in the intervention group were invited to join the closed nurse-led social media platform that included diabetes information, action planning, unmoderated chat, and questions and answers. The outcomes of diabetes self-care behavior, hemoglobin A1c (HbA1c) percentage, fasting blood sugar level (FBS), systolic and diastolic blood pressure, and triglyceride (TG) and total cholesterol levels were measured at baseline, 3 months, and 6 months. A linear mixed model was used to analyze the effectiveness of the intervention over time. Qualitative data were collected from interviews with seven patients engaged in the intervention and analyzed using qualitative content analysis.
After 6 months, insulin users who were provided with the social media intervention had significantly lower FBS and TG levels than those with usual care (135.80 ± 12.37 vs. 175.82 ± 15.34 mg/dL, p = 0.049; 206.85 ± 38.26 vs. 387.50 ± 56.19 mg/dL, p = 0.013; respectively). Although a similar rate of decrease in the HbA1c level over time was observed among insulin and noninsulin users after the social media intervention, this decrease was significantly greater among noninsulin users at 3 and 6 months compared with the control group (6.38 ± 0.34 vs. 7.25 ± 0.24, p = 0.040; 6.31 ± 0.37 vs. 7.28 ± 0.26, p = 0.036; respectively). Interview with seven patients who engaged in the intervention revealed that their engagement in the intervention was primarily determined by their acceptance of the role of managing their diabetes. Being engaged in the intervention, patients benefited from information sharing and interactive support to motivate their self-care, nurses' professional advice to modify their behaviors, and action planning to make progress toward behavioral change.
The positive outcomes of the nurse-led social media intervention indicate that the social media platform is an effective strategy to implement diabetes self-management in clinical nursing practice.
The social media intervention would be successfully implemented by nurses to facilitate patients accepting their role in diabetes management and employing key services for diabetes information, support, professional advice, and action planning.