Optimizing Highly Infectious Disease Isolation Unit Management: Experiences From the Infectious Diseases Isolation and Research Unit, Fort Portal, Uganda.

Infectious disease outbreaks on the scale of the current coronavirus disease 2019 (COVID-19) pandemic are a new phenomenon in many parts of the world. Many isolation unit designs with corresponding workflow dynamics and personal protective equipment postures have been proposed for each emerging disease at the health facility level, depending on the mode of transmission. However, personnel and resource management at the isolation units for a resilient response will vary by human resource capacity, reporting requirements, and practice setting. This study describes an approach to isolation unit management at a rural Uganda Hospital and shares lessons from the Uganda experience for isolation unit managers in low- and middle-income settings.

基于扎根理论的援鄂护士职业精神分析

目的:基于扎根理论分析援鄂护士的职业精神内涵。方法:选取山西医科大学12 所直属附属医院援鄂护士为研究对象，用扎 根理论对援鄂感悟进行分析。结果:共形成112 个概念、14 个一级范畴、6 个二级范畴。援鄂护士的职业精神包括家国情怀的职业使 命、大爱无疆的职业品质、尊重和平等对待病人的职业伦理、团结协作的职业作风、乐观必胜的职业态度、精益求精的职业素养6 个 方面。结论:挖掘护士职业精神的内涵，有助于深刻阐释护士工作的意义和价值，生动展示护士的良好精神风貌，大力弘扬"南丁格 尔精神"，对于提升护士的职业认同感、加强护士职业精神培育、构建和谐医患关系具有重要意义.

Delivering asthma reviews during the Covid-19 pandemic

The Covid-19 pandemic meant that the delivery of asthma management in primary care changed virtually overnight, requiring the introduction of alternatives to face-to-face care. This study examines the experiences of nurses who were performing asthma reviews during the pandemic, identifying the key themes that emerged, as well as providing recommendations for future practice.

Analysis of mental health and sleep problems among nursing and midwifery staff during the COVID-19 pandemic

Introduction: Nursing and midwifery staff members are at high risk of mental disorders. Depression, anxiety, and insomnia are commonly reported symptoms among healthcare professionals during the COVID-19 pandemic. Chronic insomnia leads to lower quality of life, worse professional performance and deterioration of cognitive function. Moreover, it increases the risk of metabolic and cardiovascular diseases. Material and methods: The study included 235 nurses (n =133) and midwives (n =102). The diagnostic methods included a descriptive and demographic questionnaire, The General Health Questionnaire (GHQ-28), The Pittsburgh Sleep Quality Index (PSQI), and The Insomnia Severity Index (ISI). The study was conducted using an online survey. Results: There are no statistically significant intergroup differences in terms of mental state, sleep quality and the insomnia level in the groups of nurses and midwives. 9% of subjects used psychological support and revealed lower assessment of their mental health, poorer sleep quality and the higher insomnia rate. The stable mental health of nurses and midwives positively correlated with the sleep quality and negatively with the insomnia level. 63% of study participants assessed their sleep quality as low. The symptoms of clinical insomnia were present in 35% of subjects. Conclusions: Insomnia is a serious health problem for nursing and midwifery staff during the COVID-19 pandemic. The implementation of preventive programmes focused on medical workers' mental health should be a priority in prevention of long-term consequences of sleep problems and insomnia.

Enhancing the Capacity of Health Systems to Overcome Challenges and Strengthening Nurses and other Healthcare Professionals in COVID-19 Process

Nowadays, leaders and executives are faced with a complex set of problems that do not have a complete solution, threaten their career and the future of their institutions, and that the parties are harmed. When evaluating ambiguous information that contradicts each other, the priority of the manager and leader should be to implement the solution that gives the least harm to the majority. When a process such as COVID-19, which caused a pandemic and left our lives under uncertainty, more than one crisis situation emerged, which we had to manage both personally and as healthcare professionals. The important point here is related to how we manage and lead these extraordinary situations we encountered in the Quantum era. How we keep pace with change and how we can lead this planning process is an important issue. Because people faced a risk in the context of the most important human right and constitutional right "right to live”. Therefore, how to protect ourselves and stay healthy during this process have been our top priorities. The first thing that comes to mind when it comes to protecting and strengthening health is undoubtedly the health professionals who have adopted this issue as a professional principle. Health professionals have important responsibilities in planning this crisis in terms of planning, speed, compliance and trust. This article, prepared in a compilation style, discusses what can be done within the scope of the COVID-19 process, by improving the capacity of managers and leaders to overcome difficulties in the health system they are in and strengthening nurses and health professionals.

TELEMEDICINE IN HYPERTENSION

The COVID19 pandemic resulted in lock-downs and reduction of social interactions to reduce the risks of disease transmission. Routine medical services were affected and telemedicine was rapidly adopted for the diagnosis, monitoring, and treatment of many chronic diseases including hypertension. We look at the considerations for the design and set-up of telemedicine for the management of hypertension. Many aspects need attention in order to ensure a safe, reliable, and effective program. Many regulatory agencies developed guidelines, advisories, regulations, and legislation to manage telemedicine. We examine some of these guidelines and their differences in South East Asian countries. Often, the professional clinical service standards in telemedicine are maintained by the state medical boards or councils. Additional training or certification and licensure is needed prior to providing telemedicine services. In-person visits are required when remote consultations cannot meet the professional clinical standards. Because telemedicine can traverse national boundaries, different regulators differ in their approach to the provision of telemedicine services to overseas patients. Nonetheless, the doctor must meet the same standard of care for overseas patients. Also, practice insurance will need to explicitly cover the practice of telemedicine especially for overseas patients. Besides the professional clinical standards, telemedicine differs by technology platforms, communication devices, software, and blood pressure monitoring devices. These varied devices and software require further evaluation of technical standards for safety, reliability, data privacy, storage, transmission, and licensure. Some of the guidelines also cover the need for quality improvements and technology upgrades. Regardless, there have been many studies of telemedicine in hypertension covering many aspects of care. Some can be simpler telemonitoring of blood pressure to highly sophisticated ones with devices linked to personal communicators (usually cellphone) with feedback to healthcare professionals (doctors, nurses, dietitians, pharmacists) and tagged to clinical interventions to improve the control of hypertension. Reviews of these studies show that hypertension telemedicine programs are effective but the evidence may be available in different practice settings and patient types, thus, complicating the design and recommendations. Therefore, it is important to review the type of practice and patients, determine which aspects are lacking to be targeted, and designing a good program. A good program will lead to better clinical outcomes, patient satisfaction, lower cost, reduced manpower for delivery of care, and convenience all round. Clinical practice guidelines and undergraduate and postgraduate medical training need to encompass telemedicine for the future.

Cancer nurses have experienced ‘moral injury' due to the pandemic

First, a Happy New Year to you all. I hope you enjoyed the festive break. In this issue, our cover article (evidence and practice, page 21) explains how emotional labour can lead to exhaustion and burnout, which contributes to a high turnover in the nursing workforce. It examines the differences in resilience and coping strategies of less experienced nurses compared with their more experienced counterparts.

Does the RUSON employment model support transition to practice, relieve workload pressure and improve patient care?

The article examines whether the Registered Undergraduate Student of Nursing (RUSON) employment model can help improve transition to practice and address workforce shortages in Australia. Topics discussed include the global nursing shortage following the COVID-19 pandemic, challenges facing new nursing graduates, and the RUSON employment model's success in reducing workload pressure and increasing job satisfaction for registered nurses.

Palliative care terminology and practice in intensive care units in the Czech Republic: results of PEOpLE-C19 study

Study goal: Palliative care is an essential part of a complex approach to patients in the intensive care unit (ICU). This study aimed to describe palliative care practice in ICU in the Czech Republic. Study type: a cross-sectional, questionnaire study Material and methods: The inclusion criteria for study participation were nurses or physicians taking care of patients in the ICU for patients with Coronavirus Disease 2019 (COVID-19). The participants could participate by filling out the electronic survey with 40 questions. The questionnaire was evaluated by descriptive statistical analysis. Results: 313 questionnaires were analyzed. Participants reported up to 15 different terms for end-of-life care, the most often being palliative care (75.1%, n=235). The supportive care, especially sedatives, was most frequently adjusted according to the patient's needs. On the other hand, as a standard approach, the parenteral (35.8%, n=112) and enteral (17.3%, n=54) nutrition were most often withdrawn. Regarding organ support, renal replacement therapy (69.7%, n=218) and vasopressors (60.4%, n=189) were often withdrawn. The most rarely withdrawn organ support was artificial ventilation (24.6%, n=77), endotracheal intubation (11.5%,n=36), and tracheostomy cannula (2.9%, n=9). The majority of respondents would appreciate further education in palliative care. Conclusion: Palliative care is an essential theme not only in the COVID-19 pandemic. The palliative care terminology and practice used in the Czech Republic are heterogeneous. There is a space for further research and education in palliative care.

An early return-to-work program for COVID-19 close contacts in healthcare during the Omicron wave in Japan

During the coronavirus disease 2019 (COVID-19) pandemic, maintaining adequate staffing in healthcare facilities is important to provide a safe work environment for healthcare workers (HCWs). Japan's early return-to-work (RTW) program may be a rational strategy at a time when there is an increased demand for the services of HCWs. We assessed whether the early RTW program for HCWs who have been in close contact with a COVID-19 case in our hospital was justified. Close contacts were identified according to the guidance document of the World Health Organization. HCWs who met all of the following conditions were eligible to apply to an early RTW program: (1) difficult to replace with another HCW, (2) received the third dose of a COVID-19 mRNA vaccine, (3) a negative COVID-19 antigen test before each work shift, and (4) consent from relevant HCWs and their managers to participate in the program. Between January and March 2022, 256 HCWs were identified as close contacts (median age, 35 years;192 female). Thirty-seven (14%) secondary attack cases of COVID-19 were detected. Among 141 HCWs (55%) who applied to the early RTW program, nurses and physicians comprised about three-quarters of participants, with a higher participation rate by physicians (78%) than nurses (59%). Eighteen HCWs tested positive for COVID-19 by the sixth day after starting the early RTW program. No COVID-19 infection clusters were reported during the observation period. These findings suggest that the early RTW program for COVID-19 close contacts was a reasonable strategy for HCWs during the Omicron wave. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

POSTAL MEDICINE DELIVERY FOR STAGE-2 HYPERTENSIVE PATIENTS IN COVID-19 SITUATION: TURNING CRISIS TO OPPORTUNITY

Introduction: The COVID-19 pandemic has influenced healthcare systems, particularly in the areas of non-communicable diseases, such as hypertension, where the majority of patients require medication therapy and frequent visits. The postal medicine delivery (PMD) approach was an innovative solution to keep antihypertensive drugs accessible under the social distance regulation. Objective: We aimed to investigate the effectiveness of the PMD in terms of blood pressure (BP) control (< 140/90 mmHg), and target organ damage (TOD) including myocardial infarction, heart failure, acute stroke, and progression of chronic kidney disease) during the use of PMD. Design and method: This was a cross-sectional study in a university hospital, conducted between 11th March to 27th May 2020 when the hospital policy stated that outpatient departments' service would be reduced, and physicians were encouraged to use PMD. Patients without a history of TOD and who had a history of well BP control (< 140/90 mmHg) for the last 2 weeks, were enrolled. All of the patients used smartphones and LINE® applications for contacting the nurse coordinator every 3 months to report their home BP. After 6 months of PMD, patients were assigned to have a follow-up visit at the hospital for office BP measurement and having metabolic panel checked. Results: Thirty-eight patients met the inclusion criteria, and 68% were women. Most of the patients (97.4%) had used home BP monitoring (HPBM). The rate of BP control in goal was 64.2%. There was no TOD during the PMD approach. The medication boxes were sent successfully via postal service within 5-10 days, with no loss or damage recorded. All of the patients reported that they had been taking their antihypertensive medications. More than two-thirds (68.4%) continued to follow a low-sodium diet, while 76.3 percent continued to exercise regularly. Conclusions: In the COVID-19 epidemic, the PMD method could be another effective and safe strategy to enhance medicine access, if suitable enrolment criteria and communication between healthcare practitioners and patients are maintained. (Figure Presented).

Professional Quality of Life of Chinese Nurses and Its Correlation with Benefit Findings

Objective: To understand the current situation of nurses' professional quality of life in China and its correlation with benefit findings, so as to provide reference for formulating targeted measures to improve nurses' professional quality of life in China. Methods: Questionnaire star was used to conduct a cross-sectional survey of 11 924 registered nurses in China from January 2022 to April 2022 using the General Information Questionnaire, the Professional Quality of Life Scale (ProQOL) and the General Benefit Discovery Scale (GBFS). SPSS 22.0 software was used for data analysis. Results: The scores of various dimensions of nurses' ProQOL scale were: Compassion satisfaction was (32.71±6.81) points, burnout was (27.38±5.20) points, secondary traumatic stress was (28.44±6.67) points, and the total score of GBFS was (100.90±18.04) points. The results of multiple linear stepwise regression showed that the main influencing factors of compassion satisfaction were marital status, position, work unit level and educational background (P <0.05). The main influencing factors of burnout were position, professional title, work unit level and whether there were children to be taken care of at home (P <0.05). The main influencing factors of secondary traumatic stress were education background, marital status, professional title, whether there was an old person to be taken care of at home, whether to take care of COVID-19 patients, whether to be an epidemic support staff and position (P <0.05). Benefit finding independently predicted the three dimensions of nurses' professional quality of life (P <0.001). Conclusions: Chinese nurses' professional quality of life was at a moderate level and it was significantly affected by benefit finding. Attention should be paid to factors such as marital status, work unit level, position, professional title, education background, whether there was an old person to be taken care of at home, whether to take care of COVID-19 patients, so as to improve the level of nurses' benefit finding, promote their personal growth, provide good job guarantee, and improve Chinese nurses' professional quality of life. © 2023, Editorial department of Chinese Medical Ethics. All rights reserved.

Hybridizing adaptive large neighborhood search with kernel search: a new solution approach for the nurse routing problem with incompatible services and minimum demand

The average age of the population has grown steadily in recent decades along with the number of people suffering from chronic diseases and asking for treatments. Hospital care is expensive and often unsafe, especially for older individuals. This is particularly true during pandemics as the recent SARS-CoV-2. Hospitalization at home has become a valuable alternative to face efficiently a huge increase in treatment requests while guaranteeing a high quality of service and lower risk to fragile patients. This new model of care requires the redefinition of health services organization and the optimization of scarce resources (e.g., available nurses). In this paper, we study a Nurse Routing Problem that tries to find a good balance between hospital costs reduction and the well-being of patients, also considering realistic operational restrictions like maximum working times for the nurses and possible incompatibilities between services jointly provided to the same patient. We first propose a Mixed Integer Linear Programming formulation for the problem and use some valid inequalities to strengthen it. A simple branch-and-cut algorithm is proposed and validated to derive ground benchmarks. In addition, to efficiently solve the problem, we develop an Adaptive Large Neighborhood Search hybridized with a Kernel Search and validate its performance over a large set of different realistic working scenarios. Computational tests show how our matheuristic approach manages to find good solutions in a reasonable amount of time even in the most difficult settings. Finally, some interesting managerial insights are discussed through an economic analysis of the operating context. © 2022 The Authors. International Transactions in Operational Research published by John Wiley & Sons Ltd on behalf of International Federation of Operational Research Societies.

Nurses' Use of Holistic, Complementary and Alternative Medicine Methods Against COVID-19 Anxiety

Context • Health professionals have been experiencing physical and mental fatigue, affective disorders, and sleep problems due to the stress experienced during the COVID-19 pandemic. As in most outbreaks and pandemics, nurses are at the forefront of the fight against the coronavirus and have experienced high anxiety levels. People can resort to many methods of coping with stressful situations, including complementary and alternative medicine (CAM). Objective • The study intended to assess nurses' anxiety levels about COVID-19 during the peak period of its second wave in Turkey and to examine the methods that they used to cope with that anxiety as well as their attitudes toward CAM. Design • The research team designed a descriptive and cross-sectional study Setting • The study was conducted in a training and research hospital in the Aegean region of Turkey between February 2021 and May 2021, during the second wave of the COVID-19 pandemic. Participants • Participants were 168 nurses working in the hospital. Outcome Measures • Data were collected with the Sociodemographic Information Form, Coronavirus Anxiety Scale (CAS), and Holistic Complementary and Alternative Health Questionnaire (HCAMQ), which has two subdimensions, CAM and Holistic Health (HH). Results • A significant relationship was found between the unit where the nurses worked and their scores on the CAM subdimension (P < .037). A significant relationship was also found between the nurses' anxiety about the COVID-19 epidemic and the scores on the holistic health (HH) subdimension (P < .001) and the HCAMQ (P < .016). To cope with anxiety, the nurses who experienced anxiety used the following complementary methods: (1) saying prayers and worshipping (56.6%), (2) taking hot and cold showers (54.6%), and (3) drinking herbal teas and infusions (49.3%). A weak correlation was found between the CAS, CAM, and HCAMQ scores (P < .05). Conclusions • The current study found that it could be beneficial for nurses to apply complementary methods to reduce their anxiety, because it's not known how long the COVID-19 pandemic will continue. In line with these results, it's extremely important to determine the psychological symptoms and to determine the priorities for solving these problems in nurses. Therefore, it's recommended that nurses should identify their anxieties about COVID-19 and that they should use complementary methods to manage their anxieties. © 2023, InnoVision Communications. All rights reserved.

A Community Medical Center Data-Driven Staffing Model: A Quality Improvement Project

Work and staffing practices need to be redesigned to better meet the needs of the changing nurse workforce. Predictive analytics were used in this quality improvement project to examine historical census and staffing volumes of hospital units to support a more proactive staffing and scheduling model. Research found an increase in use of premium pay, and several external forces, such as the COVID-19 pandemic, impacted outcomes. The staffing ecosystem developed during this project to include clinical nursing leadership, finance personnel, human resources personnel, clinical education experts, and information technology wil continue its oversight in making strides at reducing premium pay costs.

The PPE spotter role: Supporting best practice in acute and long-term care

Healthcare workers are at high risk of contracting infections including COVID-19 due to close and frequent contact with patients. To promote appropriate use of personal protective equipment (PPE) and to enhance protection of healthcare workers during the COVID-19 pandemic, we trained a team of registered nurses to serve as "PPE Spotters”. This team offered in-person observation, support, feedback, and on-the-spot teaching about proper PPE use and hand hygiene practices. Evaluation showed staff and leaders felt the Spotters effectively promoted best practices for PPE and hand hygiene, and 86% recommended the program continue. PPE Spotters now serve a formal role in the organization, supporting both acute and long-term care.

A preceptorship programme for school nurses and health visitors

A preceptorship programme for health visitors and school nurses in Highland, Scotland, was developed, delivered and evaluated from 2015 until 2021. The programme used video-conferencing technology to connect remote and rural preceptees, particularly during the Covid-19 pandemic. Preceptees' feedback about the programme was positive;the key benefits highlighted were better networking and peer support capabilities and reduced isolation. As well as describing the programme and its development, this article provides recommendations for other organisations about how to develop a preceptorship programme in their field of practice.

Prevalence and Severity of COVID-19 and Missed Job Opportunities among Healthcare Workers in Mazandaran Province, February-June 2020

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Materials and methods: In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Results: The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion: COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease.