Nursing in the spotlight: Talk about nurses and the nursing profession on Twitter during the early COVID-19 pandemic.

BACKGROUND: Nurses comprise the largest portion of healthcare workers and are integral to the COVID-19 response. Twitter has become a popular platform for the public, including nurses, to engage in pandemic-related discourse. PURPOSE: We sought to analyze the representation of the nursing profession and characterize nurses' experiences during the pandemic from tweets published in April 2020. METHODS: We analyzed tweets using natural language processing, Word Adjacency Graph (WAG) Modeling, and thematic analysis. Authors independently reviewed 10% of raw tweets in each WAG-generated topic, qualitatively analyzed tweets, and identified emerging themes. FINDINGS: Six themes emerged: Support and Recognition of Nurses, Military Metaphors, Superhuman/Spiritual Metaphors, Advocacy, Personal Experiences with Nurses, and Social/Political Commentary. Public perception of nurses was positive, but nurses conveyed harsh realities of their work. DISCUSSION: Findings highlight discrepancies in nursing experiences and public perceptions of nursing. Further research should accurately identify and convey the complexities of the nursing profession.

Hospital-Acquired Pressure Injuries and Acute Skin Failure in Critical Care: A Case-Control Study.

PURPOSE: The purpose of this study was to examine clinical characteristics and risk factors for critically ill patients who develop pressure injuries and identify the proportion of validated unavoidable pressure injuries associated with the proposed risk factors for acute skin failure (ASF). DESIGN: Retrospective case-control comparative study. SUBJECTS AND SETTING: The sample comprised adult critically ill participants hospitalized in critical care units such as surgical, trauma, cardiovascular surgical, cardiac, neuro, and medical intensive care and corresponding progressive care units in 5 acute care hospitals within a large Midwestern academic/teaching healthcare system. Participants who developed hospital-acquired pressure injuries (HAPIs) and patients without HAPIs (controls) were included. METHODS: A secondary analysis of data from a previous study with HAPIs and matching data for the control sample without HAPIs were obtained from the electronic health record. Descriptive and multivariate logistic regression analyses were conducted. RESULTS: The sample comprised 475 participants; 165 experienced a HAPI and acted as cases, whereas the remaining 310 acted as controls. Acute Physiology and Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001), mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P < .001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002) were higher in the HAPI group. Multivariate logistic regression analysis identified participants with respiratory failure (odds ratio [OR] = 3.00; 95% confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI, 3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002), severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR = 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95% CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences between unavoidable HAPI, avoidable HAPI, or the control group were identified based on the proposed ASF risk factors. CONCLUSION: This study provides important information regarding avoidable and unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as patient acuity, organ failure, tissue perfusion, sepsis, and history of prior pressure injury, are associated with avoidable and unavoidable HAPI development. In addition, we were unable to support a relationship between unavoidable HAPIs and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the documentation of appropriate interventions and not necessarily with the identification of clinical risk factors.