Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.

BACKGROUND: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. OBJECTIVE: The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. METHODS: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. RESULTS: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. CONCLUSIONS: RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

[COVID 19: Nursing Leadership and innovations on the field to face the pandemic]. / COVID 19: Leadership infermieristica e innovazioni sul campo per affrontare la pandemia.

INTRODUCTION: In the Italian and European literature there are still few studies describing the impact of the COVID-19 pandemic on the organization of nursing care in hospitals, on the actions taken by nursing leaders to contain it, and on the outcomes of these interventions. AIM: To describe nursing leaders' experiences with reorganizing healthcare pathways, through management data and personal accounts. METHODS: A retrospective quali-quantitative observational study was conducted at the Mauriziano Hospital in Turin, with 484 beds and over 1,700 workers. Quantitative data were analyzed through descriptive statistical indices and integrated with qualitative data collected through semi-structured telephone interviews. The analysis of the quantitative and qualitative data provided an objective and experiential representation of the implemented interventions. RESULTS: We described the impact of interventions introduced by the nursing leadership during the pandemic on hospital services. In particular, the reorganization of the emergency department and of the prevention and psychological support services for the hospital's health workers. In addition, specific initiatives to support the discharge of COVID-19 positive patients, and to support and manage contacts with family members both during the hospitalization of their loved ones and following death are described. DISCUSSION AND CONCLUSION: This study contributes to the discussion on some crucial issues: the increasingly clear relationship between adequate staffing and safety of patients and professionals, the importance of a good working environment and a solid leadership, the importance of continuing education for professionals and adequate skill mixes; all highlighted by the pandemic.

Challenges facing nurse managers during and beyond COVID-19 pandemic in relation to perceived organizational support.

AIM: To explore challenges facing nurse managers during and beyond coronavirus disease, 2019 (COVID-19) pandemic and its relation to perceived organizational support. BACKGROUND: When faced with high-pressure situations like the COVID-19 pandemic, it is critical that nurse managers be equipped with the support they need to successfully surpass these hard times. METHODS: Descriptive correlational design was utilized. The study was conduct at different health care settings across Egypt. Convenience sampling technique was employed to recruit (214) nurse managers. Two instruments were used; questionnaire of challenges faced by nurse managers and survey of perceived organizational support. Mann-Whitney test, Kruskal-Wallis test, Spearman's correlation, and regression analysis were utilized. RESULTS: The highest percentage of managers reported being faced with high level of challenges. There was a highly statistically significant negative correlation between challenges currently faced by managers and their perception of organizational support. CONCLUSION: The COVID-19 pandemic had placed additional challenges on nurse managers and these challenges are expected to persist in the future. Higher perception of organizational support minimizes managers' perception of being challenged in times of pandemics. IMPLICATIONS FOR NURSING MANAGEMENT: Better training focused on disaster management, ethical decision making, leading in times of uncertainty, and maintaining well-being will help nurse managers lead better their teams.

A Most Welcome Spring.

The end of this year's winter brings much-needed hope.

A framework for delivering nursing care to older adults with COVID-19 in nursing homes.

Public health emergencies threaten the lives of U.S. citizens, often in disproportionate ways. Hardest hit are vulnerable populations of older adults (OAs) residing in nursing homes (NHs), who comprised nearly 43% of all deaths from COVID-19 in NHs in 2020. New Jersey (NJ) ranks #2 nationally behind New York with the highest numbers of resident deaths; more than 50% of all COVID-19-related deaths in NJ have occurred in NHs. This public health emergency has prompted investigators to evaluate existing structural, resident, process of care, regulatory, and policy characteristics that have impacted the delivery of nursing care within NJ NHs. In this manuscript, we discuss data from NJ NHs during COVID-19, drawing from publicly available data, state reports, and the geriatric literature to offer recommendations. Based on evidence-based practices (EBPs), we present a series of recommendations to modify existing contextual factors in NHs to best prepare for the next health disaster.

Nursing governance: adaptation in times of pandemic: experience at Clínica Las Condes / Gobernanza de enfermería: adaptación en tiempos de pandemia: experiencia en Clínica Las Condes

La pandemia SARS-CoV-2 ha desafiado el despliegue de todo el equipo de salud, movilizando no solo un recurso humano, también equipamiento, insumos y una infraestructura, que permita responder una alta demanda de pacientes críticos, que requirió abrir más camas críticas, manejada por un personal sanitario sin experiencia en UCI y con equipamiento e insumos limitados. El trabajo en equipo, la comunicación efectiva y el liderazgo en enfermería, son competencias esenciales en la primera ola de la pandemia, por lo que el objetivo de este artículo es describir la innovación de la orgánica estructural de enfermería, especialmente en las áreas de hospitalización de paciente crítico, para velar por el cuidado del paciente, la familia y el equipo de salud.

The SARS-CoV-2 pandemic has challenged the deployment of the entire health team, mobilizing not only a human resource, but also equipment, supplies and an infrastructure, which allows responding to a high demand for critical patients, which required opening more critical beds, managed by health personnel without ICU experience and with limited equipment and supplies. Teamwork, effective communication and leadership in nursing are essential competencies in the first wave of the pandemic, so the objective of this article is to describe the innovation of the structural nursing organization, especially in hospitalization areas. Critical patient, to ensure the care of the patient, the family and the health team

Leveraging Professional Governance During the COVID-19 Pandemic.

Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care.

Shared Governance in Times of Change.

A strong shared governance framework gives nurses control over their practice. Whether unit based or system wide, shared governance provides the infrastructure to deliver high-quality patient care, especially in a crisis. This month's Magnet® Perspectives column takes a closer look at the concept of shared governance, how it has evolved, why it is important, and how it helped nurses in Magnet hospitals navigate the early months of the COVID-19 pandemic. We explore the critical nature of ensuring that everyone's voice is heard to not only survive but also ultimately thrive during times of change.

Nursing's Response to the Executive Order to Advance American Kidney Health.

The state of American kidney health is currently under the microscope. In the United States, approximately 20,000 persons advance to end-stage renal disease annually. Trends indicate accelerating increases in cost of care and a high mortality rate among patients with end-stage renal disease, with only 57% of patients surviving after 3 years. An executive order by the White House has placed the transformation of kidney care at the forefront of the country's health care agenda. The order focuses on key issues including improving outcomes, reducing treatment-related expenditures and increasing kidney donations. Mobilization of health care resources directed toward policymaking, workforce growth and development, and research will be critical to effectively achieve this executive order. Nursing's response, as the health care profession with the most members, will be crucial to achieving response implementation and success of the order. This article describes immediate and future actions including policy, leadership, clinical, educational, and research initiatives that the nursing profession should take to advance kidney health. It calls for specific actions by nursing and focuses on nursing organizations, nursing research, quality improvement initiatives, nursing innovation, advanced practice nursing, and the nephrology and transplant nursing workforce in order to improve kidney health nationally. The impact of the SARS-CoV-2 pandemic on kidney health and the implications for the profession of nursing are outlined. Although there are still many unknowns about the pandemic, nursing's voice is necessary to ensure the ongoing delivery of high-quality care.

[When, how, why and whom for there will be an "after" Covid-19?] / Ci sarà - quando, come, perché, per chi - un "dopo" - Covid 19?

. When, how, why and whom for there will be an "after" Covid-19? The announced, but unpredicted, radical and global experience of the Covid-19 pandemia has revealed the degree of ignorance, fragmentation, inadequacy of the national and international knowledge and strategies of intervention and, even more substantially, of coordination across all the critical areas of prevention and care. The importance of the nursing component of the organisation and of the technical and cultural aspects of health care delivery and accessibility has been underlined as a protagonist of the resistance and resilience during the worst period of the emergency, and should be specifically involved in this renewal, where a profound modification of the interactions, hierarchies, roles of various professions is required. A long term, widespread, flexible experimentation of country specific and international solutions must be envisaged and timely activated. The 'grammar' and the major concrete characteristics of the methodology which could be usefully adopted to guarantee the feasibility and effectiveness of this 'systemic' experimentation are proposed and exemplified.

[How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the Covid-19 outbreak? Results from an exploratory research in some European countries]. / Come sono cambiati gli ospedali, le Terapie Intensive, l'assistenza al malato critico in tempi di Covid-19? Risultati di una indagine esplorativa in alcuni contesti europei.

. How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the COVID-19 outbreak? Results from an exploratory research in some European countries. INTRODUCTION: During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels. AIMS: To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients. METHODS: Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs. RESULTS: A total of 62 nurses responded to the survey; average age 37.5 years, 31 (60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p<0.01), as well as the number of nurses per shift from 10.2 (SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p<0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden. CONCLUSION: These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.