Exploring the effects of the COVID-19 pandemic on nurse managers.

BACKGROUND: Research shows that front-line nurses' workload and stress levels increased during the coronavirus disease 2019 (COVID-19) pandemic, however, there is little research of these factors in relation to nurse managers. Previous research undertaken in Austria found that some nurse managers working in nursing homes undertook clinical as well as managerial functions during the pandemic, a double burden that could have increased their stress levels and have had adverse psychological, physical and social consequences. AIM: To investigate the effects of the COVID-19 pandemic on nurse managers' workload, perceptions of teamwork and stress levels, and the physical, psychological and social consequences of working during the pandemic. METHOD: A cross-sectional design was used. Respondents (n=238) were sent an online questionnaire during the second wave of the pandemic (which in Austria was November 2020 to March 2021) containing questions on demographics and fear of infection, their current workload compared with pre-pandemic workload, their perceptions of the influence of the pandemic on teamwork, their levels of stress measured using the Perceived Stress Scale (PSS), and the physical, psychological and social consequences of working during the pandemic. RESULTS: Most respondents (95%) had to undertake more or much more work than usual during the pandemic, while just over half (52%) perceived that the influence of the pandemic on teamwork had been positive throughout or partially positive. Overall, the respondents' level of stress was moderate, as measured by the PSS. Around 28% of respondents were afraid of infecting someone other than themselves, notably their families, employees and patients. Fear for themselves, their families and their patients or residents were commonly reported psychological consequences of working during the pandemic, while confusion due to information overload was the second most commonly reported psychological consequence. CONCLUSION: Comparing results with previous research is difficult due to the lack of research of nurse managers' experiences of the pandemic. Fear appears to have been a major issue for nurse managers during the pandemic, particularly in relation to infection and information overload. This emphasises the need for healthcare organisations to focus on the mental health and well-being of nurse managers, as well as front-line staff, during and after crisis situations such as a pandemic. Organisations may consider reworking and adopting already-established COVID-19 regulations, schedules and local guidelines, particularly in terms of communication and infection control, which could help to reduce nurse managers' fear in future crisis situations.

Psychosocial interventions for healthcare workers during the COVID-19 pandemic: rapid review and meta-analysis.

This rapid review was conducted by following a predefined protocol developed by the Cochrane Rapid Reviews Methods Group. A total of 172 potential reviews and 167 primary studies of interest were found. AMSTAR II was used to assess the quality of the included reviews and the JBI Checklist for Randomized Controlled Trials for primary studies. Overall, four studies were included in this review. The study quality ranged from 5 to 12 out of 13 possible stars. No robust evidence was found that psychosocial interventions can reduce psychological distress. No significant effect could be found regarding post-traumatic stress. Two studies on anxiety were identified, one which showed an effect and another which did not. The psychosocial intervention had no beneficial effect on burnout and depression, whereas providing a mindfulness- or relaxation-based intervention resulted in a significant improvement in sleep quality. By considering the secondary results and results of previous reviews, a combination of training and mindfulness seems to be beneficial for decreasing anxiety and stress in home care workers. In summary, the evidence-based recommendations are still limited and, therefore, more evidence is needed to make a general statement of high certainty about the effects.

Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom: A multi-site, cross-sectional study.

OBJECTIVES: The aim of this study is to describe and compare the prevalence rates of urinary incontinence as well as the management of urinary incontinence in the nursing home setting in Austria, the Netherlands, Turkey and the UK. METHODS: This study is a secondary analysis of the 2017 and 2018 data from a multi-site, cross-sectional study which is performed annually in the nursing home setting in Austria, the Netherlands, Turkey and the UK. RESULTS: A total of 23,334 nursing home residents was included in this study, most of whom were female. The urinary incontinence prevalence rates ranged from 13.8% in Turkey to 35.1% in Austria. In all countries, the most frequently used intervention for urinary incontinence management was the use of absorbent products and/or catheters (ranging from 81% in Turkey to 94.5% in Austria). The countries differed with regard to the methods used to assess the type of urinary incontinence, scheduled individual bathroom visits and medication evaluation. In the UK (77.1%), scheduled individual bathroom visits were a more frequent measure than in Austria (51.3%), the Netherlands (24.4%) and Turkey (10.2%). CONCLUSION: The most frequently used nursing intervention in all countries was the use of absorbent products and/or catheters. Future studies on the over- or misuse of these products are warranted. In order to avoid the over- or misuse of these products in the nursing home setting, the use of the evidence- and consensus-based algorithm provided by the Wound, Ostomy and Continence Nurses Society™ is recommended.

Rapid review and meta-analysis of the effectiveness of personal protective equipment for healthcare workers during the COVID-19 pandemic.

Objectives: Healthcare workers (HCWs) worldwide have and are using personal protective equipment (PPE) as COVID-19 prevention measures, including gloves, gowns, goggles, masks and hand hygiene. Although several reviews have been published on the effectiveness of PPE, these often include studies on other inflectional diseases. This is problematic, because these diseases differ with regard to, e.g. the transmissibility and viral loads in the days after infection. Therefore, we assessed the effectiveness of PPE to protect HCWs from COVID-19 infections. Design: Rapid review of literature. Methods: We followed a practical guide to conduct the rapid review based on a protocol established by the Cochrane Rapid Reviews Methods Group. Meta-analyses have been conducted to synthesize the results. The confidence in the evidence was determined using the GRADE method. Results: We found 461 reviews and 208 primary studies, of which 16 systematic reviews included 11 observational studies of interest. Wearing PPE conferred significant protection against infection with COVID-19 as opposed to not wearing adequate PPE. Overall, the review results show that wearing face masks can significantly protect HCWs from infection. We found no effects for wearing gloves and gowns. Practicing thorough hand hygiene and having proper PPE, as compared to lacking proper PPE, showed a protective but not statistically significant effect. No studies reported the side effects of wearing PPE or acceptance rates. Conclusion: This evidence supports PPE use by HCW, and especially N95 masks, to reduce the risk of a COVID-19 infection.

Secondary data analysis of intertrigo in hospital and geriatric settings: a comparison of prevalence, anatomical locations, and interventions.

BACKGROUND: Skin conditions and dermatological diseases (eg, intertrigo) in older patients are common in clinical practice. In addition to the negative impact on the patient's health, diseases such as intertrigo place a financial burden on the health care system. PURPOSE: The purpose of this secondary data analysis was to compare the prevalence, anatomical locations, and applied interventions of intertrigo in patients in hospitals and geriatric institutions. METHODS: The authors report the outcome of a secondary data analysis of data collected from 2012 to 2016 from the Nursing Quality Measurement 2.0. This is an annually conducted cross-sectional multicenter study. Descriptive statistics and statistical tests were used to analyze the data. RESULTS: Of patients in the hospital, 2.4% (n = 15,152) had intertrigo compared with 3.4% (n = 3743) of patients in geriatric institutions. In general, expert consultation was the least used intervention for the treatment of intertrigo in hospitals (6.1%, n = 359) and geriatric institutions (9.8%, n = 122). CONCLUSION: Independent of the setting, considering the worldwide climate change, the authors expect that the number of patients with intertrigo will be increasing. Therefore, they highly recommend implementing standardized skin assessments for moisture-associated skin damage to identify intertrigo as early as possible. Moreover, as the consultation of experts was seldom used in both settings, advances in the interdisciplinary and interprofessional management of moisture-associated skin damages are needed.

COVID-19 pandemic: Burdens on and consequences for nursing home staff.

The objective of this study was to assess burdens placed on and consequences of the COVID-19 pandemic on nursing home staff. DESIGN: We conducted a qualitative descriptive interview study. METHODS: We interviewed 18 nurses, nursing aides and care aides from five different nursing homes by using a semi-structured interview guideline between June and September 2020. Data were analysed with a qualitative content analysis method by combining an inductive and deductive coding frame. RESULTS: Results show that the qualitative work load and work organization were major concerns. Regarding the qualitative work load, participants stated that they were required to perform additional tasks to care for residents, because the pandemic interventions placed the residents under stress and dealing with relatives presented significant challenges. Nursing home staff reported that psychological consequences such as uncertainty, fear and stress represented major effects of the COVID-19 situation. CONCLUSION: We could show that qualitative workloads were assessed and perceived differently. Most nursing home care staff members experienced the changes in working conditions as both physically and psychologically challenging. IMPACT: We highly recommend that nursing home staff receive support in such pandemics by being allowed, for example personal protective equipment breaks. Individually tailored programs need to be established to enhance wellbeing and decrease psychological stress and fear in such challenging times.

Which factors influence the prevalence of institution-acquired falls? Results from an international, multi-center, cross-sectional survey.

PURPOSE: Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. DESIGN: This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. METHODS: Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data. FINDINGS: IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. CONCLUSIONS: This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.

Influence of nursing staff working hours on stress levels during the COVID-19 pandemic: A cross-sectional online survey.

BACKGROUND: Working as a nurse means being able to provide high-quality care 24/7. Studies have shown that the average number of working hours per week is a significant predictor of stress and that the severity of the coronavirus disease 2019 (COVID-19) pandemic has increased the nurses' stress levels. OBJECTIVE: The aim of this study was to investigate the influence of the nursing staff's working hours during the COVID-19 pandemic on the perceived level of stress. METHOD: We carried out an online cross-sectional survey and measured the stress level with the perceived stress scale. RESULTS: Most of the nurses experienced a moderate level of stress. We identified a statistically significant association between increased numbers of working hours per week and the nurses' perceived stress level. In addition, 15% of the nurses who had worked more than 40 h reported experiencing a high level of stress. CONCLUSION: These results reflect the negative consequences of prolonged working hours. For this reason, a (inter)national discussion is needed on the topic of restricting the working hours of healthcare workers during such pandemics. This discussion can improve the health and safety of healthcare workers, patients and members of the general population.

Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic.

AIM: This study gives insights into the association between the use of personal protective equipment (PPE), wearing time of masks and stress among frontline nursing staff during the COVID-19 pandemic. BACKGROUND: PPE can have physical consequences like headache and pain, which could result in increased nurse stress levels. METHODS: A total of 2600 nurses participated in this online survey. The questionnaire is based on literature and includes the perceived level of stress scale. RESULTS: We found no significant association between the use of PPE and stress. Nurses who wore masks for more than 8 h had significant higher stress levels than those who used the masks for a shorter period. CONCLUSIONS: The duration of wearing masks is associated with nurse's stress level. Our findings can help nurses to argue a higher frequency of breaks and a maximum duration of mask usage in their organisations. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend that nursing managers implement practical strategies such as a mask break task force. This task force could promote awareness for mask breaks and recommend and allocate rooms or locations such as balconies for mask breaks.

Improving the quality of nursing care in Austria: 10 years of success.

AIMS: We provide more updated and comprehensive insights, including descriptions of changes that have taken place in the quality of pressure injury care provided in hospitals over a 10-year period. BACKGROUND: Various nursing quality measurements do not present a comprehensive view on nursing-sensitive quality indicators or place a focus on one specific care problem. METHODS: It is a repeated cross-sectional multicentre study conducted annually on 1 day including comprehensive data regarding nursing-sensitive care problems and quality indicators on the structure, process and outcome levels. RESULTS: The prevalence of pressure injuries decreased over the years from 4.4% to 2.9%, and the frequency of interventions increased. CONCLUSION: The Nursing Quality Measurement 2.0 initiative shows considerable improvements over a 10-year period. Therefore, the maintenance of such nursing databases should be treated as a prerequisite to providing high-quality nursing care and safe nursing practice. One main benefit of creating and maintaining such databases is that allow users to screen for improvements, for example in pressure injury care. These observations can be used to develop marketing strategies and/or to empower and engage nursing staff. IMPLICATIONS FOR NURSING MANAGEMENT: Participation in such quality measurements allows the comparison of data collected in wards and institutions in many different countries, enabling them to set appropriate benchmarks. Furthermore, the results can be compared over a period of time, highlighting systematic changes, trends or improvements (e.g., due to implemented innovations).

Which Characteristics of Fecal Incontinence Predispose Incontinence-Associated Dermatitis? A Classification and Regression Tree Analysis.

OBJECTIVE: To investigate which characteristics of fecal incontinence (FI) are predictors for incontinence-associated dermatitis (IAD) using the Classification and Regression Tree method. DESIGN AND SETTING: Data collected from 2014 to 2016 during the Austrian Nursing Quality Measurement 2.0, an annually conducted, cross-sectional, multicenter prevalence study, were merged and analyzed. MAIN OUTCOME MEASURE: The duration, frequency, and amount of FI were used as predictors for IAD. Nurses were asked if the participants suffered from IAD based on their clinical judgment (yes/no). MAIN RESULTS: In total, 1,513 participants with FI were included in this analysis. More than 75% of the participants with FI were to a great extent or completely care dependent. Of all FI participants, nearly 6% suffered from IAD, and more than 70% received special skin care for IAD prevention. Participants with FI had the highest risk of developing IAD if they experienced FI every day, had FI for less than 3 months, and had developed the FI in their current institution. CONCLUSIONS: Nurses face many challenges while helping patients with FI maintain healthy skin. Knowledge of the results of this study and accumulated knowledge about the specific characteristics of FI that are associated with the development of IAD can help healthcare personnel prevent IAD. Based on these results, improving patient education for persons with newly diagnosed FI to prevent IAD is recommended. Research studies should use the definition of FI established by the International Continence Society.

Nutritional problems and their non-pharmacological treatment in adults undergoing haematopoietic stem cell transplantation-A systematic review.

OBJECTIVE: This systematic review aimed to identify the most relevant problems related to malnutrition in adult patients undergoing haematopoietic stem cell transplantation (HSCT) and to identify non-pharmacological interventions to treat these problems. METHODS: A systematic search for each research question was performed in MEDLINE, CINAHL, Embase, the Cochrane Library, Google Scholar and reference lists in the period 2009-2019. RESULTS: Six and nine studies were included respectively. Quantitative pooling of data was not possible due to the heterogeneity of the studies. Oral mucositis (OM), nausea/vomiting, diarrhoea and dysgeusia were the most frequently reported nutritional problems. Cryotherapy and laser therapy seem to be effective in the prevention and treatment of OM. Recommendations for or against the use of mouth rinses and light therapy in the treatment of OM cannot be made, as too few studies have been conducted in this area. The evidence for non-pharmacological treatment options in the case of nausea/vomiting and diarrhoea is rather limited. No study was identified with regard to treatment of dysgeusia. CONCLUSION: Nutrition in HSCT patients has not yet been studied to a satisfactory extent. There is an urgent need for high-quality studies to be conducted in this area to optimise the care of patients undergoing haematopoietic stem cell transplantation.

The relationship between care dependency and pain in nursing home residents.

CONTEXT: Pain is a common health problem experienced by up to 57 % of nursing home residents which has many negative side effects, including a reduced quality of life. Several studies have been carried out on the prevalence of pain and pain management. However, these study findings remain controversial. OBJECTIVES: Therefore, the aim of this study was to compare care dependent and care independent nursing home residents with regard to their (1) pain prevalence and levels and (2) their pain management. METHODS: This cross-sectional study is conducted annually in Austrian nursing homes. We measured pain prevalence and levels by asking questions about the pain experienced and pain level measured in the seven days prior to the interview, as well as the pain experienced at the time of this interview. RESULTS: The study sample comprised 81.1 % of the 1528 residents of Austrian nursing homes. Overall, pain prevalence was higher in care dependent residents than in care independent residents. Care dependent residents experienced more often mild/moderate pain than care independent residents. Both, prevalence and levels of pain were not statistically significant different between the levels of care dependency. Care dependent residents who suffered from pain received a statistically significantly higher number of non-pharmacological interventions as compared to care independent residents who suffered from pain. CONCLUSIONS: We identified a higher prevalence of pain among care dependent residents. Furthermore, the found differences in pain relief seem to be correlated with different degrees of care dependency, an aspect that requires further investigation.

Malnutrition risk and hospital-acquired falls in older adults: A cross-sectional, multicenter study.

AIM: To assess the relationship of malnutrition risk and in-hospital falls in a patient group of older hospitalized patients (65-79 and ≥80 years). METHODS: A cross-sectional, multicenter, point-prevalence study was conducted in 68 Austrian hospitals with 3702 hospitalized older patients. The relationship between malnutrition risk and falls was analyzed using univariate and multivariate binary logistic regression analyses. Data were analyzed separately for two age groups, patients were aged 65-79 years (n = 2320) and ≥80 years (n = 1382). RESULTS: Prevalence of hospital-acquired falls was 5.2%, and prevalence of risk of malnutrition was 24.3% (Malnutrition Universal Screening Tool) and 16.2% (definition using body mass index and weight loss). The univariate analysis showed significant associations of malnutrition risk and in-hospital falls for patients aged ≥80 years (odds ratio 2.1; 95% confidence interval 1.2-3.6) but not for patients aged 65-79 years. The multivariate logistic regression analysis did not show significant associations between malnutrition risk and hospital-acquired falls. CONCLUSIONS: The results of this study show that malnutrition risk is a predictor for in-hospital falls in very old patients (≥80 years). In this patient group, the screening and assessment of nutritional status as well as nutritional interventions for the prevention/treatment of malnutrition risk should be considered as one important factor for successful fall prevention. Studies are necessary to assess the effect of nutritional interventions as part of a multifaceted fall-prevention program. Geriatr Gerontol Int 2020; 20: 348-353.

Structure, Process, and Quality Indicators for Pressure Injury Prevention and Care in Austrian Hospitals: A Quality Improvement Project.

The purpose of this quality improvement point-prevalence project conducted in 2017 was to describe the structure, process, and outcome indicators for pressure injury (PI) prevention and care in 37 Austrian hospitals with 208 wards and 2955 patients, with an average age of 66 years. Structural indicators such as PI guideline availability were measured on hospital and ward levels. On the process level, patients were assessed to determine whether PI interventions such as mobilization or use of moisturizer/barrier cream were implemented. On the outcome level, data on the presence of hospital-acquired PIs based on skin inspection were collected. These data were collected using the Austrian version of the National Prevalence Measurement of Care Problems, a standardized survey. Structural level results showed PI protocols or guidelines were available in 75.7% of the participating institutions. Staff education such as refresher courses was seldom available on the ward level (46.6%). Process-level results indicated the most commonly applied intervention in both patients at risk of or had a PI was the use of skin-protectant moisture barrier creams (63.1% and 85.2%, respectively). Patients with PIs also frequently received interventions focusing on the heels (72.9%) and mobilization (69.2%). With regard to the outcome level, the overall and hospital-acquired PI prevalence rates were 3.6% and 1.3%, respectively. We recommend focusing on staff, patient and family education including the prevention and treatment of hydration and nutritional deficits, an uncommonly used intervention in Austria based on these data, to improve the quality of PI prevention and care in the hospital setting.

Adaptation of evidence-based guideline recommendations to address urinary incontinence in nursing home residents according to the ADAPTE-process.

AIMS AND OBJECTIVES: To adapt international guideline recommendations for the conservative management of urinary incontinence (UI), defined as any involuntary loss of urine, in Austrian nursing home residents following the ADAPTE-process. BACKGROUND: Many international guidelines for managing UI are available. Nevertheless, the international recommendations have not yet been adapted to address the Austrian nursing home context. This crucial adaptation process will enhance the acceptance and applicability of the recommendations as well as encourage adherence among Austrian nurses and nursing home residents. DESIGN: This study is a methodological study based on the ADAPTE-process, including a systematic search, quality appraisal of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) instrument as well as an external review by means of a Delphi technique. The guidelines had to be topic-relevant, published within the last 3 years and achieve a rigor of development score of 80% using the AGREE II instrument. METHODS: We searched international guideline databases to identify adequate guidelines. Two raters assessed the quality of each guideline, ascertaining that it fulfilled the inclusion criteria using the AGREE II instrument. We translated the identified recommendations into German and externally reviewed for their applicability in the Austrian context. RESULTS: We identified 1,612 hits in 10 databases. After applying inclusion and exclusion criteria, we assessed five international clinical guidelines for quality using the AGREE II instrument. One clinical guideline fulfilled the inclusion criteria. This clinical guideline contains 116 recommendations, of which 29 were applicable in the Austrian nursing home setting. CONCLUSION: We identified only one suitable guideline, possibly due to the stringent nature of the inclusion criteria. However, following low-quality guidelines may result in the use of recommendations that are not based on evidence and, therefore, may lead to suboptimal nursing care and outcomes.