Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic. METHODS: We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data. RESULTS: Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models. CONCLUSION: The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes.

A comparative analysis of NCLEX pass rates: Nursing health human resources considerations.

AIMS: To examine performance differences among different writers of the National Council Licensure Examination-Registered Nurse (NCLEX-RN) examination in Canada; to compare Canadian and U.S. writer pass rate data; and to identify if changes in the Canadian nursing workforce can be related to the introduction of NCLEX-RN. BACKGROUND: In January 2015, the entry-to-practice licensing examination changed from the Canadian Registered Nurse Examination to the NCLEX-RN, and pass rates declined. METHODS: This comparative analytic study examined NCLEX-RN pass rate data for 2015, 2016 and 2017 using publicly available data. The Canadian data were compared with that from U.S. nurses taking the examination. RESULTS: Overall year-end pass rates among Canadian writers appeared to improve significantly in 2016 (95% to 96.3%, p < 0.001, from 2015 to 2016) but declined again from 96.3% to 90.4% in 2017 (p < 0.001). Pass rates remain significantly lower for first attempt Canadian writers compared to first attempt U.S. writers (2015: 69.7% vs. 84.5%, p < 0.001). CONCLUSIONS: The change in licensing examination had a major impact on pass rates for new graduates entering the nursing profession and potentially the number of new nurses entering the profession in Canada immediately after graduation. IMPLICATIONS FOR NURSING MANAGEMENT: A loss of entry-level workers to the nursing profession in Canada affects workforce management strategies, particularly with respect to worker shortages.

Influence of Tetrabromobisphenol A, with or without Concurrent Triclosan, upon Bisphenol A and Estradiol Concentrations in Mice.

BACKGROUND: Humans are commonly exposed to multiple environmental chemicals, including tetrabromobisphenol A (TBBPA; a flame retardant), triclosan (an antimicrobial agent), and bisphenol A (BPA; polycarbonate plastics). These chemicals are readily absorbed and may interact with each other. OBJECTIVES: We sought to determine whether TBBPA, given alone or in combination with triclosan, can modulate the concentrations of BPA and 17ß-estradiol (E2). METHODS: Female and male CF-1 mice were each given a subcutaneous injection of 0-27mg TBBPA, with or without concurrent 0.33mg triclosan, followed by dietary administration of 50µg/kg body weight 14C-BPA. Radioactivity was measured in blood serum and tissues through liquid scintillation counting. In subsequent experiments, female and male CF-1 mice were each given a subcutaneous injection of 0 or 1mg TBBPA and E2 was measured in urine 2-12 h after injection. RESULTS: Doses as low as 1mg TBBPA significantly elevated 14C-BPA concentrations in the uterus and ovaries of females; in the testes, epididymides, vesicular-coagulating glands, and preputial glands of males; and in blood serum, heart, lungs, and kidneys of both sexes; urinary E2 concentrations were also elevated. Lower doses of TBBPA or triclosan that had no effects on their own elevated 14C-BPA concentrations when the two substances were given concurrently. CONCLUSION: These data indicate that TBBPA, triclosan, and BPA interact in vivo, consistent with evidence that TBBPA and triclosan inhibit enzymes that are critical for BPA and E2 metabolism. https://doi.org/10.1289/EHP1329.