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Aim To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks. Background The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID-19, but there appear to be differences in health beliefs of nurses within and between countries regarding these. Methods This qualitative descriptive study used content analysis with a framework approach. Findings There were major differences in nurse participants' beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts. Conclusion Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level. Implications for nursing policy and health policy The COVID-19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence-based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide-reaching education campaign.

Aim: This paper discusses four main strategies for addressing nursing shortages that have been persistent, widespread and growing. Fallout from the COVID-19 pandemic might offer valuable impetus to address this tenacious challenge. Background: Nursing shortages are common, widespread and have been persistent for most of a century. Many of the reasons behind these shortages are well known and are themselves enduring, as are the types of strategies put forward for addressing them. These strategies can generally be classified into four main categories: enhancing retention, improving recruitment, encouraging return to practice and drawing on international human resources. The COVID-19 pandemic is the latest major threat to ensuring a sufficiently sized and skilled nursing workforce. Many nurses have succumbed to burnout as well the plethora of factors that predated the pandemic and have a negative impact on nurse wellbeing, turnover and intention to leave. Sources of evidence: This discussion paper draws on international sources of evidence. Discussion/conclusion: This paper highlights how many of the factors behind and strategies for addressing nursing shortages at the local, national and global levels are widely studied and known. A sustained combination of strategies that focus both within and beyond health and nursing, including on the broader social context, is necessary. While COVID-19 has been extremely damaging, it might present an opportunity to make sustainable, effective reforms to address nursing shortages. Implications for policy: Knowledge users must recognise that a combination of approaches across the gamut of policies that influence nursing workforces is necessary to address nursing shortages. Attention must also focus on factors beyond nursing and healthcare if shortages are to be remedied. Refereed/Peer-reviewed

Aim To review published literature descriptions of advanced practice nurses' roles in low- and lower middle-income countries. Background Advanced practice nurse roles have the potential to address insufficient healthcare resources in low- and lower middle-income countries. Introduction This integrative review highlights advanced practice nurses' roles in the delivery of healthcare services in low- and lower middle-income countries. Methods Three electronic databases PubMed, CINAHL complete and ProQuest Health & Medicine were searched. No limits by year or language were set. The names for low- and lower middle-income countries and combinations 'related to advanced practice nurses' titles were used to identify papers. In addition, a review of publication type was performed. Themes found within the publications were assessed against the advanced practice nurses' International Council of Nurses' characteristics. An integrative review facilitated an appraisal of the papers identified. Results The initial search identified 5778 publications in 16 languages. This number was reduced to 23, from 18 low- and lower middle-income once exclusion criteria were applied. Six publications were from 1977 to 1999, and six between 2000 and 2010, with the remaining 11 from 2011 to 2018. Zambia had the most publications. Notably, 63 countries were not represented. Of those meeting inclusion criteria, the majority addressed education with a lesser extent focusing on practice and regulation of advanced practice nurse's roles. The majority were published during the last decade. Discussion This review of the published literature identified advanced practice nurses' roles and function within some healthcare systems. However, not all components were reported. Examination of the grey literature could provide additional information about the actual and potential benefits of advanced practice nurses' in low- and lower middle-income countries. Conclusion The published literature that referred to advanced practice nurses' identified their contribution to positive impacts on health care over the last 40 years. However, with only 11 publications identified in the last 7 years, further review is required to understand the advanced practice nurses' roles in these countries. Implications for nursing and/or health policy Further development of advanced practice nurses' in low- and lower middle-income countries is supported by the lack of published literature.

In this paper, we strongly advocate for universal palliative care access during the COVID‐19 pandemic. The delivery of universal palliative care services has been called for by leading global health organizations and experts. Nurses are critical to realizing this goal. COVID‐19 diagnoses and fatalities continue to rise, underscoring the importance of palliative care, particularly in the context of scant resources. To inform the writing of this paper, we undertook a review of the COVID‐19 and palliative care literature and drew on our experiences. It is very clear that investment in nurses is needed to ensure appropriate palliative care services now and into the future. Avoiding futile interventions and alleviating suffering is an ethical imperative for nurses regardless of the setting. Multi‐level practices and policies to foster the delivery of safe, high‐quality palliative care for all are urgently needed.

Aim: To explore and synthesise evidence of the literature about healthcare professionals involved in the provision of diabetes management within an Indonesian context. Background: Indonesia is challenged to control the major burden of diabetes prevalence rate that requires a multidimensional approach with the aim to optimise existing health services by involving healthcare professionals who can promote access and provide diabetes management. Methods: This literature review, which is integrated with a scoping study framework, used the electronic databases including CINAHL, PubMed, Scopus and Web of Science to locate papers particular to the Indonesian context. From the total of 568 papers found, 20 papers were selected. Results: The literature review identified physicians, nurses, pharmacists, dieticians and diabetes educators as the providers of diabetes care and management in Indonesia. Collaborative management involving either inter-disciplinary or intra-disciplinary teams, was mentioned in several papers. Internal challenges included: limited skills and knowledge. External challenges included: high patient volumes; a shortage of healthcare professionals and reduced funding. Conclusions: Overcoming the challenges cannot be undertaken with a workforce dominated by any one single healthcare profession. Coordinating with the government to improve the implementation of different roles in diabetes management will improve patient outcomes and thus reduce the burden of diabetes. Implication for nursing and health policy: Health policy reform should support nurses and other healthcare professionals in their professional development at all levels of healthcare. Policy makers can use the review findings to modify the current healthcare system to address key issues in: workforce development; funding for services and medications; and fostering multidisciplinary care for diabetes management. Keywords: Chronic Disease Care; Developing Countries; Diabetes; Health Service Management; Indonesia; Literature Review; Nursing; Nursing Roles; Scoping Review

AIM: This paper analyses and illustrates the application of Bandura's self-efficacy construct to an innovative self-management programme for patients with both type 2 diabetes and coronary heart disease. BACKGROUND: Using theory as a framework for any health intervention provides a solid and valid foundation for aspects of planning and delivering such an intervention; however, it is reported that many health behaviour intervention programmes are not based upon theory and are consequently limited in their applicability to different populations. The cardiac-diabetes self-management programme has been specifically developed for patients with dual conditions with the strategies for delivering the programme based upon Bandura's self-efficacy theory. This patient group is at greater risk of negative health outcomes than that with a single chronic condition and therefore requires appropriate intervention programmes with solid theoretical foundations that can address the complexity of care required. SOURCES OF EVIDENCE: The cardiac-diabetes self-management programme has been developed incorporating theory, evidence and practical strategies. DISCUSSION: This paper provides explicit knowledge of the theoretical basis and components of a cardiac-diabetes self-management programme. Such detail enhances the ability to replicate or adopt the intervention in similar or differing populations and/or cultural contexts as it provides in-depth understanding of each element within the intervention. CONCLUSION: Knowledge of the concepts alone is not sufficient to deliver a successful health programme. Supporting patients to master skills of self-care is essential in order for patients to successfully manage two complex, chronic illnesses. IMPLICATIONS FOR NURSING PRACTICE OR HEALTH POLICY: Valuable information has been provided to close the theory-practice gap for more consistent health outcomes, engaging with patients for promoting holistic care within organizational and cultural contexts.

MUSIC T. (2012) A review of the role the role of influenza vaccination in protecting patients, protecting healthcare workers the role of influenza vaccination. International Nursing Review59, 161–167 Aim: Many health authorities recommend routine influenza vaccination for healthcare workers (HCWs), and during the 2009 A (H1N1) pandemic, the World Health Organization (WHO) recommended immunization of all HCWs worldwide. As this remains an important area of policy debate, this paper examines the case for vaccination, the role of local guidelines, barriers to immunization and initiatives to increase uptake. Background: Seasonal influenza is a major threat to public health, causing up to 1 million deaths annually. Extensive evidence supports the vaccination of priority groups, including HCWs. Immunization protects HCWs themselves, and their vulnerable patients from nosocomial influenza infections. In addition, influenza can disrupt health services and impact healthcare organizations financially. Immunization can reduce staff absences, offer cost savings and provide economic benefits. Methods: This paper reviews official immunization recommendations and HCW vaccination studies, including a recent International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) survey of 26 countries from each region of the world. Results: HCW immunization is widely recommended and supported by the WHO. In the IFPMA study, 88% of countries recommended HCW vaccination, and 61% supported this financially (with no correlation to country development status). Overall, coverage can be improved, and research shows that uptake may be impacted by lack of conveniently available vaccines and misconceptions regarding vaccine safety/efficacy and influenza risk. Conclusions: Many countries recommend HCW vaccination against influenza. In recent years, there has been an increased uptake rate among HCWs in some countries, but not in others. Several initiatives can increase coverage, including education, easy access to free vaccines and the use of formal declination forms. The case for HCW vaccination is clear, and in an effort to further accelerate uptake as a patient safety measure, an increasing number of healthcare organizations, particularly in the USA, are implementing mandatory immunization policies, similar to other obligatory hygiene measures. However, it would be desirable if similar high vaccination uptake rates could be achieved through voluntary procedures.

Aim This paper examines aspects of pandemic policy responses to the COVID‐19 and SARS‐CoV‐2 variants and presents an integrated view of the consequences of response tactics at national and health service levels for older adults. Background Nurses are positioned at the intersection of health service and policy implementation; therefore, their influence on clinical protocols and health policy directions post pandemic is crucial to preventing further premature deaths in the 65+ years age group and others. Sources of evidence Perspectives presented here are based on a critical evaluation of the many published reports, comments, research and insights concerning the pandemic. That evidence, combined with my experience in various fields of study and professional service, enables me to envisage what some decisions and policies may mean for older people, nurses and societies worldwide. Discussion Established information on world population patterns and the location and health of national groups has been made less reliable by population shifts caused by years of geo‐political conflicts and now the impact of the pandemic. Added to this already chaotic context, the pandemic has further disrupted societies, health services and economies. Ageist responses by these systems have further disadvantaged older people and generated trust deficits that need to be resolved. Conclusion When the pandemic recedes, policy and management decisions taken by governments and hospital administrators will be a telling indicator of whether the established systematic ageism exposed during the pandemic will continue to compromise the health and longevity of older adults. Implications for nursing, health and social policy The ascendency of nursing influence within the health and social policy environment must be further strengthened to enable nurses to champion equity and fairness in the pandemic recovery effort.

Preparing the world to manage future pandemics must take priority. It is clear that we were not prepared for the COVID‐19 pandemic which continues to cause great suffering around the world. Nurses and other health professionals everywhere must be involved in health policy planning and implementation of public health measures to combat this and future pandemics. Such preparation needs community policy involvement at grassroots levels and needs to be collaboratively instigated at international levels. The death so far of over 2000 nurses is unacceptable in this pandemic, and we need to better protect and sustain the workforce. The International Council of Nurses has been instrumental in data gathering of nurses' experiences during COVID‐19. Key points from analysis of this data have been included in Second Progress Report of the World Health Organization's Independent Panel for Pandemic Preparedness and Response. This paper summarises the key messages from this report, as well as the nursing shortage. The International Council of Nurses resounds the call for massive investment in nursing education, leadership and jobs, as well as protection for our nurses on the frontlines of the pandemic.

AIM: To understand nurses' responses to COVID-19 and identify their uptake of changes in the procedure required for the management of COVID-19 in an inpatient psychiatric ward. BACKGROUND: The infection risk for COVID-19 in an enclosed inpatient psychiatric ward is high due to living arrangements in the ward and the nature of the infectious disease. INTRODUCTION: This paper describes inpatient nurses' experiences, challenges and strategies deployed at the institutional and national levels to contain the spread of infection. METHODS: Written feedback was collected to understand nurses' responses and identify their uptake of changes in procedure following the COVID-19 outbreak in the ward. FINDINGS: Nurses felt shocked, worried, isolated, expressed a lack of confidence, and experienced physical exhaustion. COVID-19 specific challenges were highlighted in the delivery of safe and quality nursing care. Nurses were satisfied with the hospital policy and strategies implemented during the outbreak, acknowledging the importance of support from nursing leaders. DISCUSSION: Practical support and strong nursing leadership have been imperative in the battle against the COVID-19 outbreak in the psychiatric hospital. Psychiatric nursing care was maintained with a modified management and treatment approach. IMPLICATIONS FOR NURSING PRACTICE: Nurses' willingness to adjust to the reconfiguration of operations to accommodate changes has been crucial for the healthcare system to run effectively. Good practices and policies established during this crisis should be developed and established permanently in nursing practice. IMPLICATIONS FOR HEALTH POLICY: Prompt and effective contingency planning and policymaking at the national and institutional level, targeting human resource management and infection control, can introduce changes and alternative options for nursing care in a pandemic. CONCLUSION: With support from influential nursing leaders, strategies and policies are imperative in ensuring the successful management of COVID situations in an inpatient psychiatric setting.

Nurses are the largest group of healthcare workers in the world, and during the COVID‐19 pandemic, nurses have been recognized worldwide as frontline warriors working hard to stem suffering, infection rates and deaths. Korean nurses experienced the effects of the pandemic earlier than in most other countries, and the work of our nurses has been recognized as a successful model in responding COVID‐19. In this paper, we share the experiences of Korean nurses, including their experiences of workload, acute shortages of staff and equipment and work overload, and suggest ongoing tasks that need to be addressed to combat the pandemic’s second wave and other possible waves. Specifically, the nursing issues relating to COVID‐19 are critically reviewed and recommendations for each issue are suggested in terms of nursing staffing, practice and policy, as well as health policy.

Aim This paper describes the situation regarding COVID-19 emergency in France as of early May 2020, the main policies to fight this virus, and the roles and responsibilities of nurses regarding their work at this time, as well as the challenges facing the profession. Background Europe continues to be affected by the COVID-19 pandemic. At the time of writing France was the fourth country with the highest number of detected cases and cumulative deaths. Sources of evidence Websites of the World Health Organization, French Government, French Agency of Public Health, French National Council of Nurses and ClinicalTrials.gov database, as well as the experiences of the authors. Discussion The history of the development of the pandemic in France helps explain the establishment of the state of health emergency and containment of the population. Many decisions made had undesirable repercussions, particularly in terms of intra-family violence, mental health disorders and the renunciation of care. Hospitals and primary care services, with significant investment by nurses, played a key role in the care of persons with and without COVID-19. Conclusion France has suffered a very high toll in terms of COVID-19 morbidity and mortality, and effects on its people, health systems and health professionals, including nurses. Implications for nursing practice Nurses are recognized for their social usefulness in France. However, it is important to consider the collateral effects of this crisis on nurses and nursing and to integrate the health emergency nursing skills established during the pandemic into the standard field of nursing competence. Implications for nursing policy The nursing profession has expectations of a reflection on and revision of nursing skills as well as of its valorization in the French healthcare system, notably carried out by the French National Council Order of Nurses.

Background National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies. Aim This study's aim was to describe the pre-data collection instrument adaptation challenges when designing the first national nursing workforce study in Poland while participating in the Nurse Forecasting: Human Resources Planning in Nursing project. Methods A descriptive analysis of the pre-data collection phase of the study. Instrument adaptation was conducted through a two-phase content validity indexing process and pilot testing from 2009 to September 2010 in preparation for primary study implementation in December 2010. Means of both content validation phases were compared with pilot study results to assess for significant patterns in the data. Results The initial review demonstrated that the instrument had poor level of cross-cultural relevance and multiple translation issues. After revising the translation and re-evaluating using the same process, instrument scores improved significantly. Pilot study results showed floor and ceiling effects on relevance score correlations in each phase of the study. Limitations The cross-cultural adaptation process was developed specifically for this study and is, therefore, new. It may require additional replication to further enhance the method. Conclusions The approach used by the Polish team helped identify potential problems early in the study. The critical step improved the rigour of the results and improved comparability for between countries analyses, conserving both money and resources. This approach is advised for cross-cultural adaptation of instruments to be used in national nursing workforce studies. Implications for nursing and health policy Countries seeking to conduct national nursing workforce surveys to improve nursing human resources policies may find the insights provided by this paper useful to guide national level nursing workforce study implementation.

BAERNHOLDT M. & COTTINGHAM S. (2011) The Clinical Nurse Leader – new nursing role with global implications. International Nursing Review58, 74–78 Aim: This paper describes the development of the Clinical Nurse Leader (CNL©) role and education, the CNL's impact and potential to improve quality globally. Background: The need for clinical nurse leadership to improve the quality of health care systems while controlling costs is recognized in reports internationally. In the USA, a new nursing role, the CNL, was developed in response to such reports. Conclusion: CNLs are master's level nurse graduates (although not necessarily recruited from a nursing background) with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. This innovative role can be adapted worldwide to improve the quality of health care systems.