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Aim: To identify and examine the explanatory variables associated with clinical competence among registered nurses (RNs) and practical nurses (PNs) working in long-term care facilities (LTCF) for older adults., Design and Methods: This was a cross-sectional study. The competence test, 'the Ms. Olsen test', was used for data collection. A convenience sample of 337 nursing staff working in LTCFs for older adults was selected between December 2020 and January 2021. A quantitative, non-experimental approach with multiple linear regression analysis examined the explanatory variables associated with clinical competence and the outcome variables., Results: The main findings of the linear regression analysis show that the nursing staff's increasing age, use of Swedish as a working language and use of the Finnish nursing practice standards had statistically significant relationships with clinical competence among the participating nursing staff., Conclusion: This is the first knowledge test that has been developed to test nursing staff's clinical competence in elderly care. In this study in Finland, the highest clinical competence was among the nursing staff who were Swedish-speaking RNs working in institutional care homes caring for patients according to national practice standards., Implications: These results may be useful to nursing staff and managers working in elderly care to understand the explanatory variables associated with clinical competence in elderly care in Finland and in bilingual settings. The study highlights the importance of using national nursing standards in elderly nursing care. Knowing the explanatory variables associated with clinical competence can provide guidance for the further education of nursing staff in these settings., Impact: Caring according to national practice standards and caring for severely ill patients are associated with clinical competence., Reporting Method: The authors adhered to the EQUATOR network guidelines Appendix S1 STROBE to report observational cross-sectional studies., Patient or Public Contribution: Registered and PNs completed a questionnaire for the data collection., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: The registered nurse (RN) workforce experienced critical pre-pandemic and pandemic shortages of labor in some areas in the United States. People living in these health professional shortage areas (HPSAs) may have less access to health services. The Bureau of Health Workforce within the Health Resources and Services Administration administers Nurse Corps scholarship and loan repayment programs to increase healthcare access by increasing the supply and distribution of RNs, nurse practitioners, and nurse faculty to HPSAs. The American Rescue Plan Act of 2021 (ARPA) made available considerable new resources for the program., Purpose: This paper reports on Nurse Corps applications, awards, and distribution in 2 cohorts in the period 2017 to 2022 to assess the impact of receiving an additional $200 million appropriated in 2021., Discussion: Additional funds through ARPA were associated with nearly threefold increases in the number of Nurse Corps awards. Program participants worked in a total of 1,316 counties (42% of all U.S. counties) in 2020 to 2022, a 76% increase from 749 counties in 2017 to 2019., Conclusion: Increased funding for scholarship and loan repayment can help to improve the distribution of nurse labor to a greater number of critical shortage areas in the United States., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background : Many of the overseas qualified nurses educated work as health care assistants and support workers for a decreased wage without scope for professional advancement. There is an imperative to ease their entry to the nursing register. Aim : To gather and provide evidence to the regulatory bodies regarding the demographics of this cohort of nurses and the challenges they face in attempting to register as a nurse. Design : This study used a mixed-method explanatory sequential design. The survey was completed by 857 unregistered nurses followed by five in-depth interviews. Results from both phases were triangulated. Results : The results signpost to the characteristics and challenges of these nurses working as unqualified grades of staff for a decreased wage without scope for professional advance. Discussion and conclusion : The downward occupational spiral of internationally educated nurses underscores the paradoxical nature of the pedagogical application of transition theory, as these nurses are compelled to revert to a novice status.

Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.

Objective: To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality., Data Sources and Study Setting: A national sample of nursing homes during 2017-2019 (pre-COVID). Data included the Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus., Study Design: Retrospective, regression analyses. We estimated separate linear models predicting six long-term facility-level outcomes. Independent variables included staffing hours per resident-day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics., Data Collection/extraction Methods: Hospital-based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded., Principal Findings: We found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low-census dementia facilities, although, high- and low-dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome., Conclusions: These findings suggest that increasing staffing will improve outcomes by similar increments in both low- and high-dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low- and high-dementia census facilities., (© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Introduction: Internationally Educated Nursing staff (IENs) are born and obtained their initial educational preparation in their home country before relocating to work in high-income countries (e.g., United States). Older adults are recipients of IENs' care. The study purpose was to synthesize relevant findings on IENs' experiences caring for older adults in various settings., Method: Arksey and O'Malley's framework approach to Scoping studies was employed. The PubMed, CINAHL, PsycINFO, Web of Science, and Google Scholar databases were searched. A labor and employment relations researcher and a health science librarian were consulted., Results: Three main themes (transitional challenges; IENs' experiences working with older adults; factors affecting IEN service delivery) and seven subthemes emerged., Discussion: Cultural beliefs and communication barriers posed particular challenges to IENs as they worked with Western peers, older adults, and families. Facilitating factors revealed can inform administrative leaders of practice initiatives. Research gaps and limitations identified can guide future study approaches., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: to analyze sleep duration and sleep quality in nursing professionals who work in shifts., Method: this is a cross-sectional, analytical research, carried out between September 2017 and April 2018, at a public hospital in southern Brazil, with the nursing team. A socio-occupational and health symptoms questionnaire, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index were used. Data are presented as descriptive and inferential statistics, bivariate analysis, and binary logistic regression., Results: participants were 308 nursing professionals with a predominance of long-term sleep, absence of drowsiness, and poor sleep quality. Short-term sleep (<6h) was associated with day shift and poor sleep quality. Sleep quality was associated with presence excessive daytime sleepiness and work day shift., Conclusion: work shift, insomnia and headache were the main factors related short-term sleep for nursing professionals. The results may justify the development of intervention research for workers' health.

Workforce issues, challenges, and opportunities., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: We performed a single-center teaching intervention with nursing providers on nasogastric tube (NG tube) clinical practice. The initial purpose of this study was the validation of whether the training was sufficient enough to be retained at a later time point., Methods: We performed a prospective pre-post study examining participants' knowledge before, immediately after, and 4 weeks after training in NG tube management. Training was delivered in face-to-face classroom sessions. Knowledge was assessed using a multiple-choice test (pretest, posttest #1and #2)., Results: A total of 137 nursing providers participated in the training intervention. Immediately after training (posttest #1) and again 4 weeks later (posttest #2), participants overwhelmingly recalled and retained the knowledge of NG tube management as compared to pretest results. Paired t -tests showed each participant increased their test score from pretest to posttest #1, t (134) = 12.64, P = .0001. Similarly, participants who took posttest #2 significantly improved their scores from the pretest to posttest #2, t (71) = 10.629, P < .0001. Secondary analysis showed that the NG tube management comfort level and age of provider were not significant in predicting test results. However, years of professional experience and frequency of NG tube care were significant predictors for higher test scores., Conclusion: To minimize the risk of NG tubes for patients, it is critical to follow clinical guidelines. This study shows that teaching interventions for providers to increase knowledge on NG tubes are beneficial. In addition, the knowledge is retained at later time points.

Background: After the first of three COVID-19 vaccination clinics in U.S. nursing homes (NHs), the median vaccination coverage of staff was 37.5%, indicating the need to identify strategies to increase staff coverage. We aimed at comparing the facility-level activities, policies, incentives, and communication methods associated with higher staff COVID-19 vaccination coverage., Methods: Design. Case-control analysis., Setting: Nationally stratified random sample of 1338 U.S. NHs participating in the Pharmacy Partnership for Long-Term Care Program., Participants: Nursing home leadership., Measurement: During February 4-March 2, 2021, we surveyed NHs with low (<35%), medium (40%-60%), and high (>75%) staff vaccination coverage, to collect information on facility strategies used to encourage staff vaccination. Cases were respondents with medium and high vaccination coverage, whereas controls were respondents with low coverage. We used logistic regression modeling, adjusted for county and NH characteristics, to identify strategies associated with facility-level vaccination coverage., Results: We obtained responses from 413 of 1338 NHs (30.9%). Compared with facilities with lower staff vaccination coverage, facilities with medium or high coverage were more likely to have designated frontline staff champions (medium: adjusted odds ratio [aOR] 3.6, 95% CI 1.3-10.3; high: aOR 2.9, 95% CI 1.1-7.7) and set vaccination goals (medium: aOR 2.4, 95% 1.0-5.5; high: aOR 3.7, 95% CI 1.6-8.3). NHs with high vaccination coverage were more likely to have given vaccinated staff rewards such as T-shirts compared with NHs with low coverage (aOR 3.8, 95% CI 1.3-11.0). Use of multiple strategies was associated with greater likelihood of facilities having medium or high vaccination coverage: For example, facilities that used ≥9 strategies were three times more likely to have high staff vaccination coverage than facilities using <6 strategies (aOR 3.3, 95% CI 1.2-8.9)., Conclusions: Use of designated champions, setting targets, and use of non-monetary awards were associated with high NH staff COVID-19 vaccination coverage., (© 2021 The American Geriatrics Society.)

Frontline workers deserve protection and follow-up support., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The enduring absence of robust nursing workforce data creates gaps to support evidence-based workforce planning and policy development., Purpose: The purpose of this study was to examine Georgia nursing workforce data available through state and national agencies to determine if significance differences exist among data sources., Methods: A cross-sectional, descriptive analysis of 2017 Georgia nursing workforce data was used to examine and compare workforce characteristics available from five data sources. The advantages and limitations of each data source were reviewed., Findings: Significant differences were noted in the quality and quantity of data collected on the Georgia nursing workforce as reported by state and national agencies. None of the datasets include in our analysis had comprehensive and timely data on the Georgia nursing workforce., Discussion: Nursing workforce stakeholders must work collaboratively to require and implement a comprehensive re-licensure survey. It is only though a standardized national minimum dataset that we can ensure an adequate nursing workforce., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: This study aims to determine whether redeploying junior doctors to assist at triage represents good value for money and a good use of finite staffing resources., Methods: We undertook a cost-minimisation analysis to produce new evidence, from an economic perspective, about the costs associated with reallocating junior doctors in the emergency department. We built a decision-analytic model, using a mix of prospectively collected data, routinely collected administrative databases and hospital costings to furnish the model. To measure the impact of uncertainty on the model's inputs and outputs, probabilistic sensitivity analysis was undertaken, using Monte Carlo simulation., Results: The mean costs for usual care were $27,035 (95% CI $27,016 to $27,054), while the mean costs for the new model of care were $25,474, (95% CI $25,453 to $25,494). As a result, the mean difference was -$1,561 (95% CI -$1,533 to -$1,588), with the new model of care being a less costly approach to managing staffing allocations, in comparison to the usual approach., Conclusion: Our study shows that redeploying a junior doctor from the fast-track area of the department to assist at triage provides a modest reduction in cost. Our findings give decision-makers who seek to maximise benefit from their finite budget, support to reallocate personnel within the ED., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Although previous studies have revealed professional consequences of burnout among nurses, less is known about the potential personal consequences. This study investigated the prevalence of suicidal ideation and attitudes toward help seeking among U.S. nurses relative to other workers, and the extent to which personal and professional factors, including burnout, were related to suicidal ideation., Methods: In November 2017, a cross-sectional survey was sent to 86,858 nurses who were members of the American Nurses Association and to a probability-based sample of 5,198 U.S. workers. The survey included questions regarding suicidal ideation, burnout, symptoms of depression, individual and professional characteristics, and willingness to seek professional help if a serious emotional problem arose. Multivariable logistic regression analyses were conducted to identify factors associated with suicidal ideation after controlling for other factors., Results: Among the 7,378 nurse respondents, 403 (5.5%) reported having suicidal ideation within the past year. Most nurses (84.2%) indicated willingness to seek professional help for a serious emotional problem. Yet nurses with suicidal ideation were less likely to report that they'd seek such help (72.6%) than nurses without suicidal ideation (85%). In a multivariable analysis of nurses' data, after controlling for other personal and professional characteristics, we found that burnout was strongly associated with suicidal ideation. Adjusted combined multivariable analyses showed that nurses were more likely than other workers to have suicidal ideation. Both nurses and other workers who reported suicidal ideation were less likely to seek help than were those who did not report such ideation., Conclusions: Compared with other U.S. workers, nurses are at higher risk for suicidal ideation, and nurses with such ideation are more reluctant to seek help than those without it. Burnout contributes to the risk of suicidal ideation. These issues warrant greater attention. Systems- and practice-level interventions must be identified and implemented, both to address the higher prevalences of burnout and suicidal ideation in nurses and to mitigate the stigma about mental health problems and other barriers to seeking help., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care., Design: Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers., Participants: Seventy-one NHs that completed the 12-month trial INTERVENTION: Implementation included distance-learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support., Measurements: Primary outcomes included all-cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30-days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes., Results: The 18 high-performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low-performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30-day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings., Conclusion: Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high-quality medical care and support of the medical director., (© 2021 The American Geriatrics Society.)

Background and Purpose: A new instrument was designed specifically to evaluate nurses' knowledge, attitude, and practice toward patients who use opioids. This study team developed and tested the psychometric properties of the Perception of Opioid Use Survey (POUS) instrument., Methods: The instrument was tested among 306 nurses at a 183 bed acute care community hospital, with psychometric evaluation for validity, reliability, and exploratory factor analysis., Results: Internal consistency results were Cronbach's alpha = .550 for the overall scale and each subscale: Self-Efficacy = .796, Attitudes = .744, Community Impact = .806, and Causative Factors = .763., Conclusions: Psychometric testing results support that the POUS is valid, reliable, and significantly correlated with theoretically selected variables., (© Copyright 2021 Springer Publishing Company, LLC.)

With nursing homes being hit hard by the COVID-19 pandemic, it is important to know whether facilities that have any cases, or those with particularly high caseloads, are different from nursing homes that do not have any reported cases. Our analysis found that through mid-June, just under one-third of nursing homes in Ohio had at least one resident with COVID-19, with over 82% of all cases in the state coming from 37% of nursing homes. Overall findings on the association between facility quality and the prevalence of COVID-19 showed that having any resident case of the virus or even having a high caseload of residents with the virus is not more likely in nursing homes with lower quality ratings.

Background: Historically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions., Methods: A mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted., Results: In total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer., Conclusions: The project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.

This study examines how Salat (prayer) in Islam moderates the relationship between job stress and life satisfaction among Muslim nursing staff. The researchers sampled 335 nursing staff employed at the University of Malaya Medical Centre in Kuala Lumpur, Malaysia. Their ages ranged from 21 to 60 years. The findings indicate the job stress was associated negatively with life satisfaction; there is a strong positive and significant correlation, respectively, between Salat and life satisfaction and that Salat reduces stress and increases the life satisfaction of Muslim nurses. Thus, Salat has a moderating effect on job stress and life satisfaction of Muslim nurses.

Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.

Aims and Objectives: We aimed to investigate the anxiety of nurses who are supporting Wuhan in fighting against coronavirus disease 2019 (COVID-19) infection and explore relevant influencing factors., Background: The COVID-19 outbreak poses a major threat to public health worldwide. Nurses play an important role in this epidemic. However, available data on the mental health among these nurses are limited., Design: A descriptive, cross-sectional survey was performed., Methods: An online questionnaire was completed by 200 nurses who went to Wuhan to help to fight against COVID-19 from another province. Data collection tools include the Chinese version of the Stress Overload Scale (SOS), the Self-Rating Anxiety Scale (SAS) and General Self-Efficacy Scale (GSES). Descriptive, single-factor correlation and multiple regression analyses were used in exploring related influencing factors. Reporting followed the STROBE guidelines., Results: The scores of SAS, SOS and GSES range from 20 to 80, 22 to 110 and 10 to 40, respectively, and the SAS (31.79 ± 7.32) and SOS (40.19 ± 12.92) and GSES scores (24.83 ± 6.60) were obtained. Anxiety was positively correlated with stress (r = .679, p < .001) but negatively correlated with self-efficacy (r = -.326, p < .001). Multiple regression analysis showed that professional qualification, sleep, stress and self-efficacy were the main factors affecting nurse anxiety (p = .006, <.001, <.001, .039, respectively)., Conclusions: Nurses who are supporting Wuhan in fighting against COVID-19 were under a low level of anxiety., Relevance to Clinical Practice: The current study suggests work stress reduction might be a key factor in reducing anxiety and maintaining mental health to support nurses who are fighting against COVID-19 infection., (© 2020 John Wiley & Sons Ltd.)

Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.

The aim of this study is to investigate the knowledge, attitude, and practice (KAP) on Coronavirus Disease 2019 (COVID-19) care among nursing staff and analyze its influencing factors. The survey was conducted on February 18, 2020, among 7,716 voluntary participants from 143 medical institutions in Zhejiang, China. The findings indicated that KAP of nursing staff scored well. However, the accuracy of psychological nursing knowledge was much lower, 14.3% only. Nursing staff working in isolation wards have higher knowledge (OR = 1.776, 95% CI: 1.491-2.116), attitude (OR = 1.542, 95% CI: 1.298-1.832), and practice (OR = 1.902, 95% CI: 1.590-2.274) scores than those in general wards. In terms of KAP, nursing staff with working experience ≤ 10 years scored lower than those with working experience ≥ 20 years, with OR values of 0.490 (95% CI: 0.412-0.583), 0.654 (95% CI: 0.551-0.775), and 0.747 (95% CI: 0.629-0.886), respectively. It is necessary to take measures to enhance the training on COVID-19, especially for KAP of junior nurses in general wards., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wen, Wang, Li and Gu.)

Objectives: To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection., Design: Cross-sectional study., Setting and Participants: In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana., Measures: Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000., Results: The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601‒0.696) and 0.649 (95% confidence interval 0.601‒0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases., Conclusions and Implications: We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention., Methods: Workers' compensation indemnity claims for years 2005-2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention., Results: The patient handling indemnity claim rate declined by 25% in years 4-6 and 38% in years 7-9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7-9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate., Conclusions: Results suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Critical care medicine continues to evolve. However, critical care cases require increasing amount of medical resources. Intensive care unit (ICU) mortality significantly impacts the overall efficiency of healthcare resources within a system of limited medical resources. This study investigated the factors related to ICU mortality using long-term nationwide cohort data in South Korea., Materials and Methods: This retrospective cohort study used data of 14905721 patients who submitted reimbursement claims to the Korean Health Insurance Service between January 1, 2011 and December 31, 2015. A total of 1498102 patients who were admitted to all ICU types, except neonatal and long-term acute care hospitals, were enrolled., Results: Of the total 1498102 participants, 861397 (57.5%) were male and 636705 (42.5%) were female. The mean age at admission was 63.4±18.2 years; most of the subjects were aged over 60 years. During the 5-year period, in-hospital mortality rate was 12.9%. In Cox analysis, both in-hospital and 28-day mortality rates were significantly higher in male patients and those of lower socioeconomic status. As age increased and the number of nursing staff decreased, the mortality risk increased significantly by two or three times. The mortality risk was lower in patients admitted to an ICU of a tertiary university hospital and an ICU where intensivists worked., Conclusion: The number of nursing staff and the presence of an intensivist in ICU were associated with the ICU mortality rate. Also, increasing the number of nursing staff and the presence of intensivist might reduce the mortality rate among ICU patients., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2021.)

Objective: To describe the prevalence and factors associated with pressure injuries related to the use of personal protective equipment during the COVID-19 pandemic., Methods: Cross-sectional study conducted using an instrument made available in social networks with 1,106 health professionals. The data were analyzed using descriptive statistics and compared, considering pvalue < 0.05., Results: There was a prevalence of 69.4% for pressure injuries related to the use of personal protective equipment, with an average of 2.4 injuries per professional. The significant factors were: under 35 years of age, working and wearing personal protective equipment for more than six hours a day, in hospital units, and without the use of inputs for protection., Conclusion: Pressure injuries related to the use of medical devices showed a high prevalence in this population. The recognition of the damage in these professionals makes it possible to advance in prevention strategies.

Background: Influenza vaccinations are recommended for medical staff as an effective and safe form of preventing influenza and its complications. The aim of the study was to assess the impact of selected educational and information interventions on the influenza vaccination coverage (IVC) in nursing personnel and their attitude towards this procedure., Material and Methods: The study participants (N = 320) were randomly divided into 4 groups. Group 1 participated in stationary training, whereas group 2 participated in distance learning. Additionally, 2 subgroups were established in each of the groups above: 1 subgroup received a reminder about the vaccination in the form of a short text message, and the other group did not receive any such reminder. The IVC rate in each group was determined; the attitude towards influenza vaccination was measured using the health belief model., Results: The highest IVC was obtained after stationary training followed by a reminder in the form of a short test message (36%). The reminder significantly affected IVC in the group attending stationary training (p < 0.05, OR = 2.5, 95% CI: 1.16-5.58); however, it had no impact on the IVC in the group participating in distance learning (p > 0.05, OR = 1.2, 95% CI: 0.51-2.83). Both stationary training and distance learning positively influenced the attitude towards influenza vaccinations. A major change in attitudes towards influenza vaccinations was observed only in the case of stationary training followed by a reminder in the form of a short text message (positive changes in perceived susceptibility and severity took place, perceived vaccination benefits increased, and perceived barriers were reduced)., Conclusions: Stationary training followed by a reminder in the form of a short text message is more effective in increasing the IVC rate compared to distance learning. It also promotes positive changes in attitudes to this prophylactic procedure, which is why it should be recommended for wider implementation. Med Pr. 2020;71(6):665-85., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Nurses employed in skilled nursing facilities (SNFs) are at risk for developing compassion fatigue. Compassion fatigue negatively impacts patient outcomes and is associated with decreased quality of care. Some nurses leave the profession due to compassion fatigue. There are no published studies in the United States focused on compassion fatigue among SNF nurses. The purpose of this interpretive phenomenological study was to identify the shared meanings of compassion fatigue among RNs caring for residents in SNFs. Shared meanings among participants were identified as: (1) I feel conflicted, which causes my compassion fatigue; (2) I feel physical and emotional manifestations of compassion fatigue; (3) Compassion fatigue is infused in every aspect of my life; and (4) We are trying to cope with compassion fatigue. Of paramount importance was the desire to make a difference in the lives of residents. Three participants sought employment outside the SNF setting due to compassion fatigue. Further research and education are needed to improve knowledge, policy, and practice. [Research in Gerontological Nursing, 13(6), 320-328.]., (Copyright 2020, SLACK Incorporated.)

Objective: The risk that health personnel have of being assaulted in the workplace is not homogeneous. Factors such as professional category, level of care or service, modulate their probability. The objective of this work was to analyze the aggressions registered by the Servicio Aragonés de Salud professionals, comparing the characteristics of those that occurred in primary care with those that took place in specialized care during 2018., Methods: A cross-sectional descriptive study was made, carried out using the information available in the Aragon aggression registry database, during the year 2018. The study variables included sociodemographic characteristics of the people attacked, type of aggression, level of assistance and sick leave. Frequencies and percentages were calculated for the qualitative variables and mean and standard deviation for the quantitative ones; the relationship between the variables was made using the Mann-Whitney and Chi-Square tests., Results: 236 assaults were registered, of which 75.4% took place in AE. The average age was 45 years. Doctors were more attacked in primary care, while nursing staff was more attacked in specialized care. In primary there were more verbal attacks, while in specialized there were more physical attacks., Conclusions: Occupational violence suffered by health professionals change depending on the level of care, where a higher incidence of assaults is observed in specialized care. It is necessary to establish improvements in the registry of aggressions in Aragón, to improve the prevention and safety of workers., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in skilled nursing facilities (SNFs)., Design: Cross-sectional study linking county SARS-CoV-2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post-acute and long-term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020., Setting and Participants: The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non-Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks., Measurements: For Genesis and non-Genesis SNFs: any outbreak (one or more residents testing positive for SARS-CoV-2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing., Results: One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non-Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6-57.7 percentage point; P = .008) difference in the probability of an outbreak for Genesis and non-Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4-20.8 cases; P = .003) for Genesis SNFs. A 10-bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6-1.2 percentage point; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five-Star ratings or past infection control deficiency citations and probability or severity of outbreak., Conclusions: Larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167-2173, 2020., (© 2020 The American Geriatrics Society.)

Background: Although it has been established that person-centered care is an essential aspect in long-term care facilities, the relationship between person-centered care and job stress among nursing staff and the effect of this relationship on their quality of life are not clear., Purpose: This study aims to investigate correlations among job stress, quality of life, and person-centered care of nurses as well as factors affecting the person-centered care abilities of nursing staff working at long-term care hospitals., Methods: Nursing staff (N = 183) in three long-term care hospitals in South Korea completed a questionnaire on job stress, quality of life, and person-centered care. Data were analyzed using the SPSS 22.0 program for descriptive statistics, using an independent t test, a one-way analysis of variance, Pearson's correlation coefficient, and multiple stepwise regression analyses., Results: Significant factors found to be associated with person-centered care included the quality of life (r = .411, p < .001) and job stress (r = -.305, p < .001) of the participant. The regression model with job stress and quality of life as predictor variables accounted for 29.2% of the variance in person-centered care., Conclusions/implications for Practice: Higher quality of life and lower job stress were found to increase the person-centered care abilities of nurses in long-term care facilities.

Objective: To describe COVID-19 hospitalized health worker cases in Brazil., Methods: This was a descriptive case series study; it included cases that became ill between February 21st and April 15th, 2020 registered on the Influenza Surveillance Information System (SIVEP-Gripe, acronym in Portuguese)., Results: Of the 184 cases, 110 (59.8%) were female and median age was 44 years (min-max: 23-85); 89 (48.4%) were nursing professionals and 50 (27.2%) were doctors. Ninety-two (50.0%) presented comorbidity, with heart disease predominating (n=37; 40.2%). Of the 112 professionals with a record of case progression, 85 (75.9%) were cured and 27 (24.1%) died, 18 of whom were male., Conclusion: The profile of COVID-19 hospitalized health workers is similar to that of the general population with regard to age and comorbidities, but different in relation to sex. The most affected areas were nursing and medicine.

Background/objectives: To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID-19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents., Design: Cross-sectional analysis on Connecticut nursing home (n = 215) COVID-19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two-part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death)., Setting: All Connecticut nursing homes (n = 215)., Participants: None., Intervention: None., Measurements: Numbers of COVID-19 confirmed cases and deaths among residents., Results: The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20-minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68-.89; P < .001); compared with one- to three-star facilities, four- or five-star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78-.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02-1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03-1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20-minute increase in RN staffing significantly predicted 26% fewer COVID-19 deaths (IRR = .74; 95% CI = I .55-1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths., Conclusion: Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases., (© 2020 The American Geriatrics Society.)

Aim: This report from the field describes impressions of the initial impact of bilateral, multi-sectoral field-based activities undertaken to strengthen International Organization for Migration/United Nations Migration Agency and US-based nurses' capacity to address complex clinical, social and cultural challenges experienced by refugees in resettlement. Authors comment on the defined and thorough health assessment process that refugees go through prior to resettlement, and focus on the essential nursing role in the health assessment process and continuum of care. The development of the interdisciplinary and collaborative partnership is described as well as next steps to move the partnership forward., Background: In 2017, International Organization for Migration/United Nations Migration Agency and the University of Minnesota, guided by experts from the United States Centers for Disease Control and Prevention, began a unique bilateral Intergovernmental-Academic partnership to enhance the health care of refugees. A key component was to strengthen nursing care of refugees through the standardization of clinical practice and nursing leadership., Sources of Evidence: Listening sessions, direct interaction between International Organization for Migration/United Nations Migration Agency and US-based refugee resettlement stakeholders, patterns in resettlement., Conclusion and Implications for Nursing and Health Policy: The report highlights the potential public health impact of a bilateral and collaborative initiative that develops and bridges key points in the migration and health trajectory of people with refugee status. Separated by geography, context and scope of work, health professionals in different roles in varied worldwide settings with a spectrum of resources may not fully understand the work of each other. Project activities were a platform through which US-based and internationally based nurses established mutuality, reciprocity and equity as partners. By strengthening systems and resources, the partnership reinforces the abilities of nurses who engage in this important work, to optimize health and wellbeing of people with refugee status., (© 2020 International Council of Nurses.)

Aims: To investigate the work stress among Chinese nurses who are supporting Wuhan in fighting against Coronavirus Disease 2019 (COVID-19) infection and to explore the relevant influencing factors., Background: The COVID-19 epidemic has posed a major threat to public health. Nurses have always played an important role in infection prevention, infection control, isolation, containment and public health. However, available data on the work stress among these nurses are limited., Methods: A cross-sectional survey. An online questionnaire was completed by 180 anti-epidemic nurses from Guangxi. Data collection tools, including the Chinese version of the Stress Overload Scale (SOS) and the Self-rating Anxiety Scale (SAS), were used. Descriptive single factor correlation and multiple regression analyses were used in exploring the related influencing factors., Results: The SOS (39.91 ± 12.92) and SAS (32.19 ± 7.56) scores of this nurse group were positively correlated (r = 0.676, p < .05). Multiple regression analysis showed that only children, working hours per week and anxiety were the main factors affecting nurse stress (p = .000, .048, .000, respectively)., Conclusions: Nurses who fight against COVID-19 were generally under pressure., Implications for Nursing Management: Nurse leaders should pay attention to the work stress and the influencing factors of the nurses who are fighting against COVID-19 infection, and offer solutions to retain mental health among these nurses., (© 2020 John Wiley & Sons Ltd.)

Background: Definitions of nursing certification are lacking in the research literature and research on certification in nursing is remarkably limited., Methods: A six-stage scoping review framework was used to identify the nature, extent, and range of certification within the nursing literature., Findings: Thirty-six articles were included in this scoping review. Most originated in the United States (89%), were classified as research articles (56%), and used a quantitative approach (90%). The majority focused on initial certification (50%), and written examination was the most prevalent approach to certification (39%). Missing and incomplete data were prevalent., Discussion: The overall lack of nursing certification origin, focus, methodological rigor, and clear certification mastery criteria have hindered meaningful study of the relationship between nursing certification and patient outcomes. Common data elements, reporting standards, and observational studies linking common data elements and patient outcomes could guide future research and improve the transparency of certification processes and reporting., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: It is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses., Objective: Investigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana., Methodology: This is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management., Findings: Overall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93-0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027)., Conclusion: There is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority., Competing Interests: The authors have declared that no competing interests exist.

Introduction: An adverse event is an incident induced while providing health care services or resulting from it, not related to the natural course of a given disease or health condition, which causes or is likely to cause negative consequences for the patient, including their death, a threat to life, the necessity of hospitalisation or its prolongation, permanent or considerable health detriment; or is a foetal disease, congenital defect or the result of foetal damage., Objective: The aim of this analysis is to explore the problem of the occurrence of adverse events from the perspective of doctors and ward nurses who manage wards., Material and Methods: The research on the occurrence of adverse events among doctors and nurses (the management staff) was conducted with the use of a postal survey., Results: It was ascertained that 86.5% of the medical personnel had taken part in an adverse event, of which 20.2% took part in an occurrence associated with pharmacotherapy, 16.2% - in an event related to diagnostics and diagnosis, or an infection - 15.7%. 14.2% of respondents were involved in an occurrence linked to a medical device malfunction, and 14.1% - in an adverse event related to an operation., Conclusions: The adverse events most often identified in the nursing professional group are occurrences associated with pharmacotherapy, and in the doctors' professional group - occurrences related to diagnostics and diagnosis. The research established that the most frequent reason for not informing patients about the occurrence of an adverse event is fear of their filing a complaint. Medical management staff show high acceptance of an adverse event reporting system as a tool for improving patient safety.

Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units., Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis., Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89., Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

It is important to improve the training for nursing home staff in order to achieve better quality of life for the elderly.This study aimed to develop a systematic training program for nursing home staff based on the concept of combination of medicine and care.Thirty-four nursing staff from 2 representative nursing homes in Qiqihar City were selected as study subjects and divided into experimental and control groups. The subjects in both groups received routine training following "National Occupational Standards of Elderly Nursing Staff". In addition, the subjects in experimental groups received systematic training at three levels based on the concept of combination of medicine and care for 4 months.After the training, the competence scores of nursing staff in experimental group increased significantly compared to control group, the living quality of the elderly in nursing homes cared by nursing staff in experimental group was significantly improved, and the satisfaction of the elderly to nursing staff in experimental group improved significantly, compared to control group (P < .05).We develop systematic training program for nursing home staff based on the concept of combination of medicine and care, which can improve nursing care for the elderly in nursing home.