Perspectives of nursing directors on emergency nurse deployment during the pandemic of COVID‐19: A nationwide cross‐sectional survey in mainland China

Construction of emergency competency models for nurses in emerging high-consequence infectious disease outbreaks: Behavioural event interview approach

BACKGROUND

Emerging high-consequence infectious disease outbreaks (EHCIDs) have significantly impacted healthcare systems worldwide. Nurses specialising in outbreak response nurses play an important role in the prevention and control of EHCIDs. However, the specific competencies required for these nurses remain undefined. This study aims to develop a competency model for nurses involved in managing EHCIDs, providing a foundation for the training and organisation of specialised nurse response teams.

METHODS

We recruited a geographically stratified sample of nurses from tertiary hospitals in four representative regions of China (Eastern, Western, Northern, Southern) for this cross-sectional study, conducted from April 2021 to April 2023. Using the validated Behavioural Event Interview (BEI) methodology, we conducted qualitative research with 40 nurses from hospitals designated for COVID-19 treatment. Participants were asked to describe three successful scenarios and three challenging experiences they encountered during recent pandemic responses with semi-structured interviews. We analysed the qualitative data using an iterative constant comparison method, employing a three-phase coding process (open, axial, selective) facilitated by NVivo 12.0 software. This analysis culminated in an evidence-based competency model. To ensure the model's reliability and validity, we performed categorical consistency checks and synchronous cross-validity testing‌.

RESULTS

The study included 20 excellent nurses and 20 average nurses. We developed a tailored nursing competency model comprising 20 total competencies, categorised into core (6 competencies), critical (7 competencies), and foundational (7 competencies). Inter-coder reliability was robust, with Cohen's κ ranging from 0.741 to 0.830, and an overall agreement of 0.773. Significant differences in competency scores (p < 0.05) were noted between high-performing and adequately-performing nurses, particularly in core and critical competencies.

CONCLUSIONS

The competency model for outbreak response nursing is scientifically robust and practically applicable. It is particularly crucial for effective nursing management in the face of sudden and uncertain infectious disease outbreaks.

Learning interventions and training methods in health emergencies: A scoping review

BACKGROUND

Keeping the health workforce and the public informed about the latest evolving health information during a health emergency is critical to preventing, detecting and responding to infectious disease outbreaks or other health emergencies. Having a well-informed, ready, willing, and skilled workforce and an informed public can help save lives, reduce diseases and suffering, and minimize socio-economic loss in affected communities and countries. Providing "just in time" support and opportunities for learning in health emergencies is much needed for capacity building. In this paper, 'learning intervention' refers to the provision of ad-hoc, focused, or personalized training sessions with the goal of preparing the health workers for emergencies or filling specific knowledge or skill gaps. We refer to 'training methods' as instructional design strategies used to teach someone the necessary knowledge and skills to perform a task.

METHODS

We conducted a scoping review to map and better understand what learning interventions and training methods have been used in different types of health emergencies and by whom. Studies were identified using six databases (Pubmed/Medline, Embase, Hinari, WorldCat, CABI and Web of Science) and by consulting with experts. Characteristics of studies were mapped and displayed and major topic areas were identified.

RESULTS

Of the 319 records that were included, contexts most frequently covered were COVID-19, disasters in general, Ebola and wars. Four prominent topic areas were identified: 1) Knowledge acquisition, 2) Emergency plans, 3) Impact of the learning intervention, and 4) Training methods. Much of the evidence was based on observational methods with few trials, which likely reflects the unique context of each health emergency. Evolution of methods was apparent, particularly in virtual learning. Learning during health emergencies appeared to improve knowledge, general management of the situation, quality of life of both trainers and affected population, satisfaction and clinical outcomes.

CONCLUSION

This is the first scoping review to map the evidence, which serves as a first step in developing urgently needed global guidance to further improve the quality and reach of learning interventions and training methods in this context.

Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China

AIM

To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China.

DESIGN

A nationwide cross-sectional online survey.

METHODS

A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation.

RESULTS

The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study

AIMS AND OBJECTIVES

To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic.

BACKGROUND

The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences.

DESIGN

A qualitative design based on phenomenological approach.

METHODS

A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines.

RESULTS

One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together.

CONCLUSIONS

Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis.

RELEVANCE TO CLINICAL PRACTICE

Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

Development of Infectious Disease Emergency Response Competencies for Nurses in China: A Delphi Study and an Analytic Hierarchy Process

Aim

To develop a set of infectious disease emergency response competencies specific to frontline nurses in China.

Background

Nurses play an important role in the infectious disease emergency response. Competency-based training is the cornerstone of the professionalization of disaster rescue, including the infectious disease emergency response. Accordingly, reaching a consensus on a set of core competencies is essential. However, information regarding the competencies needed for nurses in the infectious disease emergency response is limited.

Methods

A literature review and in-depth expert interviews were conducted to establish a draft of competencies, which consisted of 53 items, including 3 first-level index items, 12 second-level index items, and 38 third-level index items. Eighteen experts with the knowledge of infectious disease management and experience with infectious disease emergency rescue from different regions in China were recruited for Delphi consultation. A two-round Delphi survey was conducted via email. Consensus was defined as a mean importance value >4.5 and the coefficient of variation <0.25 among the experts. Finally, the analytic hierarchy process was used to determine the weight of each index on which consensus had been reached.

Results

An index system of infectious disease emergency response competencies for nurses was constructed, including 3 first-level indices (knowledge, attitudes, and skills), 10 second-level indices, and 32 third-level indices. The response rates of the two rounds of the Delphi survey were both 100%, and the authority coefficient of the 18 experts was 0.903. The weighted value of each index was established with a consistency ratio <0.1, demonstrating that skill (0.5396) ranked first among the three first-level indices, followed by knowledge (0.2970) and attitudes (0.1634).

Conclusion

The study developed a consensus on infectious disease emergency response competencies required for nurses in China, which provides guidance for the assessment and training of nurses on infectious disease emergency response. Implications for Nursing Management. According to the competency index system, nursing managers could develop effective training programs of infectious disease emergency response competency for nurses and select competent nurses for emergency response to infectious diseases.