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Objective: To understand the meanings revealed by nurses about sustainable care in its connections with the management of Healthcare Waste in hospital., Method: Qualitative research, whose theoretical and methodological references were, respectively, Complexity Theory and Grounded Theory. Nursing professionals from a public hospital in Rio de Janeiro participated in the study. Data was collected through semi-structured interviews., Results: The actions-interactions signified by the nursing staff, for the management of Healthcare Waste, revealed an understanding of the socio-environmental responsibility of the rational use of material resources; of the need for permanent education to promote environmental education; of the need to supervise the proper management of waste. The professionals perceive themselves as a driving force for reordering positive changes in this context., Conclusion: The participants signaled implications between knowledge, rational use of materials, waste generation and disposal, health economics and quality of care. From these connections, we can deduce the complex meaning of sustainable hospital nursing care in the context of Healthcare Waste management.

Background: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization., Objective: The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit., Methods: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level., Results: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each., Conclusions: RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety., (©Stacie Vilendrer, Mary E Lough, Donn W Garvert, Monique H Lambert, Jonathan Hsijing Lu, Birju Patel, Nigam H Shah, Michelle Y Williams, Samantha M R Kling. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.06.2022.)

Nurse leaders need real-time, accurate data to design care delivery models and make decisions that reflect the patient populations they serve. To support nurse leader practice and optimize patient care, we developed a unit profile dashboard to describe the unique characteristics of patient populations cared for on each clinical unit at our hospital. In this article, we describe dashboard development, challenges, use cases, and plans for data analytics to further advance nursing practice., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Care coordination is both a well-known concept discussed in a wide range of multidisciplinary health care literature and a familiar nursing role in clinical practice; however, the definition of care coordination lacks role clarity across disciplines and within the nursing profession. Despite variations, defining factors of care coordination practice exist; however, role ambiguity limits the effective implementation of evidence-based care coordination in practice and policy. Following Walker and Avant's eight-step concept analysis method, we aim to further clarify care coordination as a concept and practice role and examine the value that nursing brings to its implementation., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Patients undergoing an allogeneic hematopoietic cell transplant (allo-HCT) need to understand and adhere to the transplant process as well as post-transplant follow-up requirements. A working group has met during the eleventh edition of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) Practice Harmonization Workshops. The analysis of a survey that was sent to several transplant centers belonging to the SFGM-TC has been used as a milestone to this article. While, post-transplant medical follow-up was comparable from one center to another, nursing care was found to lack harmonization between centers, although, all patients would receive therapeutic education at one time or another regarding potential transplant-related complications. A few centers in France has established a therapeutic education program that was approved by French health authorities. The aim of this work was to set up guidelines to help centers establishing such a program in well-harmonized way., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Abstract: Strengths-based approaches focus on identifying an individual's assets and resources to find solutions that support their health. These principles are already inherent in nursing philosophies and processes. This article presents a call to reshape the current deficit-based, provider-centric model by formalizing inclusion of holistic, strengths-based approaches into nursing care., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To explore challenges facing nurse managers during and beyond coronavirus disease, 2019 (COVID-19) pandemic and its relation to perceived organizational support., Background: When faced with high-pressure situations like the COVID-19 pandemic, it is critical that nurse managers be equipped with the support they need to successfully surpass these hard times., Methods: Descriptive correlational design was utilized. The study was conduct at different health care settings across Egypt. Convenience sampling technique was employed to recruit (214) nurse managers. Two instruments were used; questionnaire of challenges faced by nurse managers and survey of perceived organizational support. Mann-Whitney test, Kruskal-Wallis test, Spearman's correlation, and regression analysis were utilized., Results: The highest percentage of managers reported being faced with high level of challenges. There was a highly statistically significant negative correlation between challenges currently faced by managers and their perception of organizational support., Conclusion: The COVID-19 pandemic had placed additional challenges on nurse managers and these challenges are expected to persist in the future. Higher perception of organizational support minimizes managers' perception of being challenged in times of pandemics., Implications for Nursing Management: Better training focused on disaster management, ethical decision making, leading in times of uncertainty, and maintaining well-being will help nurse managers lead better their teams., (© 2021 Wiley Periodicals LLC.)

Public health emergencies threaten the lives of U.S. citizens, often in disproportionate ways. Hardest hit are vulnerable populations of older adults (OAs) residing in nursing homes (NHs), who comprised nearly 43% of all deaths from COVID-19 in NHs in 2020. New Jersey (NJ) ranks #2 nationally behind New York with the highest numbers of resident deaths; more than 50% of all COVID-19-related deaths in NJ have occurred in NHs. This public health emergency has prompted investigators to evaluate existing structural, resident, process of care, regulatory, and policy characteristics that have impacted the delivery of nursing care within NJ NHs. In this manuscript, we discuss data from NJ NHs during COVID-19, drawing from publicly available data, state reports, and the geriatric literature to offer recommendations. Based on evidence-based practices (EBPs), we present a series of recommendations to modify existing contextual factors in NHs to best prepare for the next health disaster., (© 2021 Wiley Periodicals LLC.)

Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences., Competing Interests: The authors have declared that no competing interests exist.

The end of this year's winter brings much-needed hope., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nursing managers have a critical role at the hospitals. The current study aims to investigate different experiences of nursing managers., Method: This is a qualitative study that investigates the experiences of 11 nursing managers in Shiraz, Iran. Semistructured interviews and thematic analysis were, respectively, applied for data collection and analysis., Results: It could be found from the current investigation that nursing managers have a critical role at the hospitals, and their creativities have more impacts on procedures compared to organizational orders. There are four major challenges faced by nursing managers including nursing shortage, structural deficiencies, lack of authorities, and burnout. Although shortage is considered as the most important challenge, there are more emphasizes on the improvement of their controlling power in order to prevent their fatigue and burnout., Conclusion: This study showed that creativity of nursing managers is the most important factor of system management; also, shortage and deficiencies are recognized as the most significant challenges faced by them. According to the current study, the shortage of nursing staff is the central issue that has to be considered., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Ahmad Kalateh Sadati et al.)

Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The aim of this study was to describe computational ethnography as a contemporary and supplemental methodology in EHR workflow analysis and the relevance of this method to nursing research., Methods: We explore the use of audit logs as a computational ethnographic data source and the utility of data mining techniques, including sequential pattern mining (SPM) and Markov chain analysis (MCA), to analyze nurses' workflow within the EHRs. SPM extracts frequent patterns in a given transactional database (e.g., audit logs from the record). MCA is a stochastic process that models a sequence of states and allows for calculating the probability of moving from one state to the next. These methods can help uncover nurses' global navigational patterns (i.e., how nurses navigate within the record) and enable robust workflow analyses., Results: We demonstrate hypothetical examples from SPM and MCA, such as (a) the most frequent sequential pattern of nurses' workflow when navigating the EHR using SPM and (b) transition probability from one record screen to the next using MCA. These examples demonstrate new methods to address the inflexibility of current approaches used to examine nursing EHR workflow., Discussion: Within a clinical context, the use of computational ethnographic data and data mining techniques can inform the optimization of the EHR. Results from these analyses can be used to supplement the data needed in redesigning the EHR, such as organizing and combining features within a screen or predicting future navigation to improve the record that nurses use., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

A strong shared governance framework gives nurses control over their practice. Whether unit based or system wide, shared governance provides the infrastructure to deliver high-quality patient care, especially in a crisis. This month's Magnet® Perspectives column takes a closer look at the concept of shared governance, how it has evolved, why it is important, and how it helped nurses in Magnet hospitals navigate the early months of the COVID-19 pandemic. We explore the critical nature of ensuring that everyone's voice is heard to not only survive but also ultimately thrive during times of change., Competing Interests: The author declares no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The state of American kidney health is currently under the microscope. In the United States, approximately 20,000 persons advance to end-stage renal disease annually. Trends indicate accelerating increases in cost of care and a high mortality rate among patients with end-stage renal disease, with only 57% of patients surviving after 3 years. An executive order by the White House has placed the transformation of kidney care at the forefront of the country's health care agenda. The order focuses on key issues including improving outcomes, reducing treatment-related expenditures and increasing kidney donations. Mobilization of health care resources directed toward policymaking, workforce growth and development, and research will be critical to effectively achieve this executive order. Nursing's response, as the health care profession with the most members, will be crucial to achieving response implementation and success of the order. This article describes immediate and future actions including policy, leadership, clinical, educational, and research initiatives that the nursing profession should take to advance kidney health. It calls for specific actions by nursing and focuses on nursing organizations, nursing research, quality improvement initiatives, nursing innovation, advanced practice nursing, and the nephrology and transplant nursing workforce in order to improve kidney health nationally. The impact of the SARS-CoV-2 pandemic on kidney health and the implications for the profession of nursing are outlined. Although there are still many unknowns about the pandemic, nursing's voice is necessary to ensure the ongoing delivery of high-quality care.

Purpose: This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment., Design: This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018., Methods: A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods., Findings: The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment., Conclusions: This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes., Clinical Relevance: Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them., (© 2020 Sigma Theta Tau International.)

Introduction: In the Italian and European literature there are still few studies describing the impact of the COVID-19 pandemic on the organization of nursing care in hospitals, on the actions taken by nursing leaders to contain it, and on the outcomes of these interventions., Aim: To describe nursing leaders' experiences with reorganizing healthcare pathways, through management data and personal accounts., Methods: A retrospective quali-quantitative observational study was conducted at the Mauriziano Hospital in Turin, with 484 beds and over 1,700 workers. Quantitative data were analyzed through descriptive statistical indices and integrated with qualitative data collected through semi-structured telephone interviews. The analysis of the quantitative and qualitative data provided an objective and experiential representation of the implemented interventions., Results: We described the impact of interventions introduced by the nursing leadership during the pandemic on hospital services. In particular, the reorganization of the emergency department and of the prevention and psychological support services for the hospital's health workers. In addition, specific initiatives to support the discharge of COVID-19 positive patients, and to support and manage contacts with family members both during the hospitalization of their loved ones and following death are described., Discussion and Conclusion: This study contributes to the discussion on some crucial issues: the increasingly clear relationship between adequate staffing and safety of patients and professionals, the importance of a good working environment and a solid leadership, the importance of continuing education for professionals and adequate skill mixes; all highlighted by the pandemic.

Confronting global health crises requires nurses who demonstrate leadership and the ability to collaborate with other disciplines. Regional partnerships can act as "accelerant synergists" to develop the capacity of nurses locally benefiting the region as a whole., (© Copyright 2020 Springer Publishing Company, LLC.)

The year 2020 features the 200th anniversary of Florence Nightingale's birth. Her legacy is often recalled as simply being "the lady with the lamp" who cared for sick and wounded British soldiers; however, her impact on the nursing profession includes serving as a role model for many leadership behaviors and strategies that have positively impacted the health of communities and populations around the world. Through her tireless endeavors, Nightingale exemplified many leadership roles, including advocate, change agent, interprofessional collaborator, and visionary. The development of effective skills in these leadership roles remains important for all levels of nursing leaders in today's health-care environment. This article showcases Nightingale's leadership in selected leadership roles, and demonstrates her continued impact on contemporary nurses., (© Copyright 2020 Creative Health Care Management.)

Aim: To explore the ability of nurses to be adequately ready for and to respond to a disaster caused by a natural hazard., Background: During a disaster involving a healthcare facility, nurses are commonly the largest group of healthcare workers impacted. The range of problems facing nurses working in healthcare facilities in Australia and New Zealand at the time of disasters triggered by earthquakes and bushfires have been underexamined., Methods: A qualitative enquiry was used to explore matters facing nurses working in residential healthcare facilities during a natural disaster. Inductive thematic analysis was used to identify the key themes from fifteen in-depth interviews with nurses., Findings: Participants preserved a robust sense of professional duty, personal obligation and responsibility to their family, patients and the facility, demonstrating the ability to adapt, cope and respond despite experiencing diverse personal, structural and organizational barriers., Discussion: Support was provided for using interactive systems and socio-ecological frameworks to better understand the contributions that individuals, teams and organizations make to facilitate the development and maintenance of adaptive capacity and resilience in a nursing workforce. An ecological model of adaptive capacity can be operationalized to guide education, training for nurses and the development of organizational systems and strategies., Conclusion: This study identified factors that help and hinder a nursing workforce's ability to prepared for, adapt to and learn from natural hazard disasters., Implications for Nursing Policy: This understanding of disaster preparedness and how this may be applied to enable the growth of adaptive nurses provides an insight for a global audience which also adds to nurse education, service delivery, organizational and policy development., (© 2020 International Council of Nurses.)

An evaluation of clinical outcomes and cost.

. How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the COVID-19 outbreak? Results from an exploratory research in some European countries., Introduction: During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels., Aims: To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients., Methods: Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs., Results: A total of 62 nurses responded to the survey; average age 37.5 years, 31 (60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p<0.01), as well as the number of nurses per shift from 10.2 (SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p<0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden., Conclusion: These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.

Nursing research involves much planning and attention to details, yet novice and seasoned nurse researchers often overlook the day-to-day operations required to conduct research studies. Project management is a set of iterative steps that can facilitate the process of conducting nursing research. In this paper we aim to provide an overview of project management and identify ways in which its specific principles and strategies may be applied to facilitate nursing research. Here we give an overview of our current longitudinal study using a Solomon four-group design and illustrate how we applied strategies and tools from the project management literature. In addition, we offer descriptions and illustrations of several other project management tools that could have been used in specific phases of this research project. We encourage nurse educators and researchers to familiarize themselves with the principles of project management and consider using them in future studies., (Copyright © 2020. Published by Elsevier Inc.)

. When, how, why and whom for there will be an "after" Covid-19? The announced, but unpredicted, radical and global experience of the Covid-19 pandemia has revealed the degree of ignorance, fragmentation, inadequacy of the national and international knowledge and strategies of intervention and, even more substantially, of coordination across all the critical areas of prevention and care. The importance of the nursing component of the organisation and of the technical and cultural aspects of health care delivery and accessibility has been underlined as a protagonist of the resistance and resilience during the worst period of the emergency, and should be specifically involved in this renewal, where a profound modification of the interactions, hierarchies, roles of various professions is required. A long term, widespread, flexible experimentation of country specific and international solutions must be envisaged and timely activated. The 'grammar' and the major concrete characteristics of the methodology which could be usefully adopted to guarantee the feasibility and effectiveness of this 'systemic' experimentation are proposed and exemplified.

Aim: This paper describes an initiative facilitating comprehensive assessment and delivery of brief interventions for Māori youth in Northland, New Zealand., Background: The population in Northland is predominantly Māori and is one of New Zealand's most deprived populations. Māori youth have the highest youth suicide rate in the developed world and elevated numbers of youth displaying mental health issues and/or risk behaviours are of grave national concern. Like Indigenous peoples worldwide, inequities persist for Māori youth accessing and engaging with healthcare services., Description: Taking services out to Māori youth in remote and isolated areas, Northland's youth specialist nurses are reducing some barriers to accessing health care. The youth version of the Case-finding and Help Assessment Tool is a New Zealand-developed, e-screening tool for youth psychosocial issues, facilitating comprehensive assessment and brief intervention delivery., Discussion: Early detection of, and timely intervention for, mental health and risk behaviours can significantly improve health outcomes in youth. However, for this to happen barriers preventing youth from accessing appropriate care need to be overcome., Conclusion: Youth specialist nurses could improve access to care for youth from ethnic minorities, rural and isolated regions, and areas of high deprivation without overwhelming the medical profession., Implications for Nursing Policy: Specialist nurses are trained and empowered to practice at the top of their scope. With general practitioner oversight and standing order sign off specialist nurses can work autonomously to improve access to health services, without increasing the workload of doctors., Implications for Nursing Practice: Encouraging continuous self-reflection of the nurse's effectiveness in meeting patient needs, holistically and culturally, facilitates the provision of accessible care that is patient-centred and culturally safe., (© 2019 International Council of Nurses.)