Technology Use During COVID-19 Pandemic : Future Implications for Nursing and Health Care

In December 2019, reports emerged of pneumonia clusters of unknown cause at health facilities in Wuhan, China. These cases were linked to a wet animal wholesale market in the region and, after extensive epidemiologic investigation, led to identification of a novel coronavirus (COVID‐19). COVID‐19 is among a family of viruses – called coronaviruses – that can affect both humans and animals (Zhu et al., 2020). Coronavirus infections are respiratory in nature and can range from the common cold with mild symptoms to more severe infections, such as severe acute respiratory syndrome and Middle East respiratory syndrome (Perlman, 2020; World Health Organization [WHO], 2020). The newly identified COVID‐19 infection typically presents as fever, tiredness, fatigue, and dry cough (Huang et al., 2020). However, more severe symptoms such as dyspnoea, diarrhoea, pneumonia, and others have been reported. As of 9 March 2020, cases of COVID‐19 have been reported in countries across the world. The global number of reported cases has surpassed 100,000 with almost 4,000 deaths (WHO, 2020). China remains the highest risk area but, clearly, COVID‐19 is a global health problem. Nurses are central to COVID‐19 prevention and response efforts. Nursing is the largest healthcare profession in the US and the world, with approximately 3.8 million nurses in the US and over 20 million nurses worldwide. Nurses are providing front‐line care in the most patient‐facing role to complex COVID‐19 cases that require hospitalization. Individuals who have preexisting health vulnerabilities are at greatest risk for COVID‐19 complications or mortality and nursing resources are critical to managing this population. Public health experts predict that healthcare and hospital resources will become even more urgently needed as COVID‐19 spreads in communities (Jiang et al., 2020; Pan, Wang, & Huang, 2020). As one of the most trusted health professional groups, nurses also play a key role in providing public education on disease prevention and reducing the spread of misinformation around the outbreak. There has been widespread misinformation on how COVID‐19 is transmitted, who is at risk of transmitting or receiving the virus and where outbreaks are occurring (Wen, Aston, Liu, & Ying, 2020). For example, in some cases, Chinese and other Asian individuals have been assumed to be at higher risk for being infected with COVID‐19 simply because of their nationality or race, resulting in stigma and xenophobia (Wen et al., 2020). There has also been misinformation about appropriate use of face masks. Some individuals have assumed that they are protected from COVID‐19 by wearing a face mask – even though evidence is mixed from studies of other viral infections – and may neglect more efficacious infection prevention measures (e.g., handwashing) while also limiting the availability of face masks for response professionals who need them (Cowling, Zhou, Ip, Leung, & Aiello, 2010; WHO, 2020). Such misinformation may be spread via traditional media, social media, or in communities and can interfere with public health response efforts. Because of the unique patient‐facing nature of nursing work in community, outpatient, and acute care settings, there are occupational risks to providing care during the COVID‐19 outbreak. It is essential that nurses are supported to protect themselves during the management of COVID‐19 in clinical care with clear infection control protocols (standard, contact, and airborne) and adequate availability of personal protective equipment at their place of work, including/N95 respirators, masks, gowns, eye protection, face shields, and gloves (American Nurses Association [ANA], 2020). Healthcare facilities employing nurses must ensure consistent availability and use of hand hygiene supplies; provide updated information on screening, isolation, quarantine, and triage procedures based on guidance from the Centers for Disease Control and Prevention or other appropriate public health agencies; and coordinate with local, state, or national outbreak management efforts (ANA, 2020). Healthcare leaders should closely monitor the well‐being, occupational health, and safety of their clinical nursing staff. Nurses have a responsibility to stay home if they have travelled to areas that have declared states of emergency or contract COVID‐19 in their work. Healthcare leaders must support and provide resources for nurses who are exposed to COVID‐19 or experience other outbreak‐related harm as a result of their work, even if nursing resources become strained. Despite these occupational risks and the immediate need for health system interventions to support nurses, nursing also has unique responsibilities in the COVID‐19 outbreak. Nurses will continue to be at the front line of patient care in hospitals and closely involved with assessment and monitoring in outpatient and community settings. They must ensure that all patients receive individualized, high‐quality care regardless of their infection status and participate in preparation for increased nursing and health system demand related to COVID‐19. Nurses also must continue to provide education to patients and the public about the outbreak. This includes confronting misinformation, directing communities to reputable public health resources such as the World Health Organization and Centers for Disease Control and Prevention and promoting evidence‐based infection prevention measures (Centers for Disease Control & Prevention, 2020; WHO, 2020). Leaders and educators in nursing should provide education to clinical nurses and support staff about current COVID‐19 issues and risks specific to their practice area (e.g., paediatrics, maternal–infant health, nursing homes, schools, places of worship). This education should extend to nursing students, who may have additional considerations related to being in a campus environment. Finally, nurses should advocate for local, state, and national policy response to the COVID‐19 outbreak and support local preparedness and prevention efforts (International Council of Nurses, 2020; National Nurses United, 2020). Particularly, there is a need for care coordination across public health departments, communities, and healthcare systems that nurses are ideally suited to providing. A global outbreak requires the active participation of the nursing workforce in clinical care, education and information sharing, public health, and policy. Nurses are already fully engaged in COVID‐19 response and, with appropriate support, will be key players in ending the outbreak. CONFLICT OF INTEREST No conflict of interest was declared by the authors in relation to the study itself. Note that M. Cynthia LOGSDON is a JAN editor but, in line with usual practice, this paper was edited by another editor. Funding information This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.

Background COVID‐19 pandemic has impacted the way things are done in walks of life including nursing education in both developing and developed countries. Nursing schools all over the world as well as in developing countries responded to the pandemic following the guidelines of the World Health Organisation and different countries specific guidelines regarding the pandemic. Aim This reflective piece aims to describe the effect of COVID‐19 on nursing education in developing countries. Result Face‐to‐face teaching and learning were converted to virtual remote learning and clinical experiences suspended to protect the students from the pandemic. Specific but broader responses to the pandemic in the Caribbean and other developing countries have been shaped by financial, political and other contextual factors, especially the level of information technology infrastructure development, and the attendant inequities in access to such technology between the rural and urban areas. Internet accessibility, affordability and reliability in certain areas seem to negatively affect the delivery of nursing education during the COVID‐19 lockdown. Conclusion and Implications for Nursing and/or Health Policy The impact of COVID‐19 on nursing education in the Caribbean and other parts of the world has shown that if adequate measures are put in place by the way of disaster preparedness and preplanned mitigation strategies, future crises like COVID‐19 will have less impact on nursing education. Therefore, health policymakers and nursing regulatory bodies in the developing countries should put policies in place that will help in responding, coping and recovering quickly from future occurrences.

Nursing is the largest health profession, with nearly 4 million providers practicing across acute, primary, and public health care settings. In response to the pandemic, nursing schools halted on-site course delivery and redesigned programs to attenuate risks to students and faculty. Key challenges faced by schools included financial cutbacks, rapid increases in online learning technology, maintaining student academic progression, disruption to clinical learning opportunities, and meeting accreditation standards, while addressing the stress and loss experienced by faculty, staff, and students. Despite challenges, nursing organizations provided guidance for decision making, new learning resources, and faculty development opportunities. Schools of nursing leveraged their resources to redesign nursing curricula, strengthen partnerships for student clinical experiences, and address needs of the community. Nursing education will look different from its prepandemic profile in the future. Lessons learned during the pandemic point to gaps in nursing education, particularly related to disaster and public health preparedness, health equity, and technology. The American Association of Colleges of Nursing’s new Essentials—standards for professional nursing education—were finalized during the pandemic and reflect these lessons. The need for nurse scientists to conduct emergency response research was made evident. The importance of strong academic–practice partnerships was highlighted for rapid communication, flexibility, and responses to dynamic environments. For the future, nursing education and practice must collaborate to ensure that students and practicing nurses are prepared to address emergencies and pandemics, as well as the needs of vulnerable populations.