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      The Experiences of Primary Healthcare Nurses During the COVID‐19 Pandemic in Australia

      research-article
      , PhD, BN(Hons), RN, FACN 1 , , , PhD, BN(Hons), RN 2 , , PhD, MPH, BHlthSc(Nursing), RN 3 , , PhD, RN, FACN 4 , , MPH, BN, RN 5 , , PhD, RN 6 , , BN(Hons), RN 5 , 7 , , BN(Hons), RN 5 , 7
      Journal of Nursing Scholarship
      John Wiley and Sons Inc.
      Community nursing, nursing workforce, pandemic, primary care, primary healthcare

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          Abstract

          Purpose

          The COVID‐19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID‐19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment.

          Design and Methods

          Nurses employed in primary healthcare across Australia were invited to participate in a cross‐sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses’ employment, work role, and access to personal protective equipment.

          Findings

          Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID‐19, they expressed concern about work‐related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic.

          Conclusions

          This is the first study of primary healthcare nurses’ experiences during the COVID‐19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health.

          Clinical Relevance

          Understanding the implications of COVID‐19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.

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          Most cited references33

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          Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

          New England Journal of Medicine
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            Is Open Access

            0.9% saline versus Plasma-Lyte as initial fluid in children with diabetic ketoacidosis (SPinK trial): a double-blind randomized controlled trial

            Background Acute kidney injury (AKI) is an important complication encountered during the course of diabetic ketoacidosis (DKA). Plasma-Lyte with lower chloride concentration than saline has been shown to be associated with reduced incidence of AKI in adults with septic shock. No study has compared this in DKA. Methods This double-blind, parallel-arm, investigator-initiated, randomized controlled trial compared 0.9% saline with Plasma-Lyte-A as initial fluid in pediatric DKA. The study was done in a tertiary care, teaching, and referral hospital in India in children (> 1 month–12 years) with DKA as defined by ISPAD. Children with cerebral edema or known chronic kidney/liver disease or who had received pre-referral fluids and/or insulin were excluded. Sixty-six children were randomized to receive either Plasma-Lyte (n = 34) or 0.9% saline (n = 32). Main outcomes Primary outcome was incidence of new or progressive AKI, defined as a composite outcome of change in creatinine (defined by KDIGO), estimated creatinine clearance (defined by p-RIFLE), and NGAL levels. The secondary outcomes were resolution of AKI, time to resolution of DKA (pH > 7.3, bicarbonate> 15 mEq/L & normal sensorium), change in chloride, pH and bicarbonate levels, proportion of in-hospital all-cause mortality, need for renal replacement therapy (RRT), and length of ICU and hospital stay. Results Baseline characteristics were similar in both groups. The incidence of new or progressive AKI was similar in both [Plasma-Lyte 13 (38.2%) versus 0.9% saline 15 (46.9%); adjusted OR 1.22; 95% CI 0.43–3.43, p = 0.70]. The median (IQR) time to resolution of DKA in Plasma-Lyte-A and 0.9% saline were 14.5 (12 to 20) and 16 (8 to 20) h respectively. Time to resolution of AKI was similar in both [Plasma-Lyte 22.1 versus 0.9% saline 18.8 h (adjusted HR 1.72; 95% CI 0.83–3.57; p = 0.14)]. Length of hospital stay was also similar in both [Plasma-Lyte 9 (8 to 12) versus 0.9% saline 10 (8.25 to 11) days; p = 0.39]. Conclusions The incidence of new or progressive AKI and resolution of AKI were similar in both groups. Plasma-Lyte-A was similar to 0.9% Saline in time to resolution of DKA, need for RRT, mortality, and lengths of PICU and hospital stay. Trial registration Clinical trial registry of India, CTRI/2018/05/014042 (ctri.nic.in) (Retrospectively registered).
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              Sourcing Personal Protective Equipment During the COVID-19 Pandemic

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                Author and article information

                Contributors
                ehalcomb@uow.edu.au
                Journal
                J Nurs Scholarsh
                J Nurs Scholarsh
                10.1111/(ISSN)1547-5069
                JNU
                Journal of Nursing Scholarship
                John Wiley and Sons Inc. (Hoboken )
                1527-6546
                1547-5069
                31 July 2020
                : 10.1111/jnu.12589
                Affiliations
                [ 1 ] Xi Omicron Professor of Primary Health Care Nursing School of Nursing Faculty of Science Medicine & Health University of Wollongong Wollongong NSW Australia
                [ 2 ] Xi Omicron Lecturer School of Nursing Faculty of Science Medicine & Health University of Wollongong Wollongong NSW Australia
                [ 3 ] Senior Lecturer/Discipline Lead Primary Health Care and Chronic Illness School of Nursing University of Notre Dame Sydney NSW Australia
                [ 4 ] Project Officer School of Nursing Faculty of Science Medicine & Health University of Wollongong Wollongong NSW Australia
                [ 5 ] Xi Omicron PhD Candidate/Sessional Tutor School of Nursing Faculty of Science Medicine & Health University of Wollongong Bega NSW Australia
                [ 6 ] Professor of Nursing School of Nursing Faculty of Science Medicine & Health University of Wollongong, Wollongong, NSW, and Centre for Research in Nursing and Health, Level 1 Research and Education Building, St George Hospital Kogarah NSW Australia
                [ 7 ] Xi Omicron PhD Candidate/Sessional Tutor School of Nursing Faculty of Science Medicine & Health University of Wollongong Wollongong NSW Australia
                Author notes
                [*] [* ] Correspondence

                Prof. Elizabeth Halcomb, School of Nursing, University of Wollongong, Northfields Ave., Wollongong NSW 2522, Australia.

                E-mail: ehalcomb@ 123456uow.edu.au

                Author information
                https://orcid.org/0000-0001-8099-986X
                https://orcid.org/0000-0003-3113-2930
                https://orcid.org/0000-0003-0349-4248
                https://orcid.org/0000-0003-0559-9553
                https://orcid.org/0000-0003-2211-3447
                https://orcid.org/0000-0002-6143-7703
                https://orcid.org/0000-0002-3864-1300
                https://orcid.org/0000-0001-9011-368X
                Article
                JNU12589
                10.1111/jnu.12589
                7436753
                32735758
                414a5119-ee6b-4b04-be26-3ae6d307f0d8
                © 2020 Sigma Theta Tau International

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 22 June 2020
                Page count
                Figures: 2, Tables: 3, Pages: 11, Words: 14198
                Categories
                Original Manuscript
                Original Manuscripts
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.7 mode:remove_FC converted:19.08.2020

                Nursing
                community nursing,nursing workforce,pandemic,primary care,primary healthcare
                Nursing
                community nursing, nursing workforce, pandemic, primary care, primary healthcare

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