key: cord-0741970-o5498ku4
authors: Wynne, Rochelle; Conway, Aaron; Davidson, Patricia M.
title: Ensuring COVID‐related innovation is sustained
date: 2021-03-26
journal: J Adv Nurs
DOI: 10.1111/jan.14837
sha: 7ff10758ebd3708dc52405a343457332482a251e
doc_id: 741970
cord_uid: o5498ku4

nan

and 7,000 healthcare workers have died and more than 3 million healthcare workers have been infected (The International Council of Nurses, 2020) . This is heartbreaking as many of these infections and deaths were preventable. As the linchpin in the healthcare system with close and constant proximity to patients (Nayna Schwerdtle et al., 2020) , our impact on outcomes is indisputable. Nurses will again lead in this next phase of the pandemic, as programs for vaccination are initiated and scaled across the globe.

There is no doubt that non-pharmaceutical interventions, which were adopted and implemented by the community, have mitigated the burden of COVID-19 and frequently curtailed the spread of the virus. Nurses were instrumental in both community and patient education campaigns about physical distancing, the use of face masks in and out of the healthcare setting, and hand hygiene. Nurses also advocated for the importance of testing and contact tracing, as well as the need for self-isolation while waiting for test results. Vaccination provides the hope that with the sustained use of these measures, we can look to a future of focused containment. Sustained use of non-pharmaceutical interventions in combination with vaccination will reduce the threshold required for herd immunity. This threshold varies according to the virus reproductive number (R 0 ) and the number of doses necessary to achieve immunity. Estimates indicate that a threshold of 67% equates to 5.3 billion does of a single-dose or 12 to 16 billion for a multi-dose vaccine (Frederiksen et al., 2020) .

Nursing will lead this challenge in both immunization and ensuring vaccine equity.

With vaccination campaigns, we will have time and autonomy to continue to educate and encourage our communities to achieve global adequacy in protecting the health of all people in developed and developing nations. Greater risk will persist for vulnerable groups during the long haul of subsequent waves, healthcare system recovery and ongoing vaccination roll-out. Access to vaccines for those who are displaced, are in remote or logistically challenging locations, or those who simply cannot afford the financial burden of immunization must be advocated for. Nurses will be at the forefront of reducing inequities in healthcare and safeguarding future health protection (Purba, 2020) .

Considering the need for sustained efforts for virus containment in addition to vaccination programs, nurses are adjusting and adapting to the 'new COVID normal'. As the pandemic took hold, system-based changes were developed, tested, shared, implemented, scaled, and some have been sustained. Examples include new systems of patient flow, and increased telehealth, and remote care capabilities, many of these services have been nurse led. On the cusp of changes that will be realized through successful vaccination, we have an opportunity to reflect and assess on how we have managed the ongoing presence of the virus over the last year, and the implications of this for the future of ambulatory and acute care in particular. In being pushed to capacity there are new systems and practices related to 'the new normal' that will be here to stay for some time that nurses can, and should, advocate to sustain.

Changes in healthcare associated with the pandemic have been numerous and varied. The management of patient flow underwent complete revision to accommodate pandemic preparation, avoidance, and support, particularly in acute and critical care. Globally, outpatient, community-based and acute care services were severely restricted. Waiting lists for elective surgery lengthened and dramatic increases are expected in cancer diagnoses and the severity of presentations associated with cardiovascular disease over the coming months (Allahwala et al., 2020). Emergency departments (ED) created 'hot' zones for suspected/confirmed COVID cases and as the pandemic took hold there was an exponential reduction in ED presentations. Visiting hours were suspended or time limited and, in many centers, visitors were (and continue to be) prohibited.

Exceptions to these restrictions have been only for the most vulnerable patients; pediatric, birthing mothers, those in palliative care, and those with special needs related to dementia, disability, or men- Anecdotally, a range of benefits for patients and nurses continues to emerge. Increased rates of hand hygiene compliance, reduced rates of splash related eye injury, zero tolerance of working if unwell, psychosocial supports, flexible workplace arrangements, and, in maternity services, reduced numbers of visitors interrupting mother-baby bonding are positive outcomes linked to the new COVID normal. A competent workforce was crucial in responding to this pandemic. We rallied together during the pandemic surge and as 'the new normal' settles in, those who came back and those who have been most affected may leave. Community recognition of the urgent need for aged care reform, improved understanding of the requirement for and efficacy of nurse engagement in public health interventions, and a media spotlight on what nurses' work involves (Mohammed et al., 2021) are outcomes the profession has been advocating for many years. As we reset from the pandemic, nurses need to use these to advocate for, and leverage, change to improve outcomes. The future looks bright and ensuring we sustain COVIDrelated health system innovation will certainly add some sparkle.

Rochelle Wynne 1,2 Aaron Conway 3,4 Patricia M. Davidson 5 1

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