key: cord-1030920-hyjweuze
authors: Im, Eun‐Ok; Sakashita, Reiko; Oh, Eui Geum; Tsai, Hsiu‐Min; Chen, Ching‐Min; Lin, Chia‐Chin; McCauley, Linda
title: COVID‐19 and nursing research across five countries/regions: Commonalities and recommendations
date: 2021-07-21
journal: Res Nurs Health
DOI: 10.1002/nur.22171
sha: 04d1f545b023a99c8efcf05ed9d2e17013d6eb7e
doc_id: 1030920
cord_uid: hyjweuze

With the recent impact by the COVID‐19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID‐19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID‐19 impact on the research process, (b) researchers/leaders' presentations on the COVID‐19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) “a heavy emphasis on teaching and fluctuating productivity,” (b) “increased funding opportunities and governmental support,” (c) “gendered experience complicated by professional differences,” (d) “delays and changes/modifications in research process,” (e) “limited research settings and difficulties in getting access,” and (f) “increased online dissemination activities with positive changes in the image of nursing.” With all collective wisdom that nurse researchers have obtained during the COVID‐19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

Across the globe, the COVID-19 pandemic has been a serious threat to the health of all people from December 2019 when the first case was reported (Centers for Disease Control and Prevention [CDC] , 2020). Many organizations, including the World Health Organization (WHO), the CDC, and nonprofit and for-profit entities, have collaborated to assist all the countries and regions across the globe to adequately and promptly prepare for and respond to COVID-19 (CDC, 2020) . Despite these efforts, the control of COVID-19 has been a tremendous challenge to everyone throughout countries and regions with distinct cultures. Nurses, in particular, have been on the front line of this battle with the pandemic continuously and worked closely in various settings to care for the increasing number of COVID-19 positive patients (Lake, 2020) .

Nursing research has been a major part of the nursing discipline to generate and advance nursing knowledge across the globe (Meleis, 2011) . After the first nursing research study by Nightingale was conducted at the battlefield of the Crimean War in 1859 (Moody, 1990) , nursing research has gone through a number of evolutionary and revolutionary changes throughout nursing history (Stolley et al., 2000) . Until the 1950s, nursing research was mainly conducted only in the areas of nursing education and administration.

Yet, the scope of nursing research has expanded to collaboration with interdisciplinary researchers across various settings, and many new areas, such as nursing informatics, data science, and precision health have emerged (Stolley et al., 2000) . Nurses globally have witnessed these evolutionary and revolutionary changes throughout nursing communities with different cultures.

With the recent impact by the COVID-19 pandemic, nursing research has gone through unexpected tremendous changes across countries and regions . The purpose of this special report is to present the commonalities in the impact of the COVID-19 pandemic on nursing research across five countries/regions, including the United States, South Korea, Japan, Taiwan, and Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. First, the basis for this discussion paper is provided with details on the approach that was used to provide the evidence to support our discussion points. Second, the commonalities in the impact of the COVID-19 pandemic on nursing research across five countries/regions are discussed with supporting evidence. Finally, recommendations for future nursing research are made.

To identify the commonalities in the impact of the COVID-19 pandemic on nursing research across the countries/regions, seven researchers/leaders from the five different countries/regions had discussions through 3 days of an international workshop in November 2020 that was hosted by a US university in a Southern region. The researchers/leaders were invited based on their leadership positions (deans, nursing directors, and presidents). A total of 10 researchers/leaders in academia, hospitals, organizations, and governmental agencies were invited based on the recommendations by five deans/former deans at schools of nursing across the countries.

Among them, seven researchers/leaders agreed to participate in the workshop. Before the workshop, the researchers/leaders compiled/ provided the cultural exemplars/cases of the COVID-19 impact on nursing research in their own countries/regions in tables. The tables were structured by research methodology component, including study design, settings and samples, instruments/measurements, interventions, data collection methods, and data analysis process. The researchers/leaders collected the information on the impact of COVID-19 in these components of research methodology and summarized the information in the tables. The researchers/leaders also conducted literature reviews in their own countries/regions and provided the references supporting the COVID-19 impact that they included in the tables (including both general and culture-specific).

Each researcher/leader provided about 10-15 pages of tables with the information and references. At the workshop, the researchers/ leaders made presentations about the COVID-19 impact on nursing research in their own countries/regions and had group discussions through four closed sessions. To identify the evidence to support our discussion points, all the presentation files, discussion memos from the workshop, and the tables with supporting references were analyzed using a simple content analysis. The unit of analysis was individual phrases. First, line-by-line coding was done on all the materials. Then, categorization was done by grouping the codes in several categories to reflect similar issues. Finally, the categories were compared and grouped to extract the themes reflecting commonalities in the impact of the COVID-19 on nursing research. The themes were discussed through a series of discussions in the closed sessions and finalized upon unanimous agreement by all the researchers/leaders. Then, all the reviewers/leaders reviewed the themes one by one to make recommendations for future nursing research during the immediate postpandemic periods and future pandemic situations. The recommendations were summarized and finalized upon the unanimous agreement by all the researchers/leaders. Then, after the workshop, all the researchers/leaders reflected on the impact that they presented and discussed, and provided their updates on the impact. Also, a series of email discussions were conducted among the researchers/leaders to refine the themes and recommendations. Then, the themes and recommendations were reviewed and approved by all the researchers/leaders. The evidence from this content analysis and the literature reviews were used to support the discussion points that were made below.

3 | COMMONALITIES ACROSS THE COUNTRIES/REGIONS 3.1 | "A heavy emphasis on teaching and fluctuating productivity" Across countries/regions, a heavy emphasis was given to teaching efforts during the COVID-19 pandemic. For instance, in Japan, most nurse researchers were faculty members in university settings whose first priority was education. Thus, during the COVID-19 pandemic, faculty members spent a disproportionate amount of time on IM ET AL.

| 759 education, such as video-lecturing using Zoom and checking on the safety of students. In a recent survey by the Japan Academy of Nursing (Japan Academy of Nursing Science, 2021), 65.2% of the participants said that their research time was significantly reduced and 88.9% of nursing researchers were unsure about their own research activities due to uncertainty about the future. Also, in the United States, most nurse researchers were faculty members in university settings, and their teaching efforts had dramatically increased during the COVID-19 pandemic due to the adjustment of teaching methods and re-assignments of clinical rotations. Yet, in Hong Kong, about 30% of faculty members in nursing were on the research track, and about 70% of them were on the teaching track.

Those on the research track did not have heavy teaching loads during the COVID-19 pandemic.

With the heavy teaching burden among nurse researchers, significant fluctuations in productivity were noted in many countries. In the United States and Taiwan, junior faculty members rarely benefited from the increasing funding opportunities during the COVID-19 pandemic. For instance, in the United States, despite the increasing funding opportunities during the COVID-19 pandemic, very few nurse researchers, especially junior researchers, applied for the funding opportunities due to their lack of competence in shifting their focus to any topics and populations related to the COVID-19.

The research mentoring tended to focus on development of coherent research programs in terms of topics, populations, and research methods, which might prohibit junior faculty members from shifting their focus in their topics, populations, or research methods to fit with COVID-19. However, in Hong Kong, Japan, and South Korea, nursing faculty members including junior faculty members did not report any difficulties in shifting their focus of research to COVID-19-related topics, which was a contrast to those in the United States and Taiwan.

The funding situation, furthermore, differed depending on the countries/regions due to their different cultural and academic contexts. For example, because the research studies that were funded by the Japanese government tended to be medical studies with a focus on development of diagnostic methods, therapeutic methods, and vaccines (Prime Minister of Japan and His Cabinet, 2020), nurse researchers in Japan rarely received large budget grants as principal

investigators. Yet, there were more opportunities for nurse researchers in Japan to receive funding from local governments, universities, and the private sector during the pandemic if the topics were related to people's health and lives (although the amount of funding was generally <1 million yen). Indeed, some faculty members including adjunct faculty members in Japan received this kind of small research grant during the pandemic.

All the researchers/leaders across the countries/regions remarked about the gendered experience of nurse researchers during the COVID-19 pandemic. Across the countries/regions, nurse researchers tended to be women, which reflected the current gender composition of nurses in general across the countries/regions. For instance, 82% of registered nurses were female in the United States For instance, in Japan, even in dual-earner households, 80% of men did not do housework and 70% did not take care of children (Japan Gender Equality Bureau Cabinet Office, 2020). Women's burden of housework and childcare had increased under the COVID-19 pandemic (The Shizuoka Shimbun, 2020). In their traditional cultures across Asian countries/regions, women were mainly in charge of household tasks and their activities were restricted in their homes (Dibble et al., 2019; Spector, 2012) . Although multiple religions are currently practiced in all countries/regions, individual countries had their unique histories of national religions in the past (e.g., Confucianism in Taiwan and Korea, and Shintoism in Japan), which had great influences on traditional gender roles in their patriarchal cultures. For example, in Korean traditional culture, women were called Ansaram (inside person), and men were called Bakatsaram (outside person). In other words, women were in charge of all the household matters (e.g., cooking, preparing clothes, cleaning, etc.), child-care, and elder-care that happened inside their houses. Men were in charge of all the matters that happened outside their houses (e.g., breadwinning). Even in these modern days, women are still mainly in charge of household tasks, child-care, and elder-care even when they are employed (working outside their homes). Thus, these traditional gender roles made women researchers in charge of all the household tasks, child-care, and elder-care while working at home, which had detrimentally affected nurse researchers in their research productivity in general.

With the awareness of the difficulties facing women researchers, governmental and institutional supports had often been provided to them across the countries/regions. For instance, in Taiwan, to encourage and support women to devote themselves to scientific and technological research careers, the Taiwan Ministry of Science and Technology specifically provided research funding to "encourage women to engage in scientific and technological research projects" in 2020 (Taiwan Ministry of Science and Technology, 2020). In the United States, some universities provided child-care services for their faculty members during the pandemic. Yet, it was reported that not many faculty members used the child-care services. The situation was worse for nurse researchers working with COVID-19 patients in clinical settings. Across the countries/regions, stigmatization of nurses working with COVID-19 patients was often reported, subsequently complicating their research experience during the pandemic.

In addition to the gender differences, professional differences in the impact of the pandemic were noticed across the countries/regions. In Taiwan culture, compared with other health professions including medicine, nurses were more involved in direct communication and care of COVID-19 patients; nurses in hospitals needed to plan educational training programs, create health education videos for the readiness of epidemic prevention materials, make administrative protocols to protect the safety of personnel, and accomplish interdisciplinary practice (Hu et al., 2020) . Similar differences were noted in South Korea, Japan, and Hong Kong. These increased roles of nurses during the pandemic complicated the gendered experience of nurse researchers that was described above. However, few studies on nurses were conducted by nurse researchers during the pandemic.

The researchers/leaders from the United States pointed out that the funding priorities of nursing research funded by governmental agencies rarely included studies on nurses themselves. For example, the National Institute of Nursing Research (NINR) rarely funded studies about nurses themselves; rather, the priorities had been given to nursing clients.

Across the countries/regions except Taiwan, the researchers/leaders witnessed drastic delays in the overall research process and modifications in study designs, data collection methods, interventions, and data analysis process during the COVID-19 pandemic. Table 1 summarizes the current status of ongoing funded nursing studies in individual universities or institutes of the researchers/leaders who Frequent delays in data analysis process were also noted in some countries/regions. For instance, in the United States, Hong Kong, and Japan, obvious delays in data analysis process were noted by the researchers/leaders from the countries. The researchers/leaders from the United States mentioned that most delays in data analysis were in the data analyses of biomarkers that were greatly influenced by the access to the biomarker labs. The leader/researcher from Hong Kong mentioned about the difficulties in remote usages of data analysis software due to software license issues in their countries. In Japan, data analysis was delayed because some universities were locked down and faculty members subsequently could not use the analysis software.

However, in Taiwan and South Korea, the researchers/leaders did not notice obvious delays in data analysis process because most nursing studies tended not to involve biomarkers and because their data analysis software licenses allowed the remote usages of the software.

Due to the COVID-19 pandemic, limitations in access to all research settings were noted across the countries/regions. In the United States, the researchers' access to clinics and hospitals was strictly limited due to the safety and quarantine measures with social distancing and the requirements of personal protective equipment. In Hong Kong, the order of "work from home" was made by all the universities, while public hospitals and long-term care facilities restricted visitors. All the visitors to hospital authority hospitals had been banned since the end of January 3, 2020. Research facilities, such as clinics and sports centers at Hong Kong University, were closed temporarily during the pandemic. In South Korea, data collection was mostly prohibited from clinics, hospitals, and community centers. Even when data collection was permitted, there were difficulties in getting the institutions' or facilities' cooperation. Due to the pandemic situation, some ongoing community health programs were discontinued, which subsequently restricted the data collection among community participants. (100) 32 (100) 37 (100) 28 (100) 69 ( 

On the basis of the commonalities in the impact of the COVID-19

pandemic on nursing research across the five countries/regions that were discussed above, recommendations for future nursing research during the immediate postpandemic period and during other unexpected pandemic situations are made as follows. Table 2 • Need to provide necessary administrative support, human resources support, and technological support • Need to provide some targeted support (e.g., pilot grants supporting nurses' studies on nursing topics, such as depression, isolation, etc.) • Needs to invest more on nursing priorities (e.g., nurses' mental health issues during the pandemic, safety measures for nurses working with the COVID-19 positive cases)

• Could promptly adapt to the new changes in research environments and logistics • Could promote nursing research in the areas of high nursing priorities "Increased funding opportunities and governmental support"

• Need to provide a pool of funding for nurse researchers to conduct self-funded studies related to the pandemic situations • Need to advocate for nursing studies in interdisciplinary funding agencies, including governmental agencies and hospital agencies • Need to mentor junior faculty members especially in the competence of shifting their research focus to fit with available funding opportunities

• Could support nurse researchers who are frequently left behind due to low priorities given to nursing topics by funding agencies • Could prepare junior faculty members and researchers to successfully get funded in changing funding environments "Gendered experience complicated by professional differences"

• Need to conduct more studies on differences in the impact of the COVID-19 by gender and profession • Need to conduct more studies on the children of nurses working with positive cases (e.g., stigmatization)

• Could provide the knowledge basis to efficiently and fairly support nursing profession and workforce during unexpected pandemic situations "Delays and changes/modifications in research process"

• Need to be open to new technologies and innovation for future usages during pandemic situations • Need to develop new models of nursing and new devices/instruments for nursing care during pandemic situations through continuous studies in the areas of nursing priorities by collaborating with multidisciplinary and international teams • Need to mentor junior researchers with necessary knowledge and skills to work with multidisciplinary teams in pandemic situations • Need to start research initiatives in the field of infectious diseases with subsequent necessary changes in nursing education curriculum

• Could prepare nurse researchers to have expertise and experience in innovative approaches/methods • Could prepare nursing profession and workforce to be equipped with competencies and efficiencies to deal with future pandemic situations • Could prepare nurse researchers to be equipped with research competencies to continue research during future pandemic situations "Limited research settings & difficulties in getting access"

• Need to flexible in selecting research settings and data collection procedures • Need to investigate on research integrity of the new methods of data collection (e.g., potential selection bias, unauthentic cases, elderly with difficulties in using online technologies)

• Could prepare nurse researchers to be equipped with research competencies to continue research during future pandemic situations "Increased online dissemination activities with positive changes in the image of nursing"

• Need to make continuous research efforts through seminars, workshops, and conferences to improve the visibility and image of nursing during pandemic situations

• Could further improve the visibility and image of nursing future situations with changing research needs and priorities. These efforts could support nurse researchers who are frequently left behind due to low priorities given to nursing topics by funding agencies and could prepare junior faculty members and researchers to successfully get funded in changing funding environments.

Third, as the theme of "gendered experience complicated by professional differences" indicated, women researchers tended to be affected harshly by the COVID-19 pandemic because of gender stereotypes and roles. Since nurse researchers are more likely to be women, the impact of the COVID-19 on their productivity would be greater than other male-dominated professions, such as medicine. Finally, as the theme of "increased online dissemination activities with positive changes in the image of nursing" indicated, the COVID-19 pandemic situation actually increased the visibility of nursing via increased online dissemination activities through virtual conferences, workshops, and seminars and through positive collective efforts to improve the image of nursing (e.g., artworks). During the immediate postpandemic period, by using the momentum obtained from the increased visibility and improved image of nursing in general, nurse researchers/leaders need to further collaborate with multiple disciplines across the globe through seminars, workshops, and conferences to further improve the visibility and image of nursing research. In future pandemic situations, developing collaborative proposals across disciplines and countries/regions would facilitate nurse researchers' international and interdisciplinary collaborative efforts as well.

All the discussion points that are made in this paper need to be carefully interpreted due to some limitations in the evidence that was provided. First, the findings reported in this paper were limited only to the five countries/regions. Furthermore, the findings could be applied only to the specific time point and geographical countries/regions that this discussion was conducted (e.g., limited

to the five countries/regions, limited to the period from January 

Data sharing not applicable to this article as no data sets were generated for this discussion paper.

Eun-Ok Im https://orcid.org/0000-0002-7253-7996

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More U.S. men are becoming nurses but not entering other traditionally female occupations

Experience of nursing staffs in the negative pressure ward of a southern Taiwan medical center during COVID-19 pandemic

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COVID-19 and nursing research across five countries/ regions: Commonalities and recommendations