COVID‐19: Implications for Nursing and Health Care in the United States

Abstract

PurposeCOVID‐19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID‐19 far more damaging in the United States (U.S.) than necessary.Design and MethodsGuided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio‐ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.’ handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID‐19 pandemic through a review and analysis of the COVID‐19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus.FindingsFour critically important, inter‐related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce.ConclusionsThe four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID‐19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all.Clinical relevanceThe novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID‐19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi‐level solutions across critical domains. The COVID‐19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi‐level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID‐19 pandemic and future pandemics, and offers recommendations to achieve these aims.

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

“…While clinicians in addiction treatment in Ukraine maintain the continuity of OAT programs thanks to their deeply rooted professional identity and unique organizational culture despite the destruction and plummeting resources, assistance and respite is urgently needed – and it is not yet too late to provide it. This question also matters to the US, given healthcare staff shortages and a high rate of burnout ( 46 , 47 ) during Covid-19 particularly among nurses ( 48–51 ), yet the government provided little response ( 52 , 53 ), leaning into traditional expectations of healthcare staff sacrifice ( 54 ). The key learning from our pre-crisis research suggests that in low and middle-income countries like Ukraine, humanitarian crises strain already limited resources, leaving essential healthcare workers overlooked ( 5 , 55 ).…”

Nurses' experiences of hospital‐acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework

“… 40 , 41 , 42 For example, in the US, UK and Australia the increased load in the healthcare systems during COVID‐19 for crucial care, and subsequently high costs, led to job cuts and high levels of resignations for highly experienced nurses. 43 , 44 , 45 Funds for professional development were cut and redirected to the COVID‐19 response 46 ; the opportunities for education and career progress were reduced. 44 The consequences of cuts like these are under‐explored in Australia, but they are likely similar.…”

“…These findings are not novel in the context of nursing at the time of COVID‐19 40–42 . For example, in the US, UK and Australia the increased load in the healthcare systems during COVID‐19 for crucial care, and subsequently high costs, led to job cuts and high levels of resignations for highly experienced nurses 43–45 . Funds for professional development were cut and redirected to the COVID‐19 response 46 ; the opportunities for education and career progress were reduced 44 .…”

Assessment of the global healthcare industry during COVID-19 pandemic: A content analysis approach

“…At the beginning of the pandemic, healthcare systems worldwide were chaotically responding to the outbreak and its consequences. 33 While healthcare is mostly focused on providing proper treatment to infected patients, soon after, healthcare managers recognized that existing intervention policies are not serving their purpose. 34 Our data showed that international periodicals served as a source of COVID-19 data input for local and regional COVID-19 news.…”