未来由我们来塑造：护理从大流行中脱颖而出，具有洞察力，乐观和勇气| J Adv Nurs

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The theme for International Nurses Day 2023 is ‘our nurses, our future’, and in contemplating the future, it is necessary to reflect on where we are now. The COVID-19 pandemic has changed the world, particularly the world of health care and has provided a platform for radical change in health and social care sectors. As we emerge from the pandemic, nursing and nurses are left with much to reflect on and consider. Nurse researchers and scholars all over the world have literally spent many thousands of hours interrogating and scrutinizing aspects of the pandemic (Jackson, 2022). At the Journal of Advanced Nursing alone, in the past 2 years, we have published more than 300 papers focussed on the pandemic. Other nursing journals have also published volumes of work about multiple aspects of the pandemic. These accounts compel us to interrogate the world we have left behind and consider where we are headed.

Aside from the many issues in in-patient and community care including the initial lack of effective treatments, the critical need for a vaccine and disparities and racism (Chan et al., 2022; Kang & Barcelona, 2022; Okoye et al., 2023), the pandemic exposed weaknesses and flaws in pandemic preparedness and response, health communication and communicating risk, supply chains, redefined work practices and highlighted the need for rapid redeployment in direct health care and at multiple points along the health and social care continuum. Volunteering across all sectors of health and social care, education and food supply chains was needed on a scale not previously seen. The pandemic was a catalyst for digital transformation, and in nursing we saw that clearly through rapid increases in telehealth (Searby & Burr, 2021; Walthall et al., 2022), changed practices in relation to hospital visiting (Altman et al., 2021; Bloemberg et al., 2022; Lim et al., 2022) and in teaching and learning practices in nurse education (Iradukunda & Canty, 2023; Kimani, 2023; Usher et al., 2023).

The pandemic highlighted the need for an agile and responsive nursing workforce and meeting this need involved extensive redeployment, rapid upskilling and reskilling, expeditious design and implementation of new services and adjustments to usual ways of working (Endacott et al., 2022; Gardiner & MacLellan, 2022). Nurses who no longer worked in the health sector were encouraged to return to support the collective good, and if appropriate to return to practice, were provided a rapid access route to re-register. Nurses also came out of retirement to offer their services either as re-registered nurses or volunteers. Outside of the formal health sector, volunteer nurses organized foodbanks, community welfare groups, food deliveries and initiatives to combat loneliness and isolation of people staying home. These new pressures created by the pandemic occurred against a backdrop of quite longstanding global chronic and acute workforce issues. In lower- and middle-income countries particularly, health systems were already stretched with an acute shortage of doctors and nurses before the pandemic hit.

In addition to the challenges raised by the pandemic, there are many other complex issues facing nursing as we look ahead to the future—issues associated with health care and human rights for refugees, migrants, displaced persons (Commodore-Mensah et al., 2021; Wilson et al., 2022). The ongoing severe humanitarian crises affecting millions of people across the globe impacts us all. Failing to assist vulnerable populations experiencing persistent conflict, poverty and disease places us all at risk of poor health outcomes.

As we look ahead, we also need to address complex challenges such as missed nursing care, which the literature suggests is a widespread matter of concern, and raises issues about current staffing, skill mix, patient acuity and the utility of current models and frameworks of care (Dutra & Guirardello, 2021; Griffiths et al., 2018; Jackson, 2023). Nursing will also take a more active role in environmental issues including those surrounding climate changes. Some countries will need to address challenges around an ageing nursing workforce and difficulties in recruiting and retaining nurses (Lokmic-Tomkins et al., 2022).

During the pandemic, nurses worked with unparalleled levels of resilience and versatility. Nurses practised in a time of instability, disruption, uncertainty and fear for themselves and their own families, the multi-disciplinary teams they worked with and for their patients. They witnessed a high death rate of patients who were separated from their families, and in some settings, nurses themselves moved out of their family homes and leave behind their partners and children for fear of infecting them with the virus at a time when there were no effective treatments and vaccination was not available. However, effective and responsive support systems to address the nurses' psychological needs during the healthcare crises, such as COVID-19-related trauma, appeared to be lacking in many nurse working environments worldwide. It is essential that learning from what worked to support the mental health of nurses during and after the pandemic is used to develop effective easy to access interventions for use in future health emergencies.

The effects of the pandemic are likely to be felt for some time yet, and the extent and duration of the effects underlines the need for preparedness for future events and to take the many lessons from this COVID-19 pandemic into future healthcare planning. The global nature of the pandemic highlights the need for nursing and nurses to work together across professional disciplines, sectors, regions and countries and diverse populations to develop our collective resilience and ability to respond to future similar events.

As nations switch off from the doom and gloom of pandemic reporting there has been a rapid influx of hate speech, misogyny and health misinformation. As nurses face unremitting pressure and shrinking attention, hard-fought professional gains are at risk. For example, in the United Kingdom there was a surge of interest from those wanting to enter the nursing profession during the pandemic, which has subsequently disappeared, and some Universities are currently finding it difficult to recruit to undergraduate nursing courses. As we write this editorial, nurses in England are in dispute with the Government over working conditions and pay during the post-pandemic economic crisis, and a lack of recognition of their contribution to the pandemic response and as a consequence have been participating in unprecedented strike action.

The post-pandemic recovery period heralds an important opportunity to disrupt the current narrative and amplify the voices of nurses globally, including those employed in lower-resource settings. Health emergencies that require a rapid nursing response are common occurrences globally. The nursing profession must use the collective knowledge and experience from the recent pandemic to be better prepared for the next health emergency crisis. Health emergency preparedness and response is its own practice and academic discipline, to which more nurses need to sign up to and influence.

We must also continue to engage in scholarly publication and media (including social media) to shine a light on lesser known, yet essential clinical and humanitarian nursing activity. We need to invite journalists into our work settings and help them to understand modifiable sources of deprivation and poor health outcomes for our patient populations. Even in the most challenging of places there is commonly a novel news story that amplifies the positive role and contribution of nurses. We need nurse researchers and educators to continue to invent and report on innovation. Nurses have the power to quickly spread awareness and reliable health information to huge numbers of people globally. Much remains untapped in our ability to engage and inspire the future of health care. We need nurses to boldly advocate for policies that disrupt structural racism and social inequity which drives disparities in health outcomes among marginalized populations across the globe.

As we reflect on International Nurses Day 2023 and consider the theme ‘our nurses, our future’, we know that the future of nursing is ours to shape with courage. As we move into a post-pandemic world, we need to be proactive in shaping our future; to actively take the lead in promoting public understandings of nursing, and to take leadership roles in cultural, diversity, equity, inclusion (Morley et al., 2020; Sharps et al., 2023) innovations and strategies that promote adaptive clinical and organizational change in health care. If we take our power and work collaboratively, we have every reason to look ahead to a bright future in which nurses lead the way in important health and social care reforms.

全文翻译（仅供参考）

2023年国际护士节的主题是“我们的护士，我们的未来”，在思考未来时，有必要反思我们现在所处的位置。COVID-19大流行改变了世界，尤其是医疗保健领域，并为医疗和社会保健领域的彻底变革提供了平台。当我们从大流行中走出来时，护理和护士们留下了很多需要反思和考虑的事情。全世界的护士研究人员和学者实际上已经花费了数千个小时来询问和审查大流行病的各个方面（杰克逊， 2022）。仅在《高级护理杂志》上，在过去的两年里，我们就发表了300多篇关于这一流行病的论文。其他护理期刊也发表了大量关于大流行病多个方面的工作。这些叙述迫使我们质问我们已经抛在身后的世界，并考虑我们将走向何方。

除了住院和社区护理中的许多问题，包括最初缺乏有效的治疗、对疫苗的迫切需要以及不平等和种族主义（Chan等人，& nbsp; 2022; Kang& Barcelona， 2022; Okoye et al.，& nbsp; 2023年），大流行暴露了在大流行准备和应对、卫生沟通和沟通风险、供应链、重新定义的工作实践方面的弱点和缺陷，并强调了在直接卫生保健以及卫生和社会保健连续体沿着多个点快速重新部署的必要性。卫生和社会保健、教育和食品供应链等所有部门都需要前所未有的志愿服务。大流行是数字化转型的催化剂，在护理领域，我们通过远程医疗的快速增长清楚地看到了这一点（Searby& Burr， 2021; Walthall等人，& nbsp; 2022年），改变了与医院访问有关的做法（Altman等人，& nbsp; 2021; Bloemberg et al.，& nbsp; 2022; Lim et al.，& nbsp; 2022）和护士教育的教学实践（Iradukunda& Canty， 2023; Kimani， 2023; Usher等人，& nbsp; 2023年）。

大流行突出了对灵活和反应灵敏的护理工作队伍的需求，而满足这一需求涉及广泛的重新部署、快速的技能提升和技能再培训、快速设计和实施新服务以及调整常规工作方式（Endacott et al.，& nbsp; 2022;加德纳&MacLellan， 2022）。鼓励不再在卫生部门工作的护士返回，支持集体利益，并在适当情况下返回执业，为他们提供重新登记的快速通道。护士也从退休中走出来，以重新注册护士或志愿者的身份提供服务。在正规卫生部门之外，志愿护士组织了食品银行、社区福利团体、食品运送和各种举措，以消除呆在家里的人的孤独和孤立。疫情带来的这些新压力是在全球长期存在的慢性和急性劳动力问题的背景下发生的。特别是在低收入和中等收入国家，在大流行病爆发之前，卫生系统就已经因医生和护士严重短缺而捉襟见肘。

除了流行病带来的挑战外，当我们展望未来时，护理还面临许多其他复杂问题-与难民，移民，流离失所者的医疗保健和人权相关的问题（Commodore-Mensah等人，& nbsp; 2021; Wilson et al.，& nbsp; 2022年）。影响到地球仪数百万人的持续严重人道主义危机影响到我们所有人。如果不帮助持续经历冲突、贫穷和疾病的弱势群体，我们所有人都有可能健康状况不佳。

当我们展望未来时，我们还需要解决复杂的挑战，例如错过护理，文献表明这是一个普遍关注的问题，并提出了有关当前人员配备，技能组合，患者敏锐度以及当前护理模型和框架的效用的问题（Dutra& Guirardello， 2021; Griffiths等人，& nbsp; 2018;杰克逊， 2023）。护理也将在环境问题上发挥更积极的作用，包括围绕气候变化的问题。一些国家将需要解决围绕老龄化护理劳动力的挑战以及招聘和留住护士的困难（Lokmic-Tomkins等人，2022年）。

在大流行期间，护士以无与伦比的韧性和灵活性工作。护士们在一个不稳定、混乱、不确定和恐惧的时代为自己和自己的家人、与他们一起工作的多学科团队以及为他们的病人工作。他们目睹了与家人分离的患者的高死亡率，在一些情况下，护士自己也搬出了自己的家庭，留下了他们的伴侣和孩子，因为担心在没有有效治疗方法和疫苗接种的情况下感染病毒。然而，在全球许多护士工作环境中，似乎缺乏有效和反应迅速的支持系统，以解决护士在医疗危机期间的心理需求，例如COVID-19相关的创伤。至关重要的是，从流行病期间和之后支持护士心理健康的工作中学习，以制定有效的易于获得的干预措施，用于未来的卫生紧急情况。

疫情的影响可能仍会持续一段时间，而影响的程度及持续时间突显出有必要为未来事件做好准备，并将此次COVID-19疫情的诸多教训纳入未来的医疗规划。疫情的全球性质突显护理及护士需要跨专业学科、部门、地区及国家以及不同人群共同努力，以发展我们的集体复原力及应对未来类似事件的能力。

随着各国从流行病报告的厄运和悲观中解脱出来，仇恨言论、厌女症和健康错误信息迅速涌入。由于护士面临着持续的压力和日益减少的关注，来之不易的专业收益处于危险之中。例如，在大流行病期间，联合王国出现了希望进入护理专业的人的兴趣激增，但后来这种兴趣消失了，一些大学目前发现很难招收本科护理课程的学生。在我们撰写这篇社论之际，英格兰护士在疫情后的经济危机中与政府就工作条件和薪酬发生争议，他们对疫情应对的贡献缺乏认可，因此一直在参与前所未有的罢工行动。

大流行后的恢复期预示着一个重要的机会，可以打破目前的叙述，扩大全球护士的声音，包括那些在资源较少的环境中就业的护士。需要快速护理响应的突发卫生事件在全球范围内很常见。护理行业必须利用最近大流行的集体知识和经验，为下一次卫生紧急危机做好更好的准备。卫生应急准备和响应是其自身的实践和学科，需要更多的护士报名并影响。

我们还必须继续从事学术出版和媒体（包括社交媒体），以照亮鲜为人知，但必不可少的临床和人道主义护理活动。我们需要邀请记者进入我们的工作环境，帮助他们了解我们的患者群体的贫困和不良健康结果的可改变来源。即使在最具挑战性的地方，通常也有一个新颖的新闻故事，放大了护士的积极作用和贡献。我们需要护士研究人员和教育工作者继续发明和报告创新。护士有能力迅速将意识和可靠的健康信息传播给全球大量的人。在我们参与和激励医疗保健未来的能力方面，还有很多尚未开发的地方。我们需要护士大胆倡导破坏结构性种族主义和社会不平等的政策，这些政策导致地球仪边缘化人群的健康结果存在差异。

当我们反思2023年国际护士节并考虑“我们的护士，我们的未来”的主题时，我们知道护理的未来是我们用勇气塑造的。随着我们进入后大流行世界，我们需要积极主动地塑造我们的未来;积极带头促进公众对护理的理解，并在文化，多样性，公平性，包容性方面发挥领导作用（莫利et al.，& nbsp; 2020; Sharps et al.，& nbsp; 2023）的创新和战略，促进医疗保健的适应性临床和组织变革。如果我们发挥我们的力量，协同工作，我们完全有理由展望一个光明的未来，护士在重要的卫生和社会保健改革中发挥带头作用。

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