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Kim Y, Kim DH. Nurses' experience of end-of-life care for patients with COVID-19: A descriptive phenomenology study. Nurs Health Sci 2024; 26:e13124. [PMID: 38692579 DOI: 10.1111/nhs.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
The mortality rates among critically ill patients with COVID-19 have been high. The national and institutional infection control policies and resource shortages caused by the pandemic led patients to undergo deaths without dignity and inevitably changed intensive care unit (ICU) end-of-life care (EOLC) practices. This study explores ICU nurses' experiences of providing EOLC for patients with COVID-19 who died. Eight nurses participated in a qualitative phenomenological study. Semi-structured interviews were conducted from July to September 2022. Colaizzi's data analysis method was used, and the following four main themes emerged: (i) only companion in the death journey; (ii) helping families prepare for death; (iii) EOLC trapped within a framework; and (iv) EOLC in retrospect. To secure high-quality EOLC in ICU, it is important to promote practical support for nurses and EOLC-related discussions/education. Technical support, such as digital communication technologies, should be reinforced to help patients and their families participate in EOLC.
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Affiliation(s)
- Yujin Kim
- College of Nursing, Pusan National University, Yangsan-si, Korea
| | - Dong-Hee Kim
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan-si, Korea
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2
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Zachmann S, Peele C, Santhin K, Alisch A, Mannello M, Emilio C, Whalen M. Reducing Undue Burden on Nurses Related to Limited Care Partner Visitation: Lessons Learned for the Future. J Nurs Adm 2024; 54:367-370. [PMID: 38743806 DOI: 10.1097/nna.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The purpose of this article was to report best practices for reducing undue burden on nurses related to limited care partner visitation. BACKGROUND Care partners are beneficial to hospitalized patients. Restricted care partner visitation not only impacts patients and care partners but also affects nurses. METHODS Using the Johns Hopkins Evidence-Based Practice model, best practices for reducing nurse burden during periods of restricted visitation were evaluated. RESULTS Best practices include evidence-based visiting policies, technology to facilitate communication, creation of a communication liaison role or team, and communication skills training for nurses. CONCLUSIONS Nursing leaders should proactively prevent the harmful impact that visitor restrictions have on nurses.
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Affiliation(s)
- Sara Zachmann
- Author Affiliation: Registered Nurse (Zachmann), Registered Nurse (Peele), Registered Nurse (Santhin), In-House Coordinator for Organ & Tissue Donation (Alisch), Registered Nurse (Mannello), Registered Nurse (Emilio), and Evidence-Based Practice Program Coordinator (Whalen), The Johns Hopkins Hospital, Baltimore, Maryland
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Muntefering C, Kastrinos A, McAndrew NS, Ahrens M, Applebaum AJ, Bangerter L, Fields B. Integrating family caregivers in older adults' hospital stays: a needed cultural shift. Hosp Pract (1995) 2024:1-13. [PMID: 38767120 DOI: 10.1080/21548331.2024.2357510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/16/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This study aimed to examine perceived barriers and facilitators to caregiver inclusion in the hospital care of older adult family members or friends through the perspectives of (1) hospitalized older adults, (2) caregivers of a hospitalized older adult, (3) healthcare clinicians, and (4) policymakers. METHODS This qualitative descriptive exploratory study utilized semi-structured interviews with N = 24 participants and was analyzed using a framework method. RESULTS Eight codes arose that were categorized into four domains guided by the Social Ecological Model. Individual-level factors were determined both for the caregiver and for the clinician. Relationship-level factors were revealed pertaining to communication style and method. Hospital-level factors included hospital environment and resources. Societal-level factors included healthcare climate and policies. DISCUSSION Findings indicated that hospital workflows and policies inadequately support family caregivers. This study highlights potential solutions to caregivers' integration into hospital workflows.
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Affiliation(s)
| | - Amanda Kastrinos
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin- Milwaukee
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, Wisconsin
| | - Madelyn Ahrens
- Department of Kinesiology, University of Wisconsin-Madison
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | | | - Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison
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Ramirez P, Mueller A, Shelton K, Dudzinski DM, Colbert A, Jacobsen J, Greenwald JL, Ludmir J. Family Perceptions of Virtual Family-Centered Rounds in a Quaternary Cardiac Intensive Care Unit. J Intensive Care Med 2024; 39:499-504. [PMID: 38374623 DOI: 10.1177/08850666241233495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background: Family-centered rounds (FCR) reduce the risk of psychological comorbidities of family members and improve the quality of communication between providers and families. Materials and methods: We conducted a pilot quality improvement study analyzing family perceptions of virtual FCR. Family members of previously admitted cardiac ICU patients who participated in at least one session of virtual FCR between April 2020 and June 2021 at Massachusetts General Hospital were surveyed post-ICU discharge. Results: During the study, 82 family members enrolled and participated in virtual FCR with 29 completing the post-admission telephone survey. Many cardiac ICU patients were male (n = 53), and a majority were discharged home (43%) with the patient's wives being the most common respondents to the questionnaire (n = 18). Across all questions in the survey, more than 75% of the respondents perceived the highest level of care in trust, communication, relationship, and compassion with their provider. Participants perceived the highest level of care in trust (96%), explanation (88%), as well as care and understanding (89%). Conclusions: Family members of cardiac ICU patients positively rated the quality of communication and perceived a high level of trust and communication between their providers on the virtual format.
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Affiliation(s)
- Paolo Ramirez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ken Shelton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David M Dudzinski
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Annie Colbert
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Juliet Jacobsen
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jonathan Ludmir
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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Zheng Q, Zeng Z, Tang X, Ma L. Impact of an ICU bed capacity optimisation method on the average length of stay and average cost of hospitalisation following implementation of China's open policy with respect to COVID-19: a difference-in-differences analysis based on information management system data from a tertiary hospital in southwest China. BMJ Open 2024; 14:e078069. [PMID: 38643008 PMCID: PMC11033667 DOI: 10.1136/bmjopen-2023-078069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/27/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES Following the implementation of China's open policy with respect to COVID-19 on 7 December 2022, the influx of patients with infectious diseases has surged rapidly, necessitating hospitals to adopt temporary requisition and modification of ward beds to optimise hospital bed capacity and alleviate the burden of overcrowded patients. This study aims to investigate the effect of an intensive care unit (ICU) bed capacity optimisation method on the average length of stay (ALS) and average cost of hospitalisation (ACH) after the open policy of COVID-19 in China. DESIGN AND SETTING A difference-in-differences (DID) approach is employed to analyse and compare the ALS and ACH of patients in four modified ICUs and eight non-modified ICUs within a tertiary hospital located in southwest China. The analysis spans 2 months before and after the open policy, specifically from 5 October 2022 to 6 December 2022, and 7 December 2022 to 6 February 2023. PARTICIPANTS We used the daily data extracted from the hospital's information management system for a total of 5944 patients admitted by the outpatient and emergency access during the 2-month periods before and after the release of the open policy in China. RESULTS The findings indicate that the ICU bed optimisation method implemented by the tertiary hospital led to a significant reduction in ALS (HR -0.6764, 95% CI -1.0328 to -0.3201, p=0.000) and ACH (HR -0.2336, 95% CI -0.4741 to -0.0068, p=0.057) among ICU patients after implementation of the open policy. These results were robust across various sensitivity analyses. However, the effect of the optimisation method exhibits heterogeneity among patients admitted through the outpatient and emergency channels. CONCLUSIONS This study corroborates a significant positive impact of ICU bed optimisation in mitigating the shortage of medical resources following an epidemic outbreak. The findings hold theoretical and practical implications for identifying effective emergency coordination strategies in managing hospital bed resources during sudden public health emergency events. These insights contribute to the advancement of resource management practices and the promotion of experiences in dealing with public health emergencies.
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Affiliation(s)
- Qingyan Zheng
- School of Business, Sichuan Unversity, Chengdu, China
- The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhongyi Zeng
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiumei Tang
- School of Business, Sichuan Unversity, Chengdu, China
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Li Ma
- School of Business, Sichuan Unversity, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
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Holdsworth LM, Siden R, Wong BO, Verano M, Lessios AS, Tabor HK, Schapira L, Aslakson R. "Like not having an arm": a qualitative study of the impact of visitor restrictions on cancer care during the COVID-19 pandemic. Support Care Cancer 2024; 32:288. [PMID: 38622350 PMCID: PMC11018646 DOI: 10.1007/s00520-024-08473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Visitor restriction policies to prevent the spread of COVID-19 among patients and clinicians were widespread during the pandemic, resulting in the exclusion of caregivers at key points of cancer care and treatment decision-making. The aim of this study was to explore how visitor restrictions impacted cancer treatment decision-making and care from patient and physician perspectives. METHODS Sixty-seven interviews, including 48 cancer patients and 19 cancer and palliative care physicians from four academic cancer centers in the USA between August 2020 and July 2021. RESULTS Visitor restrictions that prevented caregivers from participating in clinic appointments and perioperative hospital care created challenges in cancer care that spanned three domains: practical, social, and informational. We identified eight themes that characterized challenges within the three domains across all three groups, and that these challenges had negative emotional and psychological consequences for both groups. Physicians perceived that patients' negative experiences due to lack of support through the physical presence of caregivers may have worsened patient outcomes. CONCLUSIONS Our data demonstrate the tripartite structure of the therapeutic relationship in cancer care with caregivers providing critical support in the decision-making and care process to both patients and physicians. Caregiver absences led to practical, psychosocial, and informational burdens on both groups, and likely increased the risk of burnout among physicians. Our findings suggest that the quality of cancer care can be enhanced by engaging caregivers and promoting their physical presence during clinical encounters.
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Affiliation(s)
- Laura M Holdsworth
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Rachel Siden
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bonnie O Wong
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mae Verano
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anna Sophia Lessios
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Holly K Tabor
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Rebecca Aslakson
- Department of Anesthesiology, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Alfowzan N, Valipoor S, Portillo M. Developing Resilient Community Spaces in Healthcare Facilities: An Exploratory Study of a Public Health Crisis. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:10-23. [PMID: 38149339 DOI: 10.1177/19375867231219753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVES This exploratory study aimed to investigate the impact of the COVID-19 pandemic on the design of healthcare facilities, particularly those featuring communal spaces. It sought to identify strategies that were implemented, learned, or recognized when adapting to the limitations imposed by protective measures during the pandemic. BACKGROUND Third places are social gathering places outside of home and work. Over time, these community-centric places evolved from free-standing getaways to more integrated niches in diverse contexts including healthcare. Their numerous advantages for users include enhancing community bonds and collaboration among healthcare workers. The onset of the COVID-19 pandemic resulted in a need to rethink the design of such spaces to make them more adaptable and resilient. METHODS An exploratory qualitative study was conducted through in-depth semi-structured interviews with sixteen practitioners involved in healthcare architecture and design projects during the pandemic. Data were analyzed using a thematic analysis approach. RESULTS Findings indicate that the design of shared spaces in healthcare facilities for pandemic-like situations requires a special focus on modifiability and multifunctionality, achievable through strategies such as the use of movable, unconnected, and rearrangeable furniture or partitions that could swiftly change the function of a space. Other strategies include the capacity for compartmentalization of spaces, fostering indoor-outdoor connections, integrating advanced technology, and implementing effective infection control measures. Detailed emergent themes and examples of experienced constraints are discussed. CONCLUSIONS Insights gained from our findings can be applied to new and ongoing healthcare design projects to ensure resiliency during normal and pandemic conditions.
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Affiliation(s)
- Nurah Alfowzan
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Shabboo Valipoor
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Margaret Portillo
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
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Liu SY, Amato SS, Lahey TP, Malhotra AK. Association of COVID-19 Visitor Limitations and Goals of Care Discussions in the Intensive Care Unit. J Surg Res 2024; 295:407-413. [PMID: 38070254 DOI: 10.1016/j.jss.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/28/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION The COVID-19 pandemic led to visitor restrictions in many hospitals. Since care in the surgical intensive care unit (SICU) often engages visitors as surrogate decision-makers, we investigated whether there was an association between COVID-19-related visitor restrictions, goals of care discussions (GOCD), and patient outcomes in SICU patients. METHODS We conducted a retrospective review of trauma and emergency general surgery (EGS) patients admitted to a rural tertiary SICU between July 2019 and April 2021, dividing patients into those admitted during COVID-19 visitor restrictions and those admitted at other times. Using univariate and multivariate logistic regression analyses, we compared the primary outcome, incidence of GOCD, and incidence of prolonged hospital (> 14 d) and intensive care unit length of stay (LOS, > 7 d) between the two groups. RESULTS One hundred seventy nine of 368 study patients (48.6%) presented during restricted visitation. The proportion of GOCD was 38.0% and 36.5% in the restricted and nonrestricted visitation cohorts, respectively (P = 0.769). GOCD timing and outcomes were similar in both groups. The use of telecommunication increased during restricted visitation, as did the proportion of trauma patients admitted to the SICU. On multivariable logistic regression, age and patient category were independent predictors of GOCD. On outcomes analysis, visitor restriction was associated with prolonged hospital LOS for EGS patients (odds ratio 2.44, 95% confidence interval 1.01-5.91, P value 0.048). CONCLUSIONS Restricted visitation was not associated with changes in frequency or outcome of GOCD, but was associated with prolonged hospital LOS among EGS patients who had SICU admissions. Further investigation of patient/surrogate satisfaction with virtual GOCD in the SICU setting is needed.
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Affiliation(s)
- Sarah Y Liu
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont.
| | - Stas S Amato
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - Timothy P Lahey
- Departments of Infectious Disease and Clinical Ethics, University of Vermont Medical Center, Burlington, Vermont
| | - Ajai K Malhotra
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
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Khan A, Patel SJ, Anderson M, Baird JD, Johnson TM, Liss I, Graham DA, Calaman S, Fegley AE, Goldstein J, O'Toole JK, Rosenbluth G, Alminde C, Bass EJ, Bismilla Z, Caruth M, Coghlan-McDonald S, Cray S, Destino LA, Dreyer BP, Everhart JL, Good BP, Guiot AB, Haskell H, Hepps JH, Knighton AJ, Kocolas I, Kuzma NC, Lewis K, Litterer KP, Kruvand E, Markle P, Micalizzi DA, Patel A, Rogers JE, Subramony A, Vara T, Yin HS, Sectish TC, Srivastava R, Starmer AJ, West DC, Spector ND, Landrigan CP. Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios. Pediatrics 2024; 153:e2023062666. [PMID: 38164122 DOI: 10.1542/peds.2023-062666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel "Mentor-Trio" implementation approach with multidisciplinary parent-nurse-physician teams coaching sites. METHODS Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents. RESULTS We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%-60.8% absolute increase by item), all P < .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P < .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P < .05). Twelve of 12 measures of staff safety climate improved (eg, "excellent"/"very good" safety grade improved from 80.4% to 86.3% to 88.0%), all P < .05. Patient/family experience and teaching were unchanged. CONCLUSIONS Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Shilpa J Patel
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
- Kapi'olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, Hawaii
| | - Michele Anderson
- Family Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Jennifer D Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Tyler M Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Isabella Liss
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Dionne A Graham
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Calaman
- Division of Pediatric Critical Care, NYU Langone Health/Hassenfeld Children's Hospital, NYU Grossman School of Medicine; New York City, New York
| | - April E Fegley
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Jenna Goldstein
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Jennifer K O'Toole
- Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn Rosenbluth
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
- Benioff Children's Hospital, San Francisco, University of California San Francisco School of Medicine, San Francisco, California
| | - Claire Alminde
- Department of Nursing, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Ellen J Bass
- Department of Information Science in the College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Zia Bismilla
- Departments of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Monique Caruth
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Sally Coghlan-McDonald
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Benioff Children's Hospital, San Francisco, University of California San Francisco School of Medicine, San Francisco, California
| | - Sharon Cray
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Patient Safety and Quality Improvement Committee, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Lauren A Destino
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Benard P Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Jennifer L Everhart
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Brian P Good
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Amy B Guiot
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Helen Haskell
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Mothers Against Medical Error, Columbia, South Carolina
| | - Jennifer H Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Irene Kocolas
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nicholas C Kuzma
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kheyandra Lewis
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Katherine P Litterer
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Office of Experience, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth Kruvand
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Peggy Markle
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Dale A Micalizzi
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Aarti Patel
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego, California
| | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts
| | - Anupama Subramony
- Department of Pediatrics, Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - Tiffany Vara
- Kapi'olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, Hawaii
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
- Healthcare Delivery Institute, Intermountain Health, Murray, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daniel C West
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy D Spector
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
- The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Abstract
Objective: Internal medicine (IM) residents discuss a patient's goals of care (GOC) as part of their initial consultation. Residents have described inexperience, general discomfort, limited formal teaching, and prognostic uncertainty as barriers to effective GOC conversations. The early COVID-19 pandemic resulted in rapid changes to the healthcare system on the individual, patient, and systemic level that might exacerbate and/or introduce new barriers to IM residents' GOC conversations. This qualitative study examines how the early COVID-19 pandemic challenged IM residents' ability to have effective GOC conversations. Methods: Using a constructivist grounded theory approach, participants (n=11) completed a semi-structured interview. Data collection and analysis occurred simultaneously using an open coding, constant comparison process. Interviews were completed until no new themes were identified. Results: Residents self-described their GOC conversations in 5 steps: normalization of the conversation, introduction of expected clinical course, discussion of possible care plans, exploration of the patient's values, and occasionally providing a recommendation. Residents described limited structured teaching around GOC conversations and instead relied on observed role-modelling and self-practice to hone their skillset. Residents described an increased sense of urgency to have GOC conversations due to the uncertainty of clinical course and potential for rapid deterioration of patients with COVID-19. Residents identified restrictive visitor policies as a significant barrier that contributed to feelings of dehumanization. Residents felt that these limitations affected their GOC conversations and potentially resulted in discordant care plans which contributed to moral distress. Conclusion: The early COVID-19 pandemic resulted in several barriers that challenged residents' ability to conduct effective GOC conversations. This is on the background of previously reported discomfort and limited formal training in conducting GOC conversations. Based on our findings, we present a conceptual model involving teaching validated GOC frameworks, positive role-modelling, and experiential learning to support GOC conversation education in post-graduate medical education.
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Affiliation(s)
- Alison T. Lai
- Faculty of Medicine, University of
Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| | - Nadine Abdullah
- Faculty of Medicine, University of
Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
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Wasilewski MB, Szigeti Z, Sheppard CL, Minezes J, Hitzig SL, Mayo AL, Robinson LR, Lung M, Simpson R. "You want them to be partners in therapy, but that's tricky when they're not there": A qualitative study exploring caregiver involvement across the continuum of care during the early COVID pandemic. Clin Rehabil 2024; 38:109-118. [PMID: 37518867 PMCID: PMC10631287 DOI: 10.1177/02692155231191011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Widespread visitor restrictions were implemented during the COVID-19 pandemic at acute and inpatient rehabilitation hospitals. Family caregivers were physically isolated from their loved ones, which challenged engagement in patient care and readiness for their role. Thus, we aimed to explore the involvement of family caregivers in COVID-19 patients as they journeyed across the care continuum during the early phase of the COVID-19 pandemic. DESIGN We employed a qualitative descriptive approach. PARTICIPANTS We conducted interviews with family caregivers, COVID-19 patients, and healthcare providers between August 2020 and February 2021. SETTING Participants were recruited from a single hospital network in Toronto, Ontario, Canada. Interviews were recorded and transcribed. Data were analyzed thematically. RESULTS A total of 27 participants were interviewed-12 healthcare providers, 10 patients, and 5 family caregivers. Four themes were identified: (a) Caregivers were shut out in acute COVID care, (b) Patient discharge from inpatient rehabilitation was turbulent for caregivers, (c) Caregivers were unprepared to support loved ones in the community, and (d) Patient discharge to home was heavily dependent on caregiver availability. CONCLUSIONS Visitor restrictions prevent family caregivers from being physically present at patients' bedside, leading to complex and detrimental impacts such as caregivers feeling that they were not engaged in their loved one's care planning until they were discharged. In turn, discharge to the community was met with several challenges including caregivers feeling underprepared and unsupported to meet their loved one's unique care requirements. This was exacerbated by a lack of community-based resources due to ongoing pandemic restrictions.
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Affiliation(s)
- Marina B Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zara Szigeti
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christine L Sheppard
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jacqueline Minezes
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lawrence R Robinson
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria Lung
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Simpson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Knight SL, Robinson R, Stinson C. No Visitors: Family Perceptions of Separation From Hospitalized Loved Ones. Dimens Crit Care Nurs 2023; 42:319-324. [PMID: 37756504 DOI: 10.1097/dcc.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND/INTRODUCTION Restrictions on visitors during the coronavirus disease 2019 (COVID-19) pandemic had major implications for both patients and families, impacting health care outcomes. Policies included mandatory closures, masking, and visiting restrictions both in acute and long-term care. Despite visiting restrictions in health care systems, little is known about its effects. OBJECTIVES/AIMS The objective of this study was to elicit perceptions of individuals who were separated from their loved ones during acute care hospitalization during the COVID pandemic. METHODS Individuals who experienced separation from hospitalized family members because of the "no-visitor policies" during the COVID-19 pandemic were asked to participate in a study to elicit their perceptions. After institutional review board approval, interviews were completed for those who had loved ones admitted to acute care facilities only. Audiotaped and transcribed interviews were conducted in person, via telephone, or virtually using a primary investigator-developed interview guide. Using the Colaizzi method of analysis, themes were derived. RESULTS Of the 11 completed interviews, 100% of participants were female, and all were residents of Texas. Themes derived from this pilot project were advocacy, communication, emotional upheaval, human factors, isolation, and abandonment. CONCLUSIONS Findings from patient interviews support previous published studies. Ideas for improved patient and family experience discussed by the authors include personal protective equipment for significant others, consideration of visitation policies for those patients without decision-making capabilities, and increased accessibility to communication aids for both patients and families.
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Kihara A, Kambayashi T, Shimonouchi Y, Mabuchi M, Nagai A, Kanzaki I, Fukagawa M. The Impact of Visitor Restrictions During COVID-19 Pandemic on Bereaved Family Members of Patients in Palliative Care Units. Am J Hosp Palliat Care 2023; 40:1279-1284. [PMID: 36803015 PMCID: PMC9941005 DOI: 10.1177/10499091231159522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
COVID-19 pandemic has impacted the families of patients in Palliative Care Units because of the visitor restrictions which were introduced to reduce the risk of infection. This study investigates how the bereaved families of the patients who died in end-of-life care during the pandemic evaluate the visitor restrictions and how the lack of direct communication with the patient affected them. We conducted a quantitative survey using an anonymous self-administered questionnaire. Participants were the bereaved families of patients who died in a Palliative Care Unit from April 2020 to March 2021. Their perspectives on the negative impact of COVID-19 pandemic on visitations, visitor restrictions, the quality of medical care in the month before the death of the patient, and online visitations were recorded in the survey. The results show that most participants experienced a negative impact on visitations. However, most respondents felt that the restrictions were unavoidable. According to visitor permissions in patients' last days, bereaved families were satisfied with the medical care provided for the patient and the amount of time spent with the patient in his/her last days. The importance of direct meetings during the last days of the patients' life for their family members was presented. We suggest further research to find measures which enable visitation in palliative care units, as caregiving from family and friends and maintaining COVID safety regulations are equally significant in end-of-life care.
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Affiliation(s)
- Ayumi Kihara
- Palliative Care Unit, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
| | | | | | - Makiko Mabuchi
- Palliative Care Unit, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
| | - Ayumi Nagai
- Palliative Care Unit, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
| | - Iku Kanzaki
- Palliative Care Unit, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
| | - Miyuki Fukagawa
- Palliative Care Unit, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
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14
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Munda M, Velnar T, Bosnjak R, Zele T, Gradisnik L, Spazzapan P, Kos N, Kocivnik N, Benedicic M, Prestor B. COVID-19 and Surgical Practice in Slovenia: Managing the Crisis in Neurosurgery during the COVID-19 Pandemic. Life (Basel) 2023; 13:2095. [PMID: 37895476 PMCID: PMC10608538 DOI: 10.3390/life13102095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Worldwide, the novel coronavirus disease 2019 (COVID-19) has become a significant threat to global health. Worldwide, COVID-19 has affected the health service also in Slovenia. During this time, neurosurgery is facing difficulties in its service, both in emergency and elective surgeries. In the article, we describe the anti-COVID-19 measures taken at our neurosurgical department in a medical centre in Ljubljana, Slovenia, and analysed and compared the number of emergency and elective neurosurgical procedures during the time of the pandemic.
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Affiliation(s)
- Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Tilen Zele
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
| | - Lidija Gradisnik
- Institute of Biomedical Sciences, Medical Faculty Maribor, 2000 Maribor, Slovenia;
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Natasa Kos
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
- Department of Rehabilitation, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Mitja Benedicic
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Borut Prestor
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
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15
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Boubli B, Labrunée M. [Restriction of visits induced by the COVID-19 outbreak: A better postpartum experience?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:481-483. [PMID: 37414342 DOI: 10.1016/j.gofs.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Benjamin Boubli
- Service de gynécologie-obstétrique, Polyclinique de l'Ormeau ELSAN, 12 chemin de l'Ormeau, 65000 Tarbes, France.
| | - Marc Labrunée
- Cellule recherche et innovation, Polyclinique de l'Ormeau ELSAN, 12 chemin de l'Ormeau, 65000 Tarbes, France
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16
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Tacchini-Jacquier N, Monnay S, Bonvin E, Dubuis J, Verloo H. Relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave: a PREMs study in Valais Hospital, Switzerland. BMC Health Serv Res 2023; 23:1008. [PMID: 37726727 PMCID: PMC10510254 DOI: 10.1186/s12913-023-10013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives' psychological and emotional states and how closely they could be involved in their loved one's hospitalization. STUDY AIMS Investigate relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave and the support offered by Valais Hospital's healthcare staff. METHODS Relatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones' health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed. RESULTS Of 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages. CONCLUSION Visiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient-relative communications. Future research should attempt to develop reliable, validated measurement instruments of relatives' experiences of acute-care visiting restrictions during pandemics.
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Affiliation(s)
- N Tacchini-Jacquier
- Development of Nursing Practices Unit, Valais Hospital, 86, Avenue du Grand-Champsec, CH-1951, Sion, Switzerland
| | - S Monnay
- Social Affairs and Human Resources Specialist, Valais Hospital, 86, Avenue du Grand-Champsec, CH-1951, Sion, Switzerland
| | - E Bonvin
- Valais Hospital, 86, Avenue Grand-Champsec, CH-1951, Sion, Switzerland
| | - J Dubuis
- Valais Family Caregivers' Association, 19, Avenue de Tourbillon, CH-1950, Sion, Switzerland
| | - H Verloo
- Valais Hospital, HES-SO Valais/Wallis, 5, Chemin de L'Agasse, CH-1950, Sion, Valais, Switzerland.
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17
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Ejezie CL, Savas LS, Durand C, Shegog R, Cuccaro P. The prevalence of human papillomavirus vaccination among racial and ethnic minority adolescents during the COVID-19 pandemic. JNCI Cancer Spectr 2023; 7:pkad065. [PMID: 37651597 PMCID: PMC10521629 DOI: 10.1093/jncics/pkad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination among adolescents has steadily improved over the past several years. However, research conducted to determine whether the COVID-19 pandemic disrupted this positive trend in HPV vaccine initiation among racial and ethnic minority adolescents is limited. Therefore, this study was conducted to determine if the COVID-19 pandemic and the resulting changes in the US health-care sector affected the increasing HPV vaccine initiation among non-Hispanic Black and Hispanic adolescents aged 13-17 years. METHODS Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), logistic regression and moderation analysis were used to model race-specific variations in HPV vaccine initiation (n = 49 031). Two-sided P values of up to .05 were considered statistically significant. RESULTS Hispanic (adjusted odds ratio [AOR] = 1.35, 95% confidence interval [CI] = 1.16 to 1.57) and non-Hispanic Black (AOR = 1.29, 95% CI = 1.10 to 1.51) adolescents had higher odds of HPV vaccine initiation than did non-Hispanic White adolescents. Additionally, the odds of HPV vaccine initiation were higher in 2021 (AOR = 1.22, 95% CI = 1.08 to 1.38) than in 2019. Other variables-age, region, sex, insurance status, and poverty status-were also associated with HPV vaccine initiation. CONCLUSION These findings demonstrate that during the COVID-19 pandemic, racial and ethnic minorities had higher odds of receiving the HPV vaccine. Therefore, more research of the impact of the pandemic on HPV vaccine initiation among non-Hispanic White and racial and ethnic minority adolescents is needed.
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Affiliation(s)
- Chinenye Lynette Ejezie
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lara S Savas
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Casey Durand
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
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Fraser K, Kuhn M, Swanson R, Coulter DW, Copeland C, Zuniga JM. Low Motor Dexterity and Significant Behaviors Following Hospitalized Isolation in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1287. [PMID: 37628286 PMCID: PMC10453062 DOI: 10.3390/children10081287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
The main objective of this study was to describe the cortical patterns of brain activity during a gross dexterity task and develop a behavioral profile of children experiencing isolation. A cross-sectional assessment was conducted during one visit. Sample: Four pediatric patients who had undergone isolation within a hospital comprised the full data collection. During the collection, participants completed the Box and Blocks Test of gross manual dexterity while undergoing imaging of the motor cortex using functional near-infrared spectroscopy. Participants also completed a Behavioral Assessment System for Children, Third Edition (BASC-3) self-report, which was analyzed along with a parent report to quantify their emotional and social behaviors. All participants displayed lower gross dexterity levels than normative data. Furthermore, three out of the four participants displayed ipsilateral dominance of the motor cortex during the dexterity task. Three of the participants displayed behavioral measures reported within clinically significant or at-risk scores. Clinically significant behavioral scores coupled with lower than expected manual dexterity values and ipsilateral hemispheric dominance indicate that neuroplastic changes can occur in populations undergoing hospitalized isolation. While the impacts of the treatments and isolation in this case cannot be separated, further studies should be conducted to understand these impacts of isolation.
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Affiliation(s)
- Kaitlin Fraser
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA (C.C.)
| | - Miriam Kuhn
- Department of Special Education and Communication Disorders, University of Nebraska Omaha, Omaha, NE 68182, USA
| | - Rebecca Swanson
- Pediatric Hematology and Oncology Clinic, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Don W. Coulter
- Division of Pediatric Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Children’s Hospital & Medical Center Specialty Pediatric Center, Omaha, NE 68114, USA
| | - Christopher Copeland
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA (C.C.)
| | - Jorge M. Zuniga
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA (C.C.)
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Breman RB, Neerland C, Iobst SE, Bradford LL, Barr E, Malloy S, Burgess A. Survey of Postpartum People in the United States During the First Wave of the COVID-19 Pandemic to Explore Their Perspective on Support After Discharge. J Perinat Neonatal Nurs 2023; 37:196-204. [PMID: 37494688 DOI: 10.1097/jpn.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION The purpose of this study was to capture the experiences of postpartum people during the first wave of COVID-19, specifically their access to contraception and lactation support. METHODS This cross-sectional study surveyed individuals in the United States who used the Ovia Pregnancy and Parenting app. The survey was administered via an email Web link sent to postpartum people who gave birth between March 1, 2020, and June 11, 2020. Quantitative and qualitative analyses were conducted. RESULTS A total of 388 postpartum people completed the survey. Most participants had just given birth to their first baby (68.5%; n = 261) at term gestation (37-41 weeks) (92.9%; n = 355). From the qualitative data, using content analysis, we derived 6 themes and 2 subthemes: quarantine, changes in postpartum care, loneliness and isolation, stress, resource changes, and positive impact. The theme loneliness and isolation had 2 subthemes: depression/sadness/hopelessness and anxiety. DISCUSSION The experience of being postpartum during the COVID-19 pandemic brought unforeseen challenges. Providing care and support to postpartum people during a pandemic, specifically during a time of quarantine, should be reimagined. Increased use of virtual postpartum care services and expanded mental health support could serve to fill the gaps identified by participants.
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Affiliation(s)
- Rachel Blankstein Breman
- Department of Partnerships, Professional Education and Practice, University of Maryland School of Nursing, Baltimore (Dr Breman); University of Minnesota School of Nursing, Minneapolis (Dr Neerland); Department of Nursing, Towson University College of Health Professions, Towson, Maryland (Dr Iobst); Department of Family and Community Medicine, University of Maryland Medical Center, Baltimore (Dr Bradford); University of Maryland, School of Nursing, Baltimore(Mr Barr); Ovia Health, Boston, Massachusetts (Ms Malloy); and Maryland Patient Safety Center, Elkridge (Dr Burgess)
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Hedman C, Strang P, Lundström S, Martinsson L. Symptom Management and Support in Dying Patients with Cancer and Coronavirus Disease-19-A Register-Based Study. J Palliat Care 2023; 38:261-267. [PMID: 36793233 PMCID: PMC10350711 DOI: 10.1177/08258597231157622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Little is known to what extent access to specialist palliative care (SPC) for cancer patients dying with coronavirus disease-2019 (COVID-19) affects the occurrence of breakthrough symptoms, symptom relief, and overall care, compared to hospital deaths. Our aim was to include patients with both COVID-19 and cancer and compare those dying in hospitals with those dying in SPC with reference to the quality of end-of-life care. METHODS Patients with both cancer and COVID-19 who died in hospitals (n = 430) and within SPC (n = 384) were identified from the Swedish Register of Palliative Care. The hospital and SPC groups were compared regarding the quality of end-of-life care, including the occurrence of 6 breakthrough symptoms during the last week in life, symptom relief, end-of-life care decisions, information, support, and human presence at death. RESULTS Breakthrough of breathlessness was more common in the hospital patients compared to the SPC patients (61% and 39%, respectively; p < .001), while pain was less common (65% and 78%, respectively; p < .001). Breakthrough of nausea, anxiety, respiratory secretions, or confusion did not differ. All 6 symptoms, except for confusion, were more often completely relieved in SPC (p = .014 to p < .001 in different comparisons). In SPC, a documented decision about the goal being end-of-life care and information about this were more common than in hospitals (p < .001). Also, to have family members present at the time of death and for family members to be offered a follow-up talk afterward was more common in SPC (p < .001). CONCLUSION More systematic palliative care routines may be an important factor for better symptom control and higher quality of end-of-life care in hospitals.
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Affiliation(s)
- Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Strang
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Lundström
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
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Buchbinder M, Browne A, Berlinger N, Jenkins T, Buchbinder L. Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-15. [PMID: 37347222 PMCID: PMC10758677 DOI: 10.1080/15265161.2023.2224270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic factors. We conclude by reflecting on how and why this conceptual clarity matters for improving clinicians' professional wellbeing, and offer preliminary pathways for intervention.
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Affiliation(s)
| | | | | | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA
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22
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Choo EK, Strehlow M, Del Rios M, Oral E, Pobee R, Nugent A, Lim S, Hext C, Newhall S, Ko D, Chari SV, Wilson A, Baugh JJ, Callaway D, Delgado MK, Glick Z, Graulty CJ, Hall N, Jemal A, Kc M, Mahadevan A, Mehta M, Meltzer AC, Pozhidayeva D, Resnick-Ault D, Schulz C, Shen S, Southerland L, Du Pont D, McCarthy DM. Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic. BMJ Open 2023; 13:e067986. [PMID: 37156578 PMCID: PMC10410813 DOI: 10.1136/bmjopen-2022-067986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. OUTCOMES AND ANALYSIS We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. RESULTS We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. CONCLUSIONS Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.
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Affiliation(s)
- Esther K Choo
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Matthew Strehlow
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Evrim Oral
- Department of Biostatistics, School of Public Health LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Ruth Pobee
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Andrew Nugent
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Stephen Lim
- Section of Emergency Medicine, Department of Medicine, University Medical Center New Orleans, LSU Health Sciences Center New Orleans, New Orleans, Louisiana, USA
| | - Christian Hext
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarah Newhall
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Diana Ko
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Srihari V Chari
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy Wilson
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Joshua J Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Callaway
- Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Mucio Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zoe Glick
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Christian J Graulty
- Department of Emergency Medicine, NYU Langone School of Medicine, New York, New York, USA
| | - Nicholas Hall
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Abdusebur Jemal
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Madhav Kc
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aditya Mahadevan
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Milap Mehta
- Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Dar'ya Pozhidayeva
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Resnick-Ault
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christian Schulz
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Sam Shen
- Department of Emergency Medicine Medicine, Stanford University, Palo Alto, California, USA
| | - Lauren Southerland
- Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
| | - Daniel Du Pont
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Wiebe LE, Alvesson HM, Stassen W. Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa. BMJ Open 2023; 13:e070982. [PMID: 37147101 PMCID: PMC10163331 DOI: 10.1136/bmjopen-2022-070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES To determine emergency department (ED) physicians' perceptions regarding hospital companions being prohibited from accompanying the patient during COVID-19. DESIGN Two qualitative datasets were combined. Data collected included voice recordings, narrative interviewing and semistructured interviews. A reflexive thematic analysis was conducted and guided by the Normalisation Process Theory. SETTING Six hospital EDs in the Western Cape, South Africa. PARTICIPANTS Convenience sampling was used to recruit a total of eight physicians working full time in the ED during COVID-19. RESULTS The lack of physical companions provided an opportunity for physicians to assess and reflect on a companion's role in efficient patient care. Physicians perceived that the COVID-19 restrictions illuminated that patient companions engaged in the ED as providers contributing to patient care by providing collateral information and patient support, while simultaneously engaging as consumers detracting physicians from their priorities and patient care. These restrictions prompted the physicians to consider how they understand their patients largely through the companions. When companions became virtual, the physicians were forced to shift how they perceive their patient, which included increased empathy. CONCLUSION The reflections of providers can feed into discussions about values within the healthcare system and can help explore the balance between medical and social safety, especially with companion restrictions still being practised in some hospitals. These perceptions illuminate various tradeoffs physicians had to consider throughout the pandemic and may be used to improve companion policies when planning for the continuation of the COVID-19 pandemic and future disease outbreaks.
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Affiliation(s)
- Lauren E Wiebe
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Yance B, Do K, Heath J, Fucile S. Parental Perceptions of the Impact of NICU Visitation Policies and Restrictions Due to the COVID-19 Pandemic: A Qualitative Study. Adv Neonatal Care 2023:00149525-990000000-00062. [PMID: 37036934 DOI: 10.1097/anc.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted parents' ability to participate in their infants' care during the neonatal intensive care unit (NICU) stay in unprecedented ways. PURPOSE The purpose of this study was to explore the lived experience of parents whose infants was in the NICU during the COVID-19 pandemic. METHODS A qualitative telephone interview survey was conducted. Participants included parents of preterm infants who were born less than 34 weeks' gestation during the first wave of the COVID-19 pandemic (March 2020-August 2020). Telephone surveys were conducted through open-ended questions. A thematic content analysis identifying themes was performed after interviews were completed and transcribed. RESULTS A total of 8 mothers completed the telephone survey. Key themes from this study include parents experiencing increased stress due to the restricted visitation policies, limited opportunities to care for their infant, lack of support, and inconsistent communication regarding their infant status and COVID-19 protocols. IMPLICATIONS FOR PRACTICE Suggestions provided to enhance NICU services during the pandemic include increasing parental engagement opportunities to care for their infant in the NICU, enhanced empathy and compassion from the neonatal team, and open and transparent communication. IMPLICATIONS FOR RESEARCH Further research investigating cultural impact on parents' perspectives, perspectives of fathers, long-term impact of how parents coped after discharge from the NICU, and emotional impact on NICU staff members may be beneficial to aid improvements in NICU service delivery during the ongoing and future pandemic.
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Affiliation(s)
- Brittany Yance
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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McTernan E. Against visitor bans: freedom of association, COVID-19 and the hospital ward. JOURNAL OF MEDICAL ETHICS 2023; 49:288-291. [PMID: 36163146 DOI: 10.1136/jme-2022-108297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
To ban or significantly restrict visitors for patients in hospital could seem to be simply a sensible and easy precaution to take during a pandemic: a policy that is unpopular, perhaps, and even unfortunate, but not something that wrongs anyone. However, I argue that in fact such restrictions on visitors infringe upon a fundamental right, to freedom of association. While there may still be permissible restrictions on visitors, making the case for these becomes highly demanding. One common way to understand the purpose of the fundamental liberties is as protecting us from interference in a core set of freedoms, even when such interference would be to our benefit or would promote the general good. This reframing of the importance of visitors in terms of a right also has implications for how to run hospitals beyond the pandemic era: it supports a rapid expansion of visitor access and suggests that any decision to significantly restrict visitors ought not be left in the hospital, or hospital trust's, hands.
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Affiliation(s)
- Emily McTernan
- Political Science, University College London, London, UK
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26
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Milner KA. Evolution of Visiting the Intensive Care Unit. Crit Care Clin 2023; 39:541-558. [DOI: 10.1016/j.ccc.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Rodriquez J. Reconfiguring the social organization of work in the intensive care unit: Changed relationships and new roles during COVID-19. Soc Sci Med 2023; 317:115600. [PMID: 36538836 PMCID: PMC9721201 DOI: 10.1016/j.socscimed.2022.115600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic caused hospitals to make changes to workflow that exacerbated emotional exhaustion and burnout among health care workers. This article examines one of those changes, restricted visitation, showing how it changed the social organization of work by upending established interactional patterns and relationships between health care workers, patients, and patients' families. Based on 40 interviews with intensive care unit (ICU) workers in units that were full of COVID-19 patients and had fully restricted visitation, study findings show that staff took on emotional support roles with patients that had typically been done by families at the bedside. They also faced increased anger, distrust, and misunderstandings from families who were not allowed to see their dying loved one. With each other, staff bonded together with dark humor and candid talk about the scale of deaths, constructing a shared understanding and solidarity amidst the tragedy of the pandemic.
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Affiliation(s)
- Jason Rodriquez
- Department of Sociology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02115, USA.
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Marmo S, Milner KA. From Open to Closed: COVID-19 Restrictions on Previously Unrestricted Visitation Policies in Adult Intensive Care Units. Am J Crit Care 2023; 32:31-41. [PMID: 36175358 DOI: 10.4037/ajcc2023365] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND In March 2020, rising numbers of COVID-19 infections contributed to changes in intensive care unit visitation policies, with some facilities allowing no visitors. OBJECTIVE To compare visitation policies of Magnet and Pathway to Excellence hospitals with prepandemic open visitation in adult intensive care units. METHODS A mixed-methods study was conducted from January through March 2021. Quantitative data on visitation policies were extracted from websites of 96 Magnet and Pathway to Excellence hospitals that had allowed unrestricted visits in adult intensive care units before the pandemic. Qualitative data were collected via semistructured interviews with 9 nurse leaders from these hospitals. RESULTS More than 1 year after the start of the pandemic, all of the hospitals had instituted restricted visitation policies. The policies varied, with little to no evidence-based justification. Restrictions included 83% of hospitals (n = 80) allowing just 1 visitor per day and 69% of hospitals (n = 50 of 72) allowing no visits at all for patients with COVID-19 in the intensive care unit. Five themes were found when nurse leaders' interviews were analyzed: visitors not welcome, doing harm, external decisions at system level, visiting within limits, and changes in critical care nursing work. CONCLUSION Results of the study suggest that despite the vast amount of evidence supporting the benefits of visitation and the harms of restricted visitation and expert recommendations for returning safe visitation to hospitals, Magnet and Pathway to Excellence hospitals continue to enforce restricted visitation policies in intensive care units. Patients, families, and nursing and health care staff must partner to create pandemic-proof visitation policies.
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Affiliation(s)
- Suzanne Marmo
- Suzanne Marmo is an assistant professor of social work at Sacred Heart University, Fairfield, Connecticut
| | - Kerry A Milner
- Kerry A. Milner is a professor of nursing at Sacred Heart University, Fairfield, Connecticut
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Wentlandt K, Wolofsky KT, Weiss A, Hurlburt L, Fan E, Zimmermann C, Isenberg SR. Physician perceptions of restrictive visitor policies during the COVID-19 pandemic: a qualitative study. CMAJ Open 2023; 11:E110-E117. [PMID: 36750247 PMCID: PMC9911125 DOI: 10.9778/cmajo.20220048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Little is understood of the consequences of restrictive visitor policies that were implemented in hospitals to minimize risk of infection during the COVID-19 pandemic. The objective of this study was to describe physician experiences with these policies and reflections of their effects. METHODS We conducted semistructured phone interviews from September 2020 to March 2021 with physicians practising in Ontario hospitals, recruited via professional networks and snowball sampling. We audio-recorded, transcribed and analyzed interviews to describe and interpret overarching themes by thematic analysis. RESULTS We interviewed 21 physicians (5 intensivists, 5 internists, 11 specialists in palliative care). Four main thematic categories emerged, including provider, system, patient and caregiver effects. Provider-related factors included increased time and effort on communication with a need to establish limits; increased effort to develop rapport with caregivers; lack of caregiver input on patient care; the need to act as a caregiver surrogate; and the emotional toll of being a gatekeeper or advocate for visitors, exacerbated by lack of evidence for restrictions and inconsistent enforcement. System effects included the avoidance of hospital admission and decreased length of stay, leading to readmissions, increased deaths at home and avoidance of transfer to other facilities with similar policies. Patient-related factors included isolation and dying alone; lack of caregiver advocacy; and prioritization of visitor presence that, at times, resulted in a delay or withdrawal of aspects of care. Caregiver-related factors included inability to personally assess patient health, leading to poor understanding of patient status and challenging decision-making; perceived inadequate communication; difficulty accessing caregiver supports; and increased risk of complicated grief. Participants highlighted a disproportionate effect on older adults and people who did not speak English. INTERPRETATION Our study highlights substantial negative consequences of restrictive visitor policies, with heightened effects on older adults and people who did not speak English. Research is required to identify whether the benefits of visitor restrictions on infection control outweigh the numerous deleterious consequences to patients, families and care providers.
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Affiliation(s)
- Kirsten Wentlandt
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont.
| | - Kayla T Wolofsky
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Andrea Weiss
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Lindsay Hurlburt
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Eddy Fan
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Camilla Zimmermann
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Sarina R Isenberg
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
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Impact of an Inclusive COVID-19 Visitation Policy on Patient Satisfaction and Visitor Safety. Am J Infect Control 2022:S0196-6553(22)00843-4. [PMID: 36470450 PMCID: PMC9719848 DOI: 10.1016/j.ajic.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The COVID-19 pandemic presented unique and unprecedented challenges due to limited knowledge regarding the virus's transmissibility. With guidance from the Center for Disease Control (CDC), healthcare systems instituted widespread visitor restrictions. Hospitalization is a stressful time for patients. Visitor support can help minimize this during and after discharge. METHODS A telephone interview was conducted among hospitalized COVID-19 positive patients discharged between March 1st - August 31st, 2021 to explore the patients and visitors' experiences and the impact of the visitor policy during their hospitalization. RESULTS A total of 238 patients were interviewed. For patients with visitors, 98% felt that the presence of visitors improved their overall wellbeing and satisfaction. Additionally, 86% reported that visitors were involved in helping with their care upon discharge. For patients with no visitors, 59% felt that having a visitor would have improved their hospital stay. Nearly 50% reported that the absence of visitors made it difficult for family members to remain updated and informed of their hospital care. CONCLUSION This study demonstrates that visitation for COVID-19 patients can be done safely and that there is a positive impact on patient wellbeing with increased visitor access. As we move towards COVID-19 endemicity, implementing evidence-based visitation policies that maximize patient wellbeing will be essential.
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Chua IS, Olmsted M, Plotke R, Turk Y, Trotter C, Rinaldi S, Kamdar M, Jackson VA, Gallagher-Medeiros ER, El-Jawahri A, Temel JS, Greer JA. Video and In-Person Palliative Care Delivery Challenges before and during the COVID-19 Pandemic. J Pain Symptom Manage 2022; 64:577-587. [PMID: 35985551 PMCID: PMC9383956 DOI: 10.1016/j.jpainsymman.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT Palliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic. OBJECTIVES We described trends for in-person and video visit PC delivery challenges before and during the COVID-19 pandemic in the U.S. METHODS We performed a secondary data analysis of patient characteristics and PC clinician surveys from a multisite randomized controlled trial at 20 academic cancer centers. Patients newly diagnosed with advanced lung cancer (N = 653) were randomly assigned to receive either early in-person or telehealth PC and had at least monthly PC clinician visits. PC clinicians completed surveys documenting PC delivery challenges after each encounter. We categorized patients into 3 subgroups according to their PC visit dates relative to the onset of the COVID-19 pandemic in the U.S.-pre-COVID-19 (all visits before March 1, 2020), pre/post-COVID-19 (≥1 visit before and after March 1, 2020), and post-COVID-19 (all visits after March 1, 2020). We performed Pearson's chi-squared, Fisher's exact, and Kruskal-Wallis tests to examine associations. RESULTS We analyzed 2329 surveys for video visits and 2176 surveys for in-person visits. For video visits, the pre-COVID-19 subgroup (25.8% [46/178]) had the most technical difficulties followed by the pre/post-COVID-19 subgroup (17.2% [307/1784]) and then the post-COVID-19 subgroup (11.4% [42/367]) (P = 0.0001). For in-person visits, challenges related to absent patients' family members occurred most often in the post-COVID-19 subgroup (6.2% [16/259]) followed by the pre/post-COVID-19 subgroup (3.6% [50/1374]) and then the pre-COVID-19 subgroup (2.2% [12/543]) (P = 0.02). CONCLUSION Technical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine (I.S.C.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (I.S.C.), Boston, Massachusetts, USA; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA.
| | - Molly Olmsted
- University of Massachusetts Medical School (M.O.), Worcester, Massachusetts, USA
| | - Rachel Plotke
- Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Yael Turk
- Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Chardria Trotter
- Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Simone Rinaldi
- Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Mihir Kamdar
- Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Vicki A Jackson
- Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Emily R Gallagher-Medeiros
- Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Jennifer S Temel
- Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
| | - Joseph A Greer
- Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA
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Waltz M, Canter C, Bensen JT, Berg JS, Foreman AKM, Grant TL, Lich KH, Navas A, O’Daniel JM, Powell BC, Rini CM, Staley BS, Cadigan RJ. The Burden of COVID-19 on Caregivers of Children with Suspected Genetic Conditions: A Therapeutic Odyssey. Phys Occup Ther Pediatr 2022; 43:257-271. [PMID: 36310386 PMCID: PMC10079636 DOI: 10.1080/01942638.2022.2138734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
AIMS Children with disabilities and rare or undiagnosed conditions and their families have faced numerous hardships of living during the COVID-19 pandemic. For those with undiagnosed conditions, the diagnostic odyssey can be long, expensive, and marked by uncertainty. We, therefore, sought to understand whether and how COVID-19 impacted the trajectory of children's care. METHODS We conducted semi-structured qualitative interviews with 25 caregivers who, prior to the pandemic, were on a diagnostic odyssey for their children. RESULTS Most caregivers did not report any interruptions to their child's diagnostic odyssey. The greatest impact was access to therapy services, including the suspension or loss of their child's in-person therapeutic care and difficulties with virtual therapies. This therapy gap caused caregivers to fear that their children were not making progress. CONCLUSION Although much has been written about the challenges of diagnostic odysseys for children and their families, this study illustrates the importance of expanding the focus of these studies to include therapeutic odysseys. Because therapeutic odysseys continue regardless of whether diagnoses are made, future research should investigate how to support caregivers through children's therapies within and outside of the COVID-19 context.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Courtney Canter
- Department of Anthropology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Tracey L. Grant
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Angelo Navas
- Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Christine M. Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brooke S. Staley
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - R. Jean Cadigan
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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Brown RT, Shultz K, Karlawish J, Zhou Y, Xie D, Ryskina KL. Benzodiazepine and antipsychotic use among hospitalized older adults before versus after restricting visitation: March to May 2020. J Am Geriatr Soc 2022; 70:2988-2995. [PMID: 35775444 PMCID: PMC9588494 DOI: 10.1111/jgs.17947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hospital visitation restrictions during the COVID-19 pandemic prompted concerns about unintended consequences for older patients, including an increased incidence of delirium and agitation. While first-line interventions for these conditions are non-pharmacologic, a lack of family support could result in increased use of benzodiazepines and antipsychotics, which are associated with poor outcomes in older adults. Little is known about the association of visitation policies with use of these medications among older adults. METHODS We conducted a retrospective cross-sectional study among adults aged ≥65 hospitalized from March 1 through May 31, 2020 at four hospitals in the Mid-Atlantic. The dates of onset of visitation restrictions (i.e., hospital-wide guidelines barring visitors) were collected from hospital administrators. Outcomes were use of benzodiazepines and antipsychotics, assessed using patient-level electronic health record data. Using multivariable logistic regression with hospital and study-day fixed effects, the quasi-experimental study design leveraged the staggered onset of visitation restrictions across the hospitals to measure the odds of receiving each medication when visitors were versus were not allowed. RESULTS Among 2931 patients, mean age was 76.6 years (SD, 8.3), 51.6% were female, 58.6% white, 32.5% black, and 2.6% Hispanic. Overall, 924 (31.5%) patients received a benzodiazepine and 298 (10.2%) an antipsychotic. The adjusted odds of benzodiazepine use was lower on days when visitors were versus were not allowed (adjusted odds ratio [AOR], 0.62; 95% CI, 0.39, 0.99). Antipsychotic use did not significantly differ between days when visitors were versus were not allowed (AOR, 0.98; 95% CI, 0.43, 2.21). CONCLUSIONS Among older patients hospitalized during the first wave of the pandemic, benzodiazepine use was lower on days when visitors were allowed. These findings suggest that the presence of caregivers impacts use of potentially inappropriate medications among hospitalized older adults, supporting efforts to recognize caregivers as essential members of the care team.
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Affiliation(s)
- Rebecca T. Brown
- Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kaitlyn Shultz
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason Karlawish
- Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi Zhou
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dawei Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kira L. Ryskina
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Marmo S, Hirsch J. Visitors not Welcome: Hospital Visitation Restrictions and Institutional Betrayal. JOURNAL OF POLICY PRACTICE AND RESEARCH 2022. [PMCID: PMC9465650 DOI: 10.1007/s42972-022-00063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Healthcare organizations’ continued restrictions on hospital visitation during the COVID-19 pandemic can be considered a violation of the rights of hospitalized patients to receive family visitors. Despite expert opinion related to the safety of visitation and low risk of visitor transmission with appropriate monitoring and precautions, hospital visitation restrictions have continued beyond the initial crisis phase of the pandemic, with little transparency or inclusion of key stakeholders in the decision-making process. Particularly on critical care units, blocking access to family visitors can contribute to additional harm and trauma for care-dependent hospitalized patients and their families. Utilizing an institutional betrayal framework, the aim of this commentary on hospital ICU visitation policy is to provide a discussion of how hospitals who serve a care-dependent population have placed critically ill patients, families, and healthcare workers at risk for complex trauma. Hospital social workers should incorporate an integrated social work approach to advocacy efforts which address not only individual hospitalized patient service needs, but also the uneven power differential that can contribute to inequity in visitation, medical mistrust, and long-term community trauma. On the interprofessional ICU team, social workers can function as trauma informed systems experts, coordinating and facilitating supports to help patients and families cope with hospitalization, while also advocating within their institution and with elected officials for policy change to protect patient and family–centered visitation rights.
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Affiliation(s)
- Suzanne Marmo
- Department of Social Work, Sacred Heart University, 3135 Easton Turnpike, Fairfield, CT 06825 USA
| | - Jennifer Hirsch
- School of Social Work, Michigan State University, East Lansing, MI USA
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Patel RK, Kreofsky BL, Morgan KM, Weaver AL, Brumbaugh JE, Fang JL. Family Use of Remote Infant Viewing in the Neonatal Intensive Care Unit: Impact of the COVID-19 Pandemic and Patient Room Type. Telemed J E Health 2022; 29:531-539. [PMID: 36036802 DOI: 10.1089/tmj.2022.0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Background: Remote infant viewing (RIV) uses a bedside camera to allow families to view a livestream video of their neonate 24/7 from anywhere with internet access. Objective: The aim of this study was to evaluate family use of RIV for infants in the neonatal intensive care unit (NICU) during the COVID-19 pandemic and whether RIV use varied by patient room type. Study Design: Use of RIV was evaluated for NICU patients between October 1, 2019, and March 31, 2021. The date, time, and duration of every RIV were exported from the RIV database and linked to the patient's room type. Results: Among 980 patients, 721 (73.6%) were viewed using RIV. The median (interquartile range) number of views per patient-days was 12.5 (5.4-26.0). Based on monthly aggregate data, the proportion of patients with at least one RIV increased during the pandemic from 71.6% in April 2020 to 94.3% in March 2021 (p < 0.001). The monthly number of views and view duration per patient-days also increased (p = 0.003; p = 0.029, respectively). When evaluating patient-level data by room type, the median number of views per patient-days was higher for open-bay than single-family rooms (13.5 vs. 10.5; p < 0.001) and median view duration (minutes) per patient-days was longer (21.8 vs. 12.1; p < 0.001). Conclusions: Use of RIV in the NICU increased during the COVID-19 pandemic. RIV was used more frequently and for longer duration by families with newborns in an open-bay room. RIV allows families to observe their newborn when visitor restrictions are in place or when in-person visits may be less private or do not allow for physical distancing.
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Affiliation(s)
- Rahul K Patel
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona, USA
| | - Beth L Kreofsky
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katie M Morgan
- Division of Neonatal Medicine, Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane E Brumbaugh
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Fang
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Vranas KC, Golden SE, Nugent S, Valley TS, Schutz A, Duggal A, Seitz KP, Chang SY, Slatore CG, Sullivan DR, Hough CL, Mathews KS. The Influence of the COVID-19 Pandemic on Intensivists' Well-Being: A Qualitative Study. Chest 2022; 162:331-345. [PMID: 35568205 PMCID: PMC9093195 DOI: 10.1016/j.chest.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has strained health care systems and has resulted in widespread critical care staffing shortages, negatively impacting the quality of care delivered. RESEARCH QUESTION How have hospitals' emergency responses to the pandemic influenced the well-being of frontline intensivists, and do any potential strategies exist to improve their well-being and to help preserve the critical care workforce? STUDY DESIGN AND METHODS We conducted semistructured interviews of intensivists at clusters of tertiary and community hospitals located in six regions across the United States between August and November 2020 using the "four S" framework of acute surge planning (ie, space, staff, stuff, and system) to organize the interview guide. We then used inductive thematic analysis to identify themes describing the influence of hospitals' emergency responses on intensivists' well-being. RESULTS Thirty-three intensivists from seven tertiary and six community hospitals participated. Intensivists reported experiencing substantial moral distress, particularly because of restricted visitor policies and their perceived negative impacts on patients, families, and staff. Intensivists also frequently reported burnout symptoms as a result of their experiences with patient death, exhaustion over the pandemic's duration, and perceived lack of support from colleagues and hospitals. We identified several potentially modifiable factors perceived to improve morale, including the proactive provision of mental health resources, establishment of formal backup schedules for physicians, and clear actions demonstrating that clinicians are valued by their institutions. INTERPRETATION Restrictive visitation policies contributed to moral distress as reported by intensivists, highlighting the need to reconsider the risks and benefits of these policies. We also identified several interventions as perceived by intensivists that may help to mitigate moral distress and to improve burnout as part of efforts to preserve the critical care workforce.
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Affiliation(s)
- Kelly C Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR; Department of Psychiatry, Oregon Health and Science University, Portland, OR
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin P Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR; Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Collart C, Craighead C, Rose S, Frankel R, Tucker Edmonds B, Perni U, Chien EK, Coleridge M, Ranzini A, Farrell RM. The Impact of Outpatient Prenatal Care Visitor Restrictions on Pregnant Patients and Partners During the COVID-19 Pandemic. WOMEN'S HEALTH REPORTS 2022; 3:718-727. [PMID: 36147830 PMCID: PMC9436262 DOI: 10.1089/whr.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/13/2022]
Abstract
Introduction: Methods: Results: Conclusions:
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Affiliation(s)
- Christina Collart
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Caitlin Craighead
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susannah Rose
- Center for Patient Experience, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Frankel
- Department of the Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | | | - Uma Perni
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward K. Chien
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marissa Coleridge
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Personalized Genetic Healthcare, Department of Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Angela Ranzini
- Department of OB/GYN, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ruth M. Farrell
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Personalized Genetic Healthcare, Department of Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
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Sharif L, Almutairi K, Sharif K, Mahsoon A, Banakhar M, Albeladi S, Alqahtani Y, Attar Z, Abdali F, Wright R. Quantitative research on the impact of COVID-19 on frontline nursing staff at a military hospital in Saudi Arabia. Nurs Open 2022; 10:217-229. [PMID: 35866613 PMCID: PMC9349684 DOI: 10.1002/nop2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023] Open
Abstract
AIM The aim of the study was to examine the relationship between stress, psychological symptoms and job satisfaction among frontline nursing staff at a military hospital in Saudi Arabia during the COVID-19 pandemic. DESIGN Descriptive cross-sectional study. METHODS Data were collected using an online survey. All Registered Nurses (N = 1,225) working at a military hospital between February to April 2021 were contacted, 625 responded (51%). Data were analysed using descriptive and multivariate analysis, Student's t-test for independent samples and one-way analysis of variance followed by Tukey's multiple comparison tests. RESULTS Stress was experienced more significantly than depression or anxiety. Approximately 29% of the change in scores for psychological symptoms was explained by age group, being a Saudi national and working in emergency departments (F[3,620] = 19.063, p < 0.0001). A 37% change in nursing stress scores was explained by nationality and work department. (F[5,618] = 19.754, p < 0.0001). A 29% change in job satisfaction scores was explained by nationality and work department (F[3,620] = 19.063, p < 0.0001).
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Affiliation(s)
- Loujain Sharif
- Faculty of NursingKing Abdulaziz UniversityJeddahSaudi Arabia
| | | | - Khalid Sharif
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
| | - Alaa Mahsoon
- Faculty of NursingKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Maram Banakhar
- Faculty of NursingKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Salwa Albeladi
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
| | | | - Zalikha Attar
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
| | - Farida Abdali
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
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Sakamoto R, Yoshida M, Bhandari D, Miyatake H, Kosaka M, Tanimoto T, Kami M, Ozaki A. Difficulty in continuing home care after informal caregiver was exposed to the COVID‐19: A case report. Clin Case Rep 2022; 10:e05804. [PMID: 35865763 PMCID: PMC9294520 DOI: 10.1002/ccr3.5804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Home care can present many challenges without management. During COVID‐19 pandemic, when an informal caregiver becomes infected and had to isolate themselves, finding another caregiver becomes extremely challenging. For terminally ill patients, who relies on other for even minor tasks, interruption of care could pose severe negative consequences. In home care settings, when informal caregivers are exposed to COVID‐19, it may be difficult to find replacement caregivers and care could be interrupted.
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Affiliation(s)
| | | | | | | | | | | | | | - Akihiko Ozaki
- Department of Breast Surgery Jyoban Hospital of Tokiwa Foundation Fukushima Japan
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Tomori C, Penta B, Richman R. Centering the Right to Health of Childbearing People in the US During the COVID-19 Pandemic. Front Public Health 2022; 10:862454. [PMID: 35719640 PMCID: PMC9201686 DOI: 10.3389/fpubh.2022.862454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Childbearing people in the US have experienced the double burden of increased risks from infection and significant disruptions to access and quality of essential health care services during the COVID pandemic. A single person could face multiple impacts across the course of their reproductive trajectory. We highlight how failure to prioritize this population in the COVID-19 policy response have led to profound disruptions from contraception services to vaccination access, which violate foundational principles of public health, human rights and perpetuate inequities. These disruptions continued through the omicron surge, during which many health systems became overwhelmed and re-imposed earlier restrictions. We argue that an integrated pandemic response that prioritizes the healthcare needs and rights of childbearing people must be implemented to avoid deepening inequities in this and future pandemics.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Bhavana Penta
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Rebecca Richman
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Sanchez C, Taylor M, Jones R. Visitor Behaviors Can Influence the Risk of Patient Harm: An Analysis of Patient Safety Reports From 92 Hospitals. PATIENT SAFETY 2022. [DOI: 10.33940/data/2022.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Previous research has shown that visitors can decrease the risk of patient harm; however, the potential to increase the risk of patient harm has been understudied.
Methods: We queried the Pennsylvania Patient Safety Reporting System database to identify event reports that described visitor behaviors contributing to either a decreased or increased risk of patient harm. Event reports from January 1 to June 30, 2019, were searched for keywords and reviewed for inclusion criteria. Event reports were manually coded to identify visitor influence on risk of patient harm (e.g., increase or decrease), visitor behavior, and event type.
Results: A total of 427 event reports were analyzed and we identified five categories of visitor behavior that influenced patient safety by either decreasing or increasing the risk of patient harm. We found that 63.7% (272 of 427) of event reports described a visitor behavior that decreased the risk of patient harm and the remaining 36.3% (155 of 427) of reports described behavior that increased the risk of harm. There was a greater variety of visitor behaviors that contributed to an increased risk of patient harm, as opposed to a decreased risk of harm. The visitor behavior most frequently associated with a decreased risk of patient harm was communicating with staff (91.2%, 248 of 272); for example, to inform staff of deterioration of a patient’s condition. The visitor behavior most frequently associated with an increased risk of patient harm was moving a patient (63.2%, 98 of 155). Across the 427 event reports, we found that visitor behavior was associated with seven event types; the falls event type (61.6%, 263 of 427) and medication-related event type (14.8%, 63 of 427) occurred most frequently.
Conclusion: The current study provides insight into which visitor behaviors are contributing to a decreased risk of patient harm and adds to the literature by identifying behaviors that can increase the risk of patient harm, across multiple event types. Table 6 and Table 7 outline potential safety strategies that staff and facilities may consider using to target visitor behavior. As outlined in Table 6, the use of warning and instructional signage can be a relatively low-effort and effective strategy to influence visitor behavior and address multiple behavior categories and event types.
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Velnar T, Bosnjak R. Management of neurosurgical patients during coronavirus disease 2019 pandemics: The Ljubljana, Slovenia experience. World J Clin Cases 2022; 10:4726-4736. [PMID: 35801036 PMCID: PMC9198871 DOI: 10.12998/wjcc.v10.i15.4726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/12/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is an emerging disease, caused by severe acute respiratory syndrome coronavirus-2. It bears unique biological characteristics, clinical symptoms and imaging manifestations, therefore presenting an important and urgent threat to global health. As a result, a new public health crisis arose, threatening the world with the spread of the 2019 novel coronavirus. Despite the maximal worldwide public health responses aimed at containing the disease and delaying its spread, many countries have been confronted with a critical care crisis, and even more, countries will almost certainly follow. In Slovenia, the COVID-19 has struck the health system immensely and among all the specialities, neurosurgery has also been experiencing difficulties in the service, not only in regular, elective surgeries but especially during emergencies. The management of these neurosurgical patients has become more difficult than ever. We describe our protocol in the management of neurosurgical patients in the University Medical Centre Ljubljana, Slovenia and how neurosurgical pathology was tackled during the pandemics.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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Lewis S, Liang SY, Schwarz ES, Liss DB, Winograd RP, Nolan NS, Durkin MJ, Marks LR. Patients with serious injection drug use related infections who experience patient directed discharges on oral antibiotics have high rates of antibiotic adherence but require multidisciplinary outpatient support for retention in care. Open Forum Infect Dis 2022; 9:ofab633. [PMID: 35106316 PMCID: PMC8801224 DOI: 10.1093/ofid/ofab633] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Persons who inject drugs (PWID) are frequently admitted for serious injection-related infections (SIRIs). Outcomes and adherence to oral antibiotics for PWID with patient-directed discharge (PDD) remain understudied. Methods We conducted a prospective multicenter bundled quality improvement project of PWID with SIRI at 3 hospitals in Missouri. All PWID with SIRI were offered multidisciplinary care while inpatient, including the option of addiction medicine consultation and medications for opioid use disorder (MOUD). All patients were offered oral antibiotics in the event of a PDD either at discharge or immediately after discharge through an infectious diseases telemedicine clinic. Additional support services included health coaches, a therapist, a case manager, free clinic follow-up, and medications in an outpatient bridge program. Patient demographics, comorbidities, 90-day readmissions, and substance use disorder clinic follow-up were compared between PWID with PDD on oral antibiotics and those who completed intravenous (IV) antibiotics using an as-treated approach. Results Of 166 PWID with SIRI, 61 completed IV antibiotics inpatient (37%), while 105 had a PDD on oral antibiotics (63%). There was no significant difference in 90-day readmission rates between groups (P = .819). For PWID with a PDD on oral antibiotics, 7.6% had documented nonadherence to antibiotics, 67% had documented adherence, and 23% were lost to follow-up. Factors protective against readmission included antibiotic and MOUD adherence, engagement with support team, and clinic follow-up. Conclusions PWID with SIRI who experience a PDD should be provided with oral antibiotics. Multidisciplinary outpatient support services are needed for PWID with PDD on oral antibiotics.
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Affiliation(s)
- Sophia Lewis
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Evan S Schwarz
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Division of Medical Toxicology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - David B Liss
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Division of Medical Toxicology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, MO, USA
| | - Nathanial S Nolan
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Laura R Marks
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Barr J, Cashill E. Organisational Capacity for Family Engagement During COVID: Ensuring Family Communication Needs are met for Better Engagement with Care. Int J Qual Health Care 2021; 34:6468997. [PMID: 34919702 DOI: 10.1093/intqhc/mzab157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jenny Barr
- The Royal Melbourne Hospital, Quality Improvement and Patient Experience, Grattan St, Parkville, Victoria, 3050, Australia
| | - Elizabeth Cashill
- The Royal Melbourne Hospital, Quality Improvement and Patient Experience, Grattan St, Parkville, Victoria, 3050, Australia
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45
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Conroy I, Murray A, Kirrane F, Cullen L, Anglim P, O’Keeffe D. Key requirements of a video-call system in a critical care department as discovered during the rapid development of a solution to address COVID-19 visitor restrictions. JAMIA Open 2021; 4:ooab091. [PMID: 34805775 PMCID: PMC8599714 DOI: 10.1093/jamiaopen/ooab091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/02/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic necessitated stringent visitor restrictions in critical care departments worldwide, creating challenges in keeping family members connected to patients and clinical staff. Previous studies have examined how hospitals addressed this challenge by repurposing existing tele-ICU systems or by using personal smartphones as a workaround and have analyzed clinical and family feedback. This case report addresses the experience of rapidly implementing a video-call system in the critical care department of a tertiary referral hospital that had no prior video-call system in place, detailing the key requirements in that setting. The 24 requirements were identified via interviews and surveys to both clinical and technical professionals. The top requirements identified were sound and video quality, usability for clinical staff, call control by staff, and patient privacy. From tailoring a video-call solution for this setting, we learned that video-endpoint selection is a key design decision. The initial proposal was to use wireless tablets, but the selection of a large wired video-endpoint allowed us to better address the requirements in the critical care setting. This was based on several characteristics of the large wired video-endpoint, including: high-fidelity video and sound, with directional noise-cancelling; large touch-screen setup for minimal-click navigation; wired as well as wireless connectivity.
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Affiliation(s)
- Irial Conroy
- Health Innovation Via Engineering Laboratory, Cúram SFI Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland—Galway, Galway, Ireland
| | - Aoife Murray
- Health Innovation Via Engineering Laboratory, Cúram SFI Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland—Galway, Galway, Ireland
| | - Frank Kirrane
- Department of Medical Physics and Clinical Engineering, University Hospital Galway, Galway, Ireland
| | - Leonie Cullen
- Critical Care Department, University Hospital Galway, Ireland
| | - Paul Anglim
- Department of Engineering and Science (Adjunct Lecturer), National University of Ireland—Galway, Galway, Ireland
| | - Derek O’Keeffe
- Health Innovation Via Engineering Laboratory, Cúram SFI Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland—Galway, Galway, Ireland
- School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland—Galway, Galway, Ireland, and
- Lero, SFI Centre for Software Research, National University of Ireland—Galway, Galway, Ireland
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