Psychological crisis and emergency intervention for frontline critical care workers during the COVID-19 pandemic

Society of Critical Care Medicine Guidelines on Family-Centered Care for Adult ICUs: 2024

RATIONALE

For staff in adult ICUs, providing family-centered care is an essential skill that affects important outcomes for both patients and families. The COVID-19 pandemic placed unprecedented strain on care of ICU families, and practices for family engagement and support are still adjusting.

OBJECTIVES

To review updated evidence for family support in adult ICUs, provide clear recommendations, and spotlight optimal family-centered care practices post-pandemic.

PANEL DESIGN

The multiprofessional guideline panel of 28 individuals, including family member partners, applied the processes described in the Society of Critical Care Medicine Standard Operating Procedures Manual to develop and publish evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including panel selection, writing, and voting.

METHODS

The guidelines consist of four content sections: engagement of families, support of family needs, communication support, and support of ICU clinicians providing family-centered care. We conducted systematic reviews for 15 Population, Intervention, Control, and Outcomes questions, organized among these content sections, to identify the best available evidence. We summarized and assessed the certainty of evidence using the GRADE approach. We used the GRADE evidence-to-decision framework to formulate recommendations as strong or conditional, or as best practice statements where appropriate. The recommendations were approved using an online vote requiring greater than 80% agreement of voting panel members to pass.

RESULTS

Our panel issued 17 statements related to optimal family-centered care in adult ICUs, including one strong recommendation, 14 conditional recommendations, and two best practice statements. We reaffirmed the critical importance of liberalized family presence policies as default practice when possible and suggested options for family attendance on rounds and participation in bedside care. We suggested that ICUs provide support for families in the form of educational programs; ICU diaries; and mental health, bereavement, and spiritual support. We suggested the importance of providing structured communication for families and communication training for clinicians but did not recommend for or against any specific clinician-facing tools for family support or decision aids, based on current available evidence. We recommended that adult ICUs implement practices to systematically identify and reduce barriers to equitable critical care delivery for families and suggested that programs designed to support the wellbeing of clinicians responsible for family support be developed.

CONCLUSIONS

Our guideline panel achieved consensus regarding recommendations and best practices for family-centered care in adult ICUs.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study

AIMS AND OBJECTIVES

To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic.

BACKGROUND

The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences.

DESIGN

A qualitative design based on phenomenological approach.

METHODS

A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines.

RESULTS

One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together.

CONCLUSIONS

Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis.

RELEVANCE TO CLINICAL PRACTICE

Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

Working conditions for healthcare workers at a Swedish university hospital infectious disease department during the COVID-19 pandemic: barriers and facilitators to maintaining employee wellbeing

Background

Healthcare workers (HCWs) at infectious disease departments have held the frontline during the COVID-19 pandemic. This study aimed to identify barriers and facilitators to maintaining the employees' wellbeing that may be used to increase preparedness for future pandemics within ID Departments.

Methods

In September 2020, a web-based survey on demographics and work environment was distributed to all HCWs at the Infectious Disease Department at Sahlgrenska University Hospital. Results were compared with a pre-COVID-19 survey from October 2019. A quantitative analysis of the overall effects of the pandemic on the working conditions of HCWs was conducted; in addition, a qualitative content analysis of open-ended responses was performed.

Results

In total, 222 and 149 HCWs completed the pre-COVID-19 and COVID-19 surveys (84 and 54% response rate), respectively. Overall, we found significant changes regarding increased workload, lack of emotional support in stressful work situations, and inability to recover after shifts. These factors correlated both with younger age and concern of becoming infected. The open-ended answers (n = 103, 69%) revealed five generic categories (Workload; Organizational support; Worry and ethical stress; Capability; and Cooperation and unity) with a total of 14 identified factors representing plausible individual and organizational-level barriers or facilitators to sustained employee wellbeing.

Conclusion

Younger HCWs as well as those expressing worries about contracting the infection were found to be particularly affected during the COVID-19 pandemic and these groups may require additional support in future outbreaks. Factors both increasing and decreasing the pandemic-induced negative health consequences for HCWs were identified; this knowledge may be utilized in the future.

COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.

AIM

To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.

METHODS

We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.

RESULTS

Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.

CONCLUSION

As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.

1 year impact of COVID-19 pandemic on Italian dental professionals: a cross-sectional survey

BACKGROUND

The Covid-19 pandemic has disrupted the daily work of the dental professionals, assuming unprecedented economic, managerial, and psychological implications. The aim of this cross-sectional survey was to analyze the extent of the impact linked to the imposed working conditions on the Italian dental team.

METHODS

The survey was administered with a web-based form (Google Forms®) to Italian dentists and hygienists. To be enrolled in the study, participants had to reach the adulthood and agree to sign the privacy policy. The impact of Covid-19 was analyzed through a 27-items questionnaire, which was divided into 4 main domains: personal protective equipment (PPE), operative procedures, secretarial organization, and self-reported quality of life (including elearning appraisal).

RESULTS

A total of 614 between dentists and dental hygienists completed the questionnaire. Compared to the pre-pandemic period, the use of PPE such as face shields, surgical caps and disposable gowns were implemented after the Covid-19 outbreak. Almost the whole interviewed (99.9%) received the Covid-19 vaccine. An increased use of preoperatory mouthwashes and rubber dam was referred during the pandemic, while aerosolization (i.e. ultrasound) was drastically reduced. A certain number of respondents (30% dentists, 27% hygienists) suffered from work-related stresses during the pandemic until they desired to change jobs. E-learning was considered beneficial for the 70% of participants.

CONCLUSIONS

Covid-19 pandemic influenced dental professionals' life, leading to a rearrangement of professional, managerial, and cultural life for both dentists and hygienists even after 1 yr from the outbreak.