Survey of awareness, attitudes, and compliance with COVID-19 measures among Vermont residents

Assessing factors associated with compliance to preventive measures of COVID-19 in Rwanda: a cross-sectional community survey

OBJECTIVE

To assess the level of compliance with COVID-19 preventive measures and compliance-associated factors in the Rwanda community.

DESIGN

Cross-sectional study.

SETTINGS

Country-wide community survey in Rwanda.

PARTICIPANTS

4763 participants were randomly sampled following the sampling frame used for the recent Rwanda Demographic Health Survey. Participants were aged between 22 years and 94 years.

OUTCOMES

The participants' compliance with three preventive measures (wearing a face mask, washing hands and social distancing) was the main outcome.

METHODS

From 14 February 2022 to 27 February 2022, a cross-sectional survey using telephone calls was conducted. Study questionnaires included different questions such as participants' demographics and compliance with COVID-19 preventives measures. Verbal consent was obtained from each participant. The compliance on three main preventive measures (wearing a mask, washing hands and social distancing) were the main outcomes. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with compliance (age, gender, level of education, socioeconomic status).

RESULTS

Compliance with the three primary preventive measures (washing hands 98%, wearing a mask 97% and observing social distance 98%) was at a rate of 95%. The respondents' mean age was 46±11 SD (range 22-98) years. In addition, 69% were female and 86% had attended primary education. Bivariate and regression analyses indicated a significant association among the three primary preventive measures (p<0.05). The results showed factors associated significantly between the different models (p<0.05): proper mask use and social distancing in the hand washing model; hand washing, social distancing, avoiding handshakes and not attending gatherings in the proper mask use model; hand washing and avoiding handshakes in the social distancing model.

CONCLUSION

Compliance with the three key preventive measures against COVID-19 was high in the Rwandan community and these measures were interdependent. Therefore, the importance of all three measures should be emphasised for effective disease control.

Toward COVID-19 recovery: Advanced practice nurse leadership in rural Vermont

AIM

To reflect on the inclusion of an advanced practice nurse (APN) on a clinical leadership team in rural Vermont during the COVID-19 pandemic.

BACKGROUND

During the COVID-19 pandemic, APNs contributed to the reimagining of healthcare delivery. In response to pandemic-related organizational needs, one rural health center in Vermont promoted an APN to a leadership position.

SOURCES OF EVIDENCE

This critical reflection describes the experience of one APN promoted to a clinical leadership role during the COVID-19 pandemic in rural Vermont in the United States. We use the four stages of crisis (escalation, emergency, recovery, and resolution) and the healthcare leadership framework proposed by Geerts et al. (2021) to consider how APN leaders can contribute in the "recovery stage" of the pandemic.

DISCUSSION

APNs who took on leadership roles during the pandemic may have had fewer opportunities to participate in formal leadership development. However, in the case of our rural health center, an APN was able to seek out mentorship, address operational challenges, and provide representation for advanced practice providers.

CONCLUSION

This article contributes to the literature on APN leadership during the COVID-19 pandemic, by describing a leadership opportunity that helped build APN leadership capability and capacity in our organization.

IMPLICATIONS FOR NURSING PRACTICE

APNs offer a valuable perspective on health leadership teams. As organizations move toward the recovery stage of the pandemic, different leadership styles and skills may be required.

IMPLICATIONS FOR HEALTH POLICY

The COVID-19 pandemic provided unexpected leadership opportunities for APNs. Healthcare organizations now have opportunities to reimagine clinical leadership in ways that include APNs.

Association of COVID-19 Visitor Limitations and Goals of Care Discussions in the Intensive Care Unit

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.

The Impact of Testing Capacity and Compliance With Isolation on COVID-19: A Mathematical Modeling Study

Introduction

Diagnostic tests can play an important role in reducing the transmission of infectious respiratory diseases, particularly during a pandemic. The potential benefit of diagnostic testing depends on at least 4 factors: (1) how soon testing becomes available after the beginning of the pandemic and (2) at what capacity; (3) compliance with isolation after testing positive; and (4) compliance with isolation when experiencing symptoms, even in the absence of testing.

Methods

To understand the interplay between these factors and provide further insight into policy decisions for future pandemics, we developed a compartmental model and simulated numerous scenarios using the dynamics of COVID-19 as a case study.

Results

Our results quantified the significant benefits of early start of testing and high compliance with isolation. Early start of testing, even with low testing capacity over time, could significantly slow down the disease spread if compliance with isolation is high. By contrast, when the start of testing was delayed, the benefit of testing on reducing infection spread was limited, even when testing capacity was high; the additional testing capacity required increased superlinearly for each day of delay to achieve a similar infection attack rate as in starting testing earlier.

Conclusions

Our study highlighted the importance of the early start of testing and public health messaging to promote isolation compliance when needed for an ongoing effective response to COVID-19 and future pandemics.