Preparedness for viral respiratory infection pandemic in residential aged care facilities: A review of the literature to inform post-COVID-19 response

AIMS AND OBJECTIVES

To examine what was known about disaster preparedness in residential care and to consider this in the light of the current COVID-19 pandemic.

BACKGROUND

Care homes provide long-term care to vulnerable, frail older people, as well as to young people with profound disabilities. The COVID-19 pandemic has shown that the residential care sector has been seriously affected in many parts of the world and has exposed major flaws and vulnerabilities in infection control and other processes that have resulted in considerable loss of life of residents of these facilities.

DESIGN

Discursive paper informed by a systematic literature. Review was carried out in line with PRISMA reporting guidelines. The review protocol was registered with PROSPERO on 2020 [CRD42020211847].

RESULTS

The review identified six papers meeting inclusion criteria across care residential facilities in different countries. Several prevention and mitigation strategies were identified to manage and reduce the spread and severity of viral respiratory infection pandemics. These strategies include isolation, restriction of movement, personal protective and hygienic measures, health education and information sharing, monitoring and coordination, and screening and treatment. Preparedness strategies identified were contingency planning such as reporting/communication, leadership, human resource, insurance, occupational health and resource availability. The prevention/mitigation and preparedness strategies helped to achieve decline in disease severity, reduced prevalence, reduced spread of the disease, improved readiness criteria, resource usefulness and increased intervention acceptability. This paper presents a conceptual framework exploring the interconnectedness of preparedness and prevention/ mitigation strategies and associated outcomes. We discuss areas of concern in the context of workforce employment patterns in the sector. Concerns related to the unintended consequences of strategies placed on aged care facilities, which may worsen mental health outcomes for residents, are discussed.

CONCLUSIONS

Persons in residential care settings are at greater risk of infection during a pandemic, and therefore, strict measures to protect their safety are warranted. However, they are also a group who already experience social isolation and so any measures involving restrictions to visiting and social interaction, particularly over the longer term, must be accompanied by strategies to mitigate potential loneliness and mental health sequelae arising from long-term pandemic restrictions.

RELEVANCE TO CLINICAL PRACTICE

Though there was evidence of activity in preparedness for disasters within the residential care sector, various contextual factors affecting the sector were clearly not adequately considered or addressed in pre-pandemic disaster planning, particularly in the areas of staff movements between care homes and the length of time that social isolation and restriction measures would need to be in place. Future pandemic planning should consider the nature of the workforce model in the care home sector, and factor in strategies to better support the mobile and highly casualised workforce.

The impact of COVID-19 on Bangladeshi readymade garment (RMG) workers

This paper describes the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on the readymade garment (RMG) workers of Bangladesh. It articulates the RMG workers’ existing vulnerability during the COVID-19 pandemic based on currently available evidence and personal conversations/communications with RMG workers. COVID-19 has already impacted RMG workers’ health (both physical and mental health status) and wellbeing, and resulted in loss of employment. We argue that the COVID-19 pandemic will have long-lasting effects on the garment workers, especially related to their health issues, financial hardship and inability to pay for essentials such as food, and future employment opportunities. The stakeholders (such as the international retailers/brands, Bangladesh Garment Manufacturers and Exporters Association, Government of Bangladesh) responsible for the global supply chain RMG factories should reconsider the health and overall wellbeing needs of the RMG workers during the ongoing COVID-19 pandemic.

Understanding doctoral supervision in nursing: 'It's a complex fusion of skills'

BACKGROUND

Increasing the numbers of doctorally prepared nurses is essential to the continuing development of the nursing discipline. However, supervision can be fraught with relationship issues including role blurring, boundary issues, mis-matched expectations and students and supervisors not being fully equipped for doctoral training.

OBJECTIVE

In this study, we sought to examine the experiences of nurses supervising doctoral students in the contemporary university environment.

DESIGN

Qualitative research design.

SETTINGS

Narratives were drawn from academic nurses in Australia, the United States, the United Kingdom and New Zealand.

PARTICIPANTS

Twenty-one doctorally qualified nurse academics with a combined total of 427 doctoral completions and 454 doctoral examinations participated.

METHODS

Participants were recruited via social media and snowball sampling and interviewed face-to-face using internet platforms such as Zoom©. Interviews were recorded, selectively transcribed and thematically analysed.

RESULTS

Analysis of the data resulted in one overarching theme, managing the candidature, comprised of the sub-themes: managing relationships, managing expectations, managing emotions and managing labour.

CONCLUSIONS

Successful doctoral supervision requires considerable expertise and labour and that much of the labour associated with supervision is not recognised. In additional to the cognitive and educational aspects, are processes around personal growth, emotions and relationships. We recommend that universities consider the complexity of doctoral supervision when planning workloads and supervision training activities.

Indigenous Resilience in Australia: A Scoping Review Using a Reflective Decolonizing Collective Dialogue

Contemporary definitions and understandings of resilience refer to an individual's positive adaptation to the experience of adversity. One of the challenges of this extant body of work is that the central concept of resilience is rarely questioned. Current understandings of these concepts, largely framed in Western understandings, are unquestioningly accepted, reframed for, yet not by, Indigenous peoples, and then are unchallenged when imposed on Indigenous peoples. A scoping review was conducted and reported in line with the PRISMA-ScR guidelines. The review involved the participation of local Aboriginal Research Cultural Advisory Groups who participated and approved the analysis of the findings and collaborated on the design and writing of the paper. Eight publications drew on Aboriginal constructs of resilience in examining the effectiveness of programs, processes, and practices to promote individual and/or collective resilience and well-being. Most studies emphasized the need for strategies to strengthen individual or community connection to culture to foster resilience. Six studies used culturally validated strength-based tools to measure resilience, while two relied on Western constructs. This review reveals both the distinctive colonial characteristics of adversity experienced by Aboriginal people and the range of coping strategies and protective resources that support the development of resilience within different Aboriginal communities in diverse research sites across Australia. Importantly, many studies confirm adversity is linked to the enduring legacies of colonization, continuous and cumulative transgenerational grief and loss, structural inequities, racism, and discrimination. These external factors of adversity are unique to Aboriginal populations, as are the protective factors that entail strengthening connection to culture (including language reclamation), community, ancestry and land (including management and economic development) which contribute to individual and collective resilience. These findings suggest that Aboriginal community resilience is strengthened through the collective experience of adversity, such as transgenerational grief and loss, and the resulting support structures and shared resources that are developed and maintained through cultural practices to strengthen the bonds and mutual reciprocity to participate in transformative strategies to address adversity. This review highlights that strategies such as building on community strengths, capacities, and resources is critical when strengthening resilience within Indigenous communities across Australia.

A mixed-methods evaluation of an urban Aboriginal diabetes lifestyle program

OBJECTIVE

The objective of this study was to evaluate an Aboriginal-led diabetes lifestyle program catering to urban Aboriginal people in an Aboriginal organisation.

METHODS

Mixed-methods study that employed routinely collected physiological data and audio-recorded focus group sessions. Physiological data were analysed using a multi-level model to account for participant clustering. Qualitative data were subject to thematic analysis.

RESULTS

Participants were overwhelmingly positive about the program. They lost weight and improved their diastolic blood pressure and glycaemic control; however, it was the feelings of belonging and optimism about their ability to improve their health that they most valued. Qualitative analysis revealed three main themes. These were: 'With the Mob', 'For the Mob' and 'Program Elements. The strengths of the program lay in its indigeneity, low-cost and easy-to-prepare diet, and cultural and communication skills of the director.

CONCLUSIONS

Recommendations for improvement included educating participants on the pathophysiology of diabetes, the refinement of online elements and the introduction of face-to-face group exercise. Implications for public health: Programs of this nature should be expanded and evaluated longitudinally with multiple cohorts.

Connection to... Addressing Digital Inequities in Supporting the Well-Being of Young Indigenous Australians in the Wake of COVID-19

(1) Background: This article examines whether connection to digital technologies helps connect young Indigenous people in Australia to culture, community and country to support good mental health and well-being and protect against indirect and potentially long-term effects of COVID-19. (2) Method: We reviewed literature published between February and November 2020 and policy responses related to digital strategies. We searched PubMed, Google Scholar, government policy websites and key Indigenous literature sources, identifying 3460 articles. Of these, 30 articles and 26 policy documents were included and analysed to identify existing and expected mental health outcomes among Indigenous young people associated with COVID-19 and more broadly. (3) Results: There are inequities in affordable access to digital technologies. Only 63% of Indigenous people have access to internet at home. Digital technologies and social media contribute to strong cultural identity, enhance connections to community and country and improve mental health and social and emotional well-being outcomes. (4) Discussion: Access to digital technologies can facilitate healing and cultural continuity, self-determination and empowerment for young people to thrive, not just survive, in the future. (5) Conclusion: More targeted policies and funding is urgently needed to promote digital technologies to enhance Indigenous young people's access to mental health and well-being services, maintain cultural connections and evaluate the effectiveness of these initiatives using Indigenous well-being indicators.

The expression and receipt of compassion through touch in a health setting; a qualitative study

AIM

To investigate and understand how compassion is expressed by nurses and received by patients in a hospital setting.

BACKGROUND

Concerns regarding the absence of compassion in a healthcare setting has necessitated further research in the field. To define and measure compassion is difficult and problematic. Compassion is subjective and in the contemporary literature the views of patients are under-represented. Touch is an important component of nursing practice and can also be considered problematic.

DESIGN

Secondary analysis of narrative interviews.

METHODS

Secondary analysis of 12 participant interviews with nurses (n-4) and patients (n-8). Data were collected between August 2018 and August 2019.

FINDINGS

Compassion was expressed and received through touch for nurses and patients. Patients receive compassion through the touch of the nurse and this touch conveyed comfort and safety. Touch allowed for the establishment of an authentic connection between nurse and patient. Nurses used touch to express compassion and patients received compassion when they were comforted with touch. Compassion was present in incidental touch and deliberate comforting touch. Nurses were respectful of the meanings of touch. Patients describe nurses knowing when to touch and using touch appropriately.

CONCLUSIONS

Nurses in our study were respectful of the meaning of touch for their patients and described using touch to convey compassion. Patients in our study perceived compassion through the touch by the nurse. Through these narratives, touch is revealed as an essential part of compassionate practice conveying safety, authenticity and connection.

IMPACT

Patients in this study describe receiving compassion through the use of touch which made them feel safe. Nurses in this study used touch to create an authentic connection with patients and were aware of the different meanings of touch. Avoiding touch, being wary of touch, or considering touch taboo robs patients of compassion moments.

Learning to be a doctoral supervisor: Experiences and views of nurse supervisors of higher degree research students

AIMS AND OBJECTIVES

Given the importance of doctoral training to the future of the discipline, we sought to gain insight into nurse doctoral supervisor's experiences of supervision training and preparation and their views on what quality training for doctoral supervisors in nursing would look like.

BACKGROUND

Doctorally prepared nurses have been found to contribute significantly to improvements in knowledge to inform patient care; yet there is little focus on the development of this aspect of the nursing workforce, and little evaluation of supervisor training, confidence and competence.

DESIGN

Qualitative storytelling, semi-structured interviews were conducted via a videoconferencing programme, audio-recorded and thematically analysed with twenty-one experienced nurse doctoral supervisors. Findings are reported in line with the COREQ guidelines.

RESULTS

Thematic analysis revealed four themes: 'I had a great mentor': the importance of mentorship and role modelling; 'Sometimes it's just trial and error': learning through experience; 'It's like tick a box': strengths and limitations of formal supervisor training; and 'The training should be more holistic': what should be in supervisor training.

CONCLUSIONS

We recommend doctoral supervisors be encouraged to seek mentoring for supervision, formal mentoring and clinical supervision for the first five completions and the formation of discipline-based supervisor learning groups in nursing as an adjunct to generic mandatory supervisor training.

RELEVANCE TO CLINICAL PRACTICE

Further development of clinical nursing is inextricably linked to quality nurse-led research, and doctorally prepared nurses are essential to the continued development of nursing as an evidence-informed practice discipline. Quality doctoral supervision for and by nurses is crucial and we argue that focus must be given to ensuring the development of a skilled doctoral supervision workforce in nursing.

Qualitative research interviewing: reflections on power, silence and assumptions

BACKGROUND

Novice researchers can face many challenges throughout their journey as researchers in training, particularly when interviewing for qualitative research.

AIM

To present an authentic account of the challenges a novice researcher faced when collecting data using narrative interviews.

DISCUSSION

The researcher reconsidered how previous interviews had involved power relations and the urge to seek a 'correct' answer from participants. The article explores what are considered 'data', as well as the use of laughter and silence to re-establish power dynamics.

CONCLUSIONS

Reflection, feedback from supervisors and peers, and ongoing research experience can help novice researchers understand the strengths and weaknesses of their previous interviews.

IMPLICATIONS FOR PRACTICE

Novice researchers may find this article useful when planning for challenges they may encounter when undertaking qualitative research.

Military moral injury: A concept analysis

Moral injury is the current term describing the breaching or violation of one's moral code and has gained international research attention due to suicide linkages in military populations (Jamieson et al., Invisible wounds and suicide: Moral injury and veteran mental health. International Journal of Mental Health Nursing, 29, 105-109, 2020). Moral injury's core features are spiritual/existential conflict, shame, guilt and self-condemnation. To date, research focuses on the core features of moral injury and or the nature of events that exposed individuals to moral injury. Walker and Avant (Strategies for Theory Construction in Nursing, Prentice Hall New York, 2011) concept analysis model was used to examine the literature. The aim of this study is to enhance understanding of the defining attributes, antecedents, consequences and empirical referents of moral injury and systematically analyse the concept of moral injury in the context of military members. A literature search was undertaken using specific websites and journals, electronic databases, library catalogues and hand-searches. Concept analysis was used to explicate moral injury, focusing exclusively on use of the concept in the included literature, comparing the terms used over time and across disciplines, and measurement tools for the concept. This concept analysis provides a renewed definition of moral injury in relation to the experience of veterans - 'moral trauma' and defined as: 'the existential, psychological, emotional and or spiritual trauma arising from a conflict, violation or betrayal, either by omission or commission, of or within one's moral beliefs or code(s)'. The analysis will facilitate understanding and operationalization of the concept applied to teaching, learning, practice and research.

Pandemic-related behaviours and psychological outcomes; A rapid literature review to explain COVID-19 behaviours

COVID-19 spread rapidly causing widescale loss of life and economic devastation. Efforts to contain it have resulted in measures such as closing of borders and restrictions around travel, social activities and attending places of worship. We conducted this rapid review to systematically examine, synthesize, and critically appraise the available evidence on the relationship between pandemic-related behaviours and psychological outcomes. The methods were compliant with the PRISMA guidelines. The review was preregistered with PROSPERO (Registration #: CRD42020181576). A literature search was conducted from January 2010 to April 2020 using ProQuest, Web of Science, PsycINFO, PsycARTICLES, Scopus, SAGE Journals, and CINAHL. Of 3844 articles identified, we included 11 quantitative articles in the final synthesis, representing data from 32, 049 individual respondents from eight countries. We identified three pandemics (COVID-19, MERS-CoV, Influenza A(H1N1) pdm09) as well as several psychological outcomes including anxiety, mental distress, post-traumatic stress disorder, and anger. We also identified several behaviours during pandemics and categorized them into protective, preparedness, and perverse behaviours. The review showed that even though there is limited evidence regarding pandemic-related behaviours and psychological outcomes, the current findings showed that the psychological outcomes significantly impacted on the adoption of the pandemic-related behaviours. Given the negative effects of psychological outcomes on behaviours, we recommend that mental health professionals should promote mental health support to people exhibiting psychological distress resulting from similar events in the future. Also, we recommend that future research should test the hypothesized effects of pandemics and psychological outcomes on behaviour change.

Health Professionals as Mothers of Adult Children With Schizophrenia

In this qualitative narrative study, we critically reflected upon mothering experiences of health professionals with adult children with schizophrenia. Thirteen participants from Australia, Canada, Scotland, and the United States were interviewed. The thematic analysis of the interviews resulted in one overarching theme-mothering in the context of uncertainty: unbalancing and rebalancing as mothers, and three major themes: disrupted mothering, reconfigured mothering, and resolute mothering. The findings suggested participants experienced difficulties in separating their professional role from their maternal responsibilities. The mothers gained expertise by using their dual knowledge to advocate for and support their children's mental health. The mothers' dual roles had a positive impact on their relatedness to others within their professional practice. Health care organizations might benefit from the expertise of health professionals with dual roles in the development of support, care, treatment, and delivery of services for people and their family members who live with schizophrenia.

Modes of Informed Caring: Perspectives of Health Professionals Who Are Mothers of Adult Children with Schizophrenia

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource.

Post-traumatic growth: Health professionals as mothers of adult children with schizophrenia

Worldwide, mothers provide lifelong care for their ill children. Our aim in this paper was to describe the development of post-traumatic growth in an international group of mothers. Interviews with a feminist storytelling approach were conducted with 13 health professionals who were mothers of adult children with schizophrenia. Using thematic analysis, we found they had experienced a complex traumatic process complicated by gender and health care's dominant ruling relations. Over time, the women grew and became experts by experience due to their combined mothering and professional knowledges. Health professionals can play a central role and support their peers to care for family members with mental illnesses.

Understanding the Impact of Historical Trauma Due to Colonization on the Health and Well-Being of Indigenous Young Peoples: A Systematic Scoping Review

Introduction: Indigenous Peoples are experiencing the ongoing effects of colonization. This phenomenon, historical trauma (HT), helps to address the current ill-health disparity. Aim of this scoping review was to identify sources of evidence available to understand the impact of HT on Indigenous young peoples. Method: A scoping review was conducted on available evidence-based literature. Article quality was assessed using validated quality appraisal tools. Synthesis was conducted with predefined levels of impact. Results: Consistent with the literature, the themes and levels of impact were interrelated. Despite this, studies predominately reported a singular focus with limited discussion of protective factors. Discussion: HT continues to have a profound impact on Indigenous young peoples across Canada, Australia, New Zealand, and the United States. Protective factors for HT were evident within Indigenous research designs. Future research should ensure a multilevel focus to explore intergenerational strength and how this influences culturally congruent health care.