Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review

Longitudinal Associations of Staff Shortages and Staff Levels with Health Outcomes in Nursing Homes

OBJECTIVES

To examine whether facility-reported staff shortages and total staff levels were independently associated with changes in nursing home (NH) outcomes in 2020.

DESIGN

Longitudinal cohort study.

SETTING AND PARTICIPANTS

A total of 8466 NHs with staffing and outcome data.

METHODS

This study used NH COVID-19 Public File (2020), Nursing Home Compare (2019-2020), and Payroll-Based Journal data (2019-2020). Outcome measures included the percentage of long-stay residents in a facility with declines in activities in daily living (ADLs), decreases in mobility, weight loss, and pressure ulcers in 2020 Q2, 2020 Q3, and 2020 Q4. Independent variables were whether NHs reported any shortage of aides or licensed nurses and total staff hours per resident day (HPRD). Separate 2-level (NH, state) Hierarchical Generalized Linear Mixed models examined the association of facility-reported shortages and staff hours with key NH resident outcomes, controlling for NH characteristics and COVID-19 infections.

RESULTS

The weekly percentage of NHs reporting any staff shortage averaged 20%. Total staff HPRD increased slightly from 3.7 in 2019 to 3.8 in 2020. Health outcomes were stable during 2019 and 2020 Q1 but worsened substantially starting in 2020 Q2. For example, the percentage of residents with mobility loss increased from 16.2% in 2020 Q1 to 27.9% in 2020 Q4. Facility-reported staff shortages were associated with an increase in the proportion of residents with an ADL decline (0.54 percentage points), mobility loss (0.80 percentage points), weight loss (0.22 percentage points), and pressure ulcers (0.22 percentage points) (all P < .01). Total staff HPRD was not associated with changes in any outcomes (all P > .05).

CONCLUSIONS AND IMPLICATIONS

NHs reported worsened health outcomes among long-stay residents in 2020, with worse outcomes found among facilities that reported staff shortages but not among those with lower total staff levels. Facility-reported shortages provide important quality information during the COVID-19 pandemic.

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force

BACKGROUND

A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19).

AIMS

The purpose of this study was to report on a needs assessment conducted by the MHTF.

METHODS

The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach.

RESULTS

Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support.

CONCLUSIONS

The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

Mothering children at a paediatric intensive care unit with strict visiting hours: A qualitative study

BACKGROUND

Although a child- and family-centred care (CFCC) philosophy has been emphasized and adopted for decades in paediatric critical care settings in several countries, numerous issues from parents' perspectives regarding the philosophy remain unresolved. To facilitate the full translation of CFCC into clinical practice, health care professionals need an in-depth understanding of family experiences. Real-life mothering experiences, including maternal roles and identities, remain largely unknown at paediatric intensive care units (PICUs) in the Republic of Korea, where family visitation, presence, and participation are restricted.

AIM

To explore mothering experiences at a PICU where family visitation is strictly constrained, and to identify maternal needs and values.

STUDY DESIGN

We conducted a qualitative descriptive study of eight individual in-depth interviews with seven mothers of hospitalized children. Qualitative data were analysed using inductive thematic analysis.

FINDINGS

Five major themes, along with four subthemes, emerged: (1) shifts in maternal roles and responsibilities, (2) shifts in interpersonal relationships, (3) desire for CFCC in the PICU, (4) practising self-defined mothering roles, and (5) reconstructing maternal identities. The themes revealed the experiences of becoming mothers of a child in a constrained PICU. Ultimately, mothers demanded that the unit improve its physical and cultural environments through, for example, liberalized family visitation and participation in the care of their children.

CONCLUSIONS

Nursing professionals should lead the charge for humanizing a restrictive PICU in the Republic of Korea by ensuring a safe and open environment and mothering continuity based on child- and family-centred holistic care.

RELEVANCE TO CLINICAL PRACTICE

Effective interventions must be developed and tested to globally establish and fully implement strong evidence-based CFCC in PICUs; constant co-commitment among children, families, health care professionals, and institutions is also necessary.

Dysphagia and aspiration during a Parkinson's hospitalization: a care partner's perspective and recommendations for improving standards of care

People with Parkinson's disease have a significantly increased incidence and risk of aspiration pneumonia when compared to those without. Aspiration pneumonia associated with dysphagia (swallowing issues), which is the leading cause of death among people with Parkinson's disease, accounting for 25% of Parkinson's deaths. There is relatively limited evidence of the most effective strategies to balance the competing needs of each Parkinson's patient as providers aim to prevent, diagnose, and manage dysphagia. Exacerbated, and in part caused, by the intricacies of dysphagia and Parkinson's disease, there is still limited understanding among hospital providers and the Parkinson's community regarding the most appropriate measures to prevent and manage dysphagia in Parkinson's disease. The Parkinson's Foundation Hospital Care Recommendations identified the prevention and management of dysphagia as a care standard necessary to eliminate harm and attain higher reliability in care. This article discusses key components of dysphagia management in the hospital, provides a case example to demonstrate the challenges that people with PD and their care partners experience in the hospital related to dysphagia, and offers recommendations on how to better manage dysphagia and involve care partners in PD hospital care.

Perceived Consequences of COVID-19 Restrictive Visitation Policy on Family Members at Rural Hospitals in Vhembe District: A Qualitative Study

From a public health standpoint, a stringent visitation policy was necessary during the COVID-19 pandemic, but it had unforeseen communicative and emotional health consequences for family members. This study explored family members' experiences regarding implementing a restricted visitation policy when a patient was admitted with COVID-19 at public hospitals in the Vhembe district. Researchers used an exploratory, descriptive, and contextual qualitative technique. Twelve family members made up the population. Unstructured telephone interviews were used to obtain the data, and open coding was used to analyse data. Ethics were consistently followed. Before taking part, participants provided verbal informed consent, acknowledging that they could withdraw from the study if necessary. Three themes emerged: inadequate measures for temporary communication channels and techniques, the mental health effects of COVID-19 admission, and poor/lack of standardised visitation policy during the COVID 19-pandemic. There was a need to balance safety from contracting COVID-19 infection and promoting family-centred care. Virtual visits through telecommunication solutions could reduce fear and anxiety as the family could be updated on the progress of the hospitalised relative. Alternatively, hospital managers must allocate a dedicated person in the unit to update families when they call and enquire about the conditions.

Visitation restriction and decision making: Healthcare surrogate experiences

OBJECTIVES

We sought to discover whether hospital visitation restrictions imposed during COVID, and remaining at some institutions, influenced surrogate decision-making.

METHODS

Thematic analysis of semi-structured interviews of people who served as healthcare surrogates for patients admitted to the intensive care unit with a palliative care consultation in January of 2021 at a large tertiary care hospital.

RESULTS

Thirteen healthcare surrogates agreed to be interviewed out of the fifty-six who were identified and invited to participate. The following themes emerged: 1) Decision-making was delayed as surrogates desire to make decisions in conjunction with the patient; 2) visitation restriction disrupted processes of grief and end-of-life rituals; 3) it prevented healing that occurs with closeness to loved ones; 4) visitation permission was poorly communicated and inconsistent; 5) virtual connection was inconsistent and proved ineffective in context; 6) communication was often stressful and confusing.

CONCLUSION

From the point of view of healthcare surrogates, visitation restriction disrupted the normal process of decision-making by impeding important healing and grief rituals, and making connection difficult, despite policies and technology that was meant to assist.

PRACTICE IMPLICATIONS

Visitation restriction carries risk such as delaying decision-making and the perceived healing benefits of visitation.

Unrepresented, unheard and discriminated against: A qualitative exploration of relatives' and professionals' views of palliative care experiences of people of African and Caribbean descent during the COVID-19 pandemic

BACKGROUND

People of African and Caribbean descent experienced disproportionately high mortality from COVID-19 and have poor access to palliative care.

AIM

To explore palliative care experiences of people of African and Caribbean descent during and immediately prior to the pandemic.

DESIGN

Qualitative interview study with thematic analysis. Refinement of themes/recommendations in consultation with an expert patient and public advisory group.

SETTING/PARTICIPANTS

Twenty-six bereaved relatives and 13 health/social care professionals (cared for people of African and Caribbean descent) from throughout England, recruited using social media, community networks and direct advertising to over 150 organisations.

RESULTS

Three themes were identified: Representation: Participants did not see themselves reflected in the palliative care services and did not expect their needs to be understood. Mistrust of the healthcare system and perceptions of racism were common and led to anticipation of inequitable care. Personalisation: Relatives and professionals reported a lack of cultural and religious sensitivity in healthcare. Assumptions were made based on ethnicity, and services not offered to all. Awareness and education: Professionals felt they lacked the knowledge to provide care to diverse communities, but were reluctant to ask, due to fear of making mistakes. Inequitable access to services was exacerbated by, but not unique to, the pandemic. Participants recommended raising awareness of palliative services, building professional competence in culturally-sensitive care, and greater ethnic diversity within services.

CONCLUSIONS

Person-centred, culturally-competent palliative care is not the norm for people of African and Caribbean descent. Expectations of inequitable care are widespread. Sustained action on multiple fronts is needed.

Staff Perceptions of the Impact of the COVID-19 Pandemic on Older Adults Living in a Residential Long-Term Care Facility

Older adults residing in long-term care facilities (LTCFs) were an at-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Actions to prevent transmission in LTCFs included visitation restrictions, suspension of group activities, and isolating residents in their rooms. Despite these measures, this vulnerable cohort experienced high levels of infection and mortality. The current article reports RNs' and health care assistants' perceptions of the impact of COVID-19 on residents in a LTCF. Using a descriptive qualitative design, semi-structured interviews, which were conducted with seven RNs and four health care assistants, were thematically analyzed. Three themes emerged: Impact on Daily Routine, Disruption to Relationships With Staff, and Vulnerability. Staff perceived residents were negatively impacted physically, emotionally, and socially as a direct consequence of COVID-19 and by strategies introduced to protect them contracting the virus. It is recommended that the long-term impact of the COVID-19 pandemic on this cohort be evaluated from the perspective of all stakeholders (i.e., residents, staff, and families) using a longitudinal research design. [Journal of Gerontological Nursing, 49(10), 44-50.].

Relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave: a PREMs study in Valais Hospital, Switzerland

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.

Psychosocial well-being in Long-Term Care in the Wake of COVID-19: Findings from a Qualitative Study in New Zealand

Drawing on Mason Durie's (1985) New Zealand Whare Tapa Whā model of health (spiritual, emotional, physical, and family domains), the goal was to link a model of well-being with the lived reality for long-term care residents and bereaved family members during COVID-19. Interviews were conducted with five residents and six family members of previous residents of one long-term care in one urban centre between July and September 2020. The increased demands imposed by the pandemic highlighted the gaps in well-being for residents and families. In particular, the inability to connect with family during COVID-19 restrictions reduced perceptions of well-being for residents. Study findings indicate that the provision of well-being for older adults and families in long-term care extends beyond the narrow bounds of the biomedical model. The Whare Tapa Whā model provides a valuable framework describing the holistic balance needed between the four health domains.

Code status orders in hospitalized patients with COVID-19

Background

The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19.

Methods

A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020).

Results

Among 1375 hospitalized patients with COVID-19, 19% (n = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) p =< 0.01, OR 1.12 and hospitalization early in the pandemic p = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts p => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, p = 0.80.

Conclusions

There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.

The impact of restrictions to visiting in paediatric intensive care during the COVID-19 pandemic

BACKGROUND

Restrictions to hospital visiting were mandated during the COVID-19 pandemic, with variability in the degree of restriction imposed. At times, paediatric intensive care units (ICU) restricted visiting to one parent/carer. Views of parents/carers and ICU staff about changes in the visiting policy are not well understood.

STUDY DESIGN

This is a Service evaluation involving questionnaire survey incorporating rating scales and free-text comments. Inner-city specialist children's hospital. Parents/carers of children on ICU between December 2020-March 2021 and staff who were working on ICU during May-June 2021. Parents and staff on ICU were invited to complete a questionnaire focusing on their experience of being or working on ICU. Quantitative data were analysed descriptively and free-text comments were thematically analysed.

RESULTS

Completed questionnaires were received from 81/103 (79%) parents/carers and 217/550 (39%) staff. The majority of parents (n = 60;77%) and staff (n = 191;89%) understood the need for the one-parent visiting policy but acknowledged it was a source of considerable stress. More staff than parents agreed it was appropriate other relatives/friends visiting was not permitted (Z = 3.715;p < .001). There was no association between parents' satisfaction with their child's care and views about the visiting policy. However, staff were more likely to report an impact on their ability to deliver family centred care if they disagreed with the policy.

CONCLUSION

The COVID-19 visiting policy had a clear impact on parents and staff. In the event of any future threat to open-access visiting to children in hospital, the potentially damaging effect on children, parents, and staff must be considered.

RELEVANCE TO CLINICAL PRACTICE

Visiting policies need to take account of parents being partners in their child's care, rather than purely visitors to the unit where their child is being cared for. Visiting for two carers should always be facilitated, including during a crisis such as a pandemic.

[Changes in the routine work and moral distress in psychiatric care during the COVID-19 pandemic : A survey among physicians active in inpatient care in Germany]

BACKGROUND

During the COVID-19 pandemic a number of ethical challenges have arisen in the healthcare system. A psychological response to moral challenges is termed moral distress (MD).

OBJECTIVE

Identification of causes of MD in inpatient psychiatric care in the context of the COVID-19 pandemic in Germany.

MATERIAL AND METHODS

A survey was conducted using a self-administered non-validated online questionnaire as part of a cross-sectional study, in which 26 items about the experience of MD were examined and open questions about the handling of the pandemic and its effects on everyday work were posed. Physicians who worked in inpatient psychiatric care during the COVID-19 pandemic in Germany were surveyed anonymously with a convenience sample. The data acquisition took place between 17 November 2020 and 6 May 2021.

RESULTS

A total of 141 participants were included. They indicated multiple pandemic-related changes in their daily work partly resulting in MD.

CONCLUSION

MD is a neglected potential burden of inpatient psychiatric care under pandemic conditions (and beyond), which requires further research and an adequate handling. These results include implications for decision makers in crisis teams as well as a need for support services such as clinical ethics consultation services.

Using Video Calls to Reduce Risky Behaviors and Enhance Instruction Understanding of Patients in Acute Care Hospitals During the COVID-19 Pandemic

Backgrounds During the COVID-19 pandemic, visitor restrictions in healthcare settings adversely affected patients. Video calls have emerged as an essential digital alternative that can decrease patients' anxiety and improve satisfaction. This study investigated whether family-initiated video calls could mitigate delirium symptoms and risky behaviors and enhance patients' comprehension of instructions. Methods This observational study used medical chart data and the Diem Payment System from a single acute care hospital in Fukuoka, Japan. The study involved patients hospitalized between May 2020 and August 2021 who used video chat systems. Patients or their relatives used video calls through Skype. The frequency of video chat use served as the primary exposure. Changes in the patients' risky behaviors and instruction comprehension upon discharge were the primary outcomes. Results A total of 532 patients were included in the study, with an average age of over 70 years. After implementing the inverse probability of treatment weighting adjustment, an improved balance across age, sex, BMI categories, and other variables was observed. The effects of video calls on risky behaviors and instruction comprehension varied. Patients with three or more video calls showed distinct effects compared with those with fewer calls. When hospitalization was limited to three weeks, video calls noticeably influenced risky behaviors (p=0.022, 95% CI:1.08-2.63), but not instruction comprehension (p=0.226, 95% CI:0.43-1.22). Conclusions The use of video calls as a visitation method in acute care hospitals during a pandemic suggests that video calls reduce risky behaviors in patients with a three-week stay. This alternative to physical visitations contributes positively to patient safety and supports ongoing efforts to prevent the spread of COVID-19.

Preparing for Future Pandemics and Public Health Emergencies: An American College of Physicians Policy Position Paper

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others.

Restrictive interventions on a psychiatric admission ward before and after COVID-19

OBJECTIVES

Restrictive interventions (seclusion, restraint and special observations) are used on psychiatric wards when there are no other means available to keep a patient or others safe. These measures can be traumatic, and the Mental Health Commission and the Health Service Executive are focused on minimising their use. We set out to determine whether, following a COVID related reduction in bed numbers on a high dependency psychiatric ward in St John of God Hospital in Dublin, there was a change in their incidence.

METHODS

Data on restrictive interventions and challenging behaviours were gathered for 9-month periods before and after March 2020 when COVID related ward changes took place. Figures were also collected on seclusion and restraint for the previous 18 months for a longer-term view. Ward and hospital occupancy levels were also recorded.

RESULTS

Between the two time periods, episodes of seclusion fell by 53% and episodes of restraint by 56%. The hours devoted to special observation declined by 30% and incidents of challenging behaviours fell by 26%. Ward occupancy levels fell by only 5%. The longer-term comparison of figures for seclusion and restraint point towards a downward trend from mid-2019 that was accentuated in the post-COVID period.

CONCLUSIONS

The changes found may relate to reduced crowding on the ward or other COVID related factors such as the emphasis on social distancing and a shared sense of purpose on the ward. The longer-term trend points towards an emerging cultural shift. The challenge now is to sustain and build upon these changes.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

Factors Associated With Physical Activity in Hospitalized Patients With Dementia

Older adults continue to spend little time engaged in physical activity when hospitalized. The purpose of this study was to (a) describe activity among hospitalized older adults with dementia and (b) identify the association between specific factors (gender, ambulation independence, comorbidities, race, and hospital setting) and their physical activity. This descriptive study utilized baseline data on the first 79 participants from the Function Focused Care for Acute Care using the Evidence Integration Triangle. Multiple linear regression models were run using accelerometry data from the first full day of hospitalization. The participants spent an average of 83.7% of their time being sedentary. Male gender, ambulation independence, and hospital setting (the hospital in which the patient was admitted) were associated with greater activity. This study reports on the limited time spent in activity for older adults with dementia when hospitalized and highlights patient profiles that are particularly vulnerable to sedentary behavior in the hospital setting.

Improving Neurology Inpatient Fall Rate: Effect of a Collaborative Interdisciplinary Quality Improvement Initiative

Objective

To reduce unwitnessed inpatient falls on the neurology services floor at an academic medical center by 20% over 15 months.

Patients and Methods

A 9-item preintervention survey was administered to neurology nurses, resident physicians, and support staff. Based on survey data, interventions targeting fall prevention were implemented. Providers were educated during monthly in-person training sessions regarding the use of patient bed/chair alarms. Safety checklists were posted inside each patient's room reminding staff to ensure that bed/chair alarms were on, call lights and personal items were within reach, and patients' restroom needs were addressed. Preimplementation (January 1, 2020, to March 31, 2021) and postimplementation (April 1, 2021, to June 31, 2022) rates of falls in the neurology inpatient unit were recorded. Adult patients hospitalized in 4 other medical inpatient units not receiving the intervention served as a control group.

Results

Rates of falls, unwitnessed falls, and falls with injury all decreased after intervention in the neurology unit, with rates of unwitnessed falls decreasing by 44% (2.74 unwitnessed falls per 1000 patient-days before intervention to 1.53 unwitnessed falls per 1000 patient-days after intervention; P=.04). Preintervention survey data revealed a need for education and reminders on inpatient fall prevention best practices given a lack of knowledge on how to operate fall prevention devices, driving the implemented intervention. All staff reported significant improvement in operating patient bed/chair alarms after intervention (P<.001).

Conclusion

A collaborative, multidisciplinary approach focusing on provider fall prevention education and staff checklists is a potential technique to reduce neurology inpatient fall rates.

The Development of a Multidisciplinary Support Network to Support Hospitalized Pediatric Patients, Their Families, and Hospital Staff During the COVID-19 Pandemic

Background

The COVID-19 pandemic led to emotional and behavioral challenges for hospitalized pediatric patients, their families, and staff. Visitor restrictions, closure of patient lounges and playrooms, masking requirements, and enhanced isolation rules resulted in limited access to typical sources of psychosocial support during this traumatic event. Complementary and integrative health therapies such as acupuncture and related therapies are well suited to provide the humanitarian support patients and families need during times of crisis.

Objective

The Multidisciplinary Support Network (i.e., Network) was formed to redesign the delivery of acupuncture and other integrative therapies alongside psychosocial support for hospitalized children, their families, and staff.

Intervention

Network members represented a broad range of previously siloed disciplines including integrative therapies, art therapy, child life, nursing, pastoral care, adolescent medicine, pediatric hospital medicine, psychology, and child and adolescent psychiatry. The Network aimed to identify gaps in service and create resources to support children and families during this challenging time.

Results

The Network compiled existing complementary and integrative services, provided training on integrative therapies to staff, pediatric trainees, and faculty, developed the Comfort Box containing items to provide symptom relief including pain, anxiety and difficulty sleeping, as well as closed-circuit programming, a pediatric companionship program connecting medical student volunteer companions with pediatric patients, and a well-being workbook.

Conclusion

Collaborative teamwork across disciplines using integrative therapies was key to humanitarian efforts to support hospitalized children and their families during this crisis.

Symptom Management and Support in Dying Patients with Cancer and Coronavirus Disease-19-A Register-Based Study

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.

The Impact of Loneliness and Social Isolation on Cognitive Aging: A Narrative Review

Social concepts such as loneliness and social isolation are fairly new factors that have been recently gaining attention as to their involvement in changes in cognitive function and association with dementia. The primary aim of this narrative review was to describe the current understanding of how loneliness and social isolation influence cognitive aging and how they are linked to dementia. Studies have shown that there is an association between loneliness, social isolation, and reduced cognitive function, in older adults, across multiple cognitive domains, as well as a heightened risk of dementia. Numerous changes to underlying neural biomechanisms including cortisol secretion and brain volume alterations (e.g., white/grey matter, hippocampus) may contribute to these relationships. However, due to poor quality research, mixed and inconclusive findings, and issues accurately defining and measuring loneliness and social isolation, more consistent high-quality interventions are needed to determine whether studies addressing loneliness and social isolation can impact longer term risk of dementia. This is especially important given the long-term impact of the COVID-19 pandemic on social isolation in older people is yet to be fully understood.

Seeking New Meaning in the Shadow of the COVID-19 Pandemic: A Qualitative Research of Spiritual Issues and Experiences among Students in Turkish Society

Spirituality is one aspect to consider given the COVID-19 pandemic. However, the number of in-depth qualitative studies on spirituality-related issues and experiences is limited. The present study investigated the spiritual problems and experiences of students during the COVID-19 pandemic. The study was carried out with 342 Muslim students undertaking a distance education program at a state university in Turkey. The study was carried out using the non-probability sampling method. The data was collected using Qualtrics through a questionnaire consisting of open-ended questions related to spirituality during COVID-19. The data was analyzed using MAXQDA. The findings consisted of three categories, including spirituality during the pandemic, attitudes and behaviors related to the pandemic with a focus on spirituality, and feelings and thoughts about spirituality during the pandemic. There were fourteen subcategories, including resilience, meaning of life, coping mechanisms, acceptance, doubts, cleanliness, solidarity, risky behaviors, digitalization, religious rituals, inner peace, death, emotions, and hope. To meet the spiritual needs of students, it can be recommended to provide a suitable place for worship, to maintain the relations of individuals with religious centers and to direct them to spiritual counseling services.

Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure

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.

Supporting bereaved people: a qualitative study on the experience of informal support providers, before and during the pandemic scenario

The COVID-19 outbreak has further highlighted the need to strengthen support networks to sustain grieving people. However, we know very little about the experience of those who, because of their emotional connection with the bereaved person or of their social function, find themselves supporting people in grief. The current study aimed to analyze the experience of grievers' informal support providers (relatives and friends, teachers, religious leaders, funeral providers, pharmacists, volunteers, and social service workers). 162 in-depth interviews were collected (meanage = 42.3, SD = 14.9; women = 63.6%). Findings highlight two different ways of talking about one's experience and two different ways of offering support. Such dissimilarities do not relate to the period in which support was offered (before or during the pandemic). The results will be discussed in order to highlight emerging training needs to support bereaved people in their difficult transition.

Volunteers, religious communities and users representatives as an alternative for visiting hospitalized patients: The importance of an infection control training

BACKGROUND

During the COVID-19 pandemic, the suspension of relatives' visits was a common measure in healthcare facilities to prevent the spread of the virus among patients. This measure caused significant adverse consequences for hospitalized patients. Volunteers' intervention was an alternative but could also lead to cross transmission events.

AIMS

in order to secure their intervention with patients, we implemented an infection control training to evaluate and to improve the knowledge of volunteers about infection control measures.

METHOD

We performed a before-after study in a group of five tertiary referral teaching hospitals in the suburbs of Paris. A total of 226 volunteers from three groups (religious representatives, civilian volunteers and users' representatives) were included. Basic theoretical and practical knowledge about infection control, hand hygiene, and glove and mask use were evaluated just before and immediately after a three-hour training program. The contribution of the characteristics of the volunteers to the results was studied.

FINDINGS

The initial conformity rate for theoretical and practical infection control measures ranged from 53% to 68%, depending on the participants' activity status and education level. Some critical shortcomings in hand hygiene as well as mask and glove wearing putatively endangered the patients and volunteers. Surprisingly, serious gaps were also identified among volunteers who experienced care activities. Regardless of their origin, the program significantly improved both their theoretical and practical knowledge (p<0.001). Real-life observance and long-term sustainability should be monitored.

CONCLUSIONS

To become a secure alternative to relatives' visits, volunteers' interventions must be preceded by the assessment of their theoretical knowledge and practical skills in infection control. Additional study, including practice audit, must confirm the implementation of the acquired knowledge in the real-life.

Coping strategies of the incarcerated during the COVID-19 pandemic: a scoping review protocol of quantitative and qualitative evidence

INTRODUCTION

To reduce the transmission of COVID-19, regulations included the use of cloth masks, sanitising regularly, maintaining social distance and having minimal personal contact. COVID-19 affected many different groups of people including service providers and users of correctional centres. In this protocol, we aim to establish evidence on the challenges and coping strategies adopted by the incarcerated and service providers of the incarcerated during the COVID-19 pandemic.

METHODS AND ANALYSIS

In this scoping review, we will use the Arksey and O'Malley framework. We will consult PubMed, PsycInfo, SAGE, JSTOR, African Journals and Google Scholar as our databases to search for evidence, and run a continuous search of articles from June 2022 until we conduct an analysis to ensure that our search results are updated. Two reviewers will independently screen the titles, abstracts and full texts for inclusion. All results will be compiled, and duplicates will be removed. Discrepancies and conflicts will be discussed with the third reviewer. All articles that meet the full-text criteria will be included for data extraction. Results will be reported in line with the review objectives and the Donabedian conceptual framework.

DISSEMINATION

Ethical approval of the study will not be applicable in this scoping review. Our findings will be disseminated in different ways, such as publishing in peer-reviewed journals and to other key correctional system stakeholders, as well as submitting a policy brief for prison decision makers and policy makers.

Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa

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.

'Scanxiety': Content analysis of pre-MRI patient experience on Instagram

INTRODUCTION

Distress and anxiety are commonly reported during the Magnetic Resonance Imaging (MRI) experience with prior studies suggesting the pre-MRI period is a time of heightened distress. There is a paucity of literature exploring preprocedural distress and anxiety, in particular qualitative research analysing patient experience. Instagram is rapidly becoming an important social media platform though which to conduct health research. A gradually increasing number of studies have examined social media to gain insight into patient experience within medical radiation science (MRS). This study is considered as the first to explore patient experience of MRI using Instagram as a data source.

METHODS

This study investigated the patient experience during the pre-MRI period by performing a content analysis on open-source Instagram posts. Ethical approval for the study was sought and approved by the Charles Sturt University, Human Research Ethics Committee.

RESULTS

Six themes emerged from the extracted data; Journey to the MRI, Waiting, Anticipating the MRI procedure, Preparing for the MRI procedure, Negative interaction, and Fear of the results.

CONCLUSION

The findings of this study provide novel self-reported and unsolicited insight into the diverse, multifactorial, and often concomitant nature of preprocedural MRI anxiety and distress.

IMPLICATIONS FOR PRACTICE

This study adds to a growing body of literature advocating for a compassionate, holistic, and person-centered approach when caring for patients in MRI that also considers their emotional and psychological wellbeing.

Experiences of Mothers of Preterm Infants in the Neonatal Intensive Care Unit During the COVID-19 Pandemic

BACKGROUND

The neonatal intensive care unit (NICU) stay following the birth of a preterm infant can be stressful and traumatic for families. During the COVID-19 pandemic, the NICU environment changed precipitously as infection control and visitor restriction measures were implemented.

PURPOSE

Our study aimed to examine the impact of the pandemic policies on the experiences of mothers of preterm infants during their stay in the NICU.

METHODS

Semistructured interviews were conducted with mothers of preterm infants hospitalized in a Canadian tertiary-level NICU. Informed by interpretive description methodology, interview content was transcribed and analyzed using a thematic analysis approach. The identified themes were validated, clarified, or refined using investigator triangulation.

RESULTS

Nine English-speaking mothers, aged 28 to 40 years, were interviewed. Four themes emerged from the analysis of their experiences: (1) disrupted family dynamic, support, and bonding; (2) physical and emotional isolation; (3) negative psychological impact compounded by added concerns, maternal role change, and survival mode mentality; and (4) positive aspects of the pandemic management measures.

IMPLICATIONS FOR PRACTICE

During the pandemic, the way that care was provided in the NICU changed. This study helps to explore how neonatal clinicians can foster individual and organizational resilience to keep patients and families at the center of care, even when the healthcare system is under intense stress.

IMPLICATIONS FOR RESEARCH

: Our results show that these changes heightened mothers' distress, but also had a modest positive impact. Further research about long-term consequences of pandemic policies on the mother and preterm infant after NICU discharge is warranted.

The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care

BACKGROUND

The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year.

METHODS

Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10-12/2019 and 10-12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital's cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests.

RESULTS

Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro).

CONCLUSIONS

The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.

Sociodemographic factors affecting depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic

Purpose

This study aimed to determine the sociodemographic factors affecting the depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic.

Design

and Methods: This descriptive cross-sectional study was conducted between March and October 2021. The sample consisted of 93 parents. Data were collected using a descriptive questionnaire, the Depression Anxiety Stress Scale (DASS- 42), and Coping Style Scale (CSS).

Results

Participants had mean DASS "depression," "anxiety," and "stress" subscale scores of 13.69 ± 8.86, 12.11 ± 8.37, and 19.09 ± 9.24, respectively. They had mean CSS "self-confident," "optimistic," "helpless," "submissive coping," and "seeking of social support" subscale scores of 2.71 ± 0.65, 2.57 ± 0.59, 2.29 ± 0.62, 2.25 ± 0.49, and 2.38 ± 0.52, respectively. Fathers had lower mean CSS "helpless" and "submissive" subscale scores than mothers. Participants who were briefed about their babies' condition by nurses had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with higher education had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with spouses with bachelor's or higher degrees had a higher median CSS "optimistic" subscale score than those with literate spouses or spouses with primary school degrees. Participants who were worried about the "no visitors" policy had a lower median CSS "self-confident" subscale score than those who were not.

Conclusions

Parents who are not allowed to see their babies due to the "no visitors" policy during the COVID-19 pandemic experience more psychosocial problems. Though not a result of the present study, the "no visitors" policy seems to affect the mother-infant attachment adversely.

Practice implications

Healthcare professionals should brief parents about what a neonatal intensive care unit is like. They should also warn them that they may not be too happy about how their baby looks before seeing them. Therefore, they should use therapeutic communication techniques to talk to them and explain the situation in a way they can understand. Moreover, they should provide parents with psychological empowerment training programs to help them adopt active coping strategies to deal with challenges in times of crisis.

Daily Oxygenation Support for Patients Hospitalized With SARS-CoV-2 in an Integrated Health System

BACKGROUND

Many COVID-19 studies are constructed to report hospitalization outcomes, with few large multi-center population-based reports on the time course of intra-hospitalization characteristics, including daily oxygenation support requirements. Comprehensive epidemiologic profiles of oxygenation methods used by day and by week during hospitalization across all severities are important to illustrate the clinical and economic burden of COVID-19 hospitalizations.

METHODS

This was a retrospective, multi-center observational cohort study of 15,361 consecutive hospitalizations of patients with COVID-19 at 25 adult acute care hospitals in Texas participating in the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study COVID-19 registry.

RESULTS

At initial hospitalization, the majority required nasal cannula (44.0%), with an increasing proportion of invasive mechanical ventilation in the first week and particularly the weeks to follow. After 4 weeks of acute illness, 69.9% of adults hospitalized with COVID-19 required intermediate (eg, high-flow nasal cannula, noninvasive ventilation) or advanced respiratory support (ie, invasive mechanical ventilation), with similar proportions that extended to hospitalizations that lasted ≥ 6 weeks.

CONCLUSIONS

Data representation of intra-hospital processes of care drawn from hospitals with varied size, teaching and trauma designations is important to presenting a balanced perspective of care delivery mechanisms employed, such as daily oxygen method utilization.

COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort

OBJECTIVES: To describe the burden of COVID-19 in Swiss long-term care facilities in 2020, to identify its influencing factors, and to assess vaccination rates among residents and healthcare workers at the end of the vaccine campaign in Switzerland in May 2021. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Long-term care facilities from two Swiss cantons (St. Gallen / Eastern Switzerland and Vaud / Western Switzerland). METHODS: We collected numbers of COVID-19 cases and related deaths and all-cause mortality for 2020, potential risk factors at the institutional level (e.g. size, infection prevention and control measures, and resident characteristics), and vaccination rates among residents and healthcare workers. Univariate and multivariate analyses were used to identify factors associated with resident mortality in 2020. RESULTS: We enrolled 59 long-term care facilities with a median of 46 (interquartile range [IQR]: 33–69) occupied beds. In 2020, the median COVID-19 incidence was 40.2 (IQR: 0–108.6) per 100 occupied beds, with higher rates in VD (49.9%) than in SG (32.5%; p = 0.037). Overall, 22.7% of COVID-19 cases died, of which 24.8% were COVID-19-related deaths. In the univariate analysis, higher resident mortality was associated with COVID-19 rates among residents (p < 0.001) and healthcare workers (p = 0.002) and age (p = 0.013). Lower resident mortality was associated with the proportion of single rooms (p = 0.012), isolation of residents with COVID-19 in single rooms (p = 0.003), symptom screening of healthcare workers (p = 0.031), limiting the number of visits per day (p = 0.004), and pre-scheduling visits (p = 0.037). In the multivariate analysis, higher resident mortality was only associated with age (p = 0.03) and the COVID-19 rate among residents (p = 0.013). Among 2936 residents, 2042 (69.9%) received ≥1 dose of the COVID-19 vaccine before 31 May 2021. Vaccine uptake among healthcare workers was 33.8%. CONCLUSION AND IMPLICATIONS: COVID-19 burden was high but also highly variable in Swiss long-term care facilities. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers was a modifiable factor associated with increased resident mortality. Symptom screening of healthcare workers appeared to be an effective preventive strategy and should be included in routine infection prevention and control measures. Promoting COVID-19 vaccine uptake among healthcare workers should be a priority in Swiss long-term care facilities.

Specialized palliative care for hospitalized patients with SARS-CoV-2 infection: an analysis of the LEOSS registry

PURPOSE

Symptom control for patients who were severely ill or dying from COVID-19 was paramount while resources were strained and infection control measures were in place. We aimed to describe the characteristics of SARS-CoV-2 infected patients who received specialized palliative care (SPC) and the type of SPC provided in a larger cohort.

METHODS

From the multi-centre cohort study Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS), data of patients hospitalized with SARS-CoV-2 infection documented between July 2020 and October 2021 were analysed.

RESULTS

273/7292 patients (3.7%) received SPC. Those receiving SPC were older and suffered more often from comorbidities, but 59% presented with an estimated life expectancy > 1 year. Main symptoms were dyspnoea, delirium, and excessive tiredness. 224/273 patients (82%) died during the hospital stay compared to 789/7019 (11%) without SPC. Symptom control was provided most common (223/273; 95%), followed by family and psychological support (50% resp. 43%). Personal contact with friends or relatives before or during the dying phase was more often documented in patients receiving SPC compared to patients without SPC (52% vs. 30%).

CONCLUSION

In 3.7% of SARS-CoV-2 infected hospitalized patients, the burden of the acute infection triggered palliative care involvement. Besides complex symptom management, SPC professionals also focused on psychosocial and family issues and aimed to enable personal contacts of dying patients with their family. The data underpin the need for further involvement of SPC in SARS-CoV-2 infected patients but also in other severe chronic infectious diseases.

Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities

Since the start of the COVID-19 pandemic in early 2020, governments around the world have adopted an array of measures intended to control the transmission of the SARS-CoV-2 virus, using both pharmaceutical and non-pharmaceutical interventions (NPIs). NPIs are public health interventions that do not rely on vaccines or medicines and include policies such as lockdowns, stay-at-home orders, school closures, and travel restrictions. Although the intention was to slow viral transmission, emerging research indicates that these NPIs have also had unintended consequences for other aspects of public health. Hence, we conducted a narrative review of studies investigating these unintended consequences of NPIs, with a particular emphasis on mental health and on lifestyle risk factors for non-communicable diseases (NCD): physical activity (PA), overweight and obesity, alcohol consumption, and tobacco smoking. We reviewed the scientific literature using combinations of search terms such as 'COVID-19', 'pandemic', 'lockdowns', 'mental health', 'physical activity', and 'obesity'. NPIs were found to have considerable adverse consequences for mental health, physical activity, and overweight and obesity. The impacts on alcohol and tobacco consumption varied greatly within and between studies. The variability in consequences for different groups implies increased health inequalities by age, sex/gender, socioeconomic status, pre-existing lifestyle, and place of residence. In conclusion, a proper assessment of the use of NPIs in attempts to control the spread of the pandemic should be weighed against the potential adverse impacts on other aspects of public health. Our findings should also be of relevance for future pandemic preparedness and pandemic response teams.

With COVID Comes Complexity: Assessing the Implementation of Family Visitation Programs in Long-Term Care

BACKGROUND AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) pandemic visitor restrictions to long-term care facilities have demonstrated that eliminating opportunities for family-resident contact has devastating consequences for residents' quality of life. Our study aimed to understand how public health directives to support family visitations during the pandemic were navigated, managed, and implemented by staff.

RESEARCH DESIGN AND METHODS

Guided by the Consolidated Framework for Implementation Research, we conducted video/telephone interviews with 54 direct care and implementation staff in six long-term care homes in two Canadian provinces to assess implementation barriers and facilitators of visitation programs. Equity and inclusion issues were examined in the program's implementation.

RESULTS

Despite similar public health directives, implementation varied by facility, largely influenced by the existing culture and processes of the facility and the staff understanding of the program; differences resulted in how designated family members were chosen and restrictions around visitations (e.g., scheduling and location). Facilitators of implementation were good communication networks, leadership, and intentional planning to develop the visitor designation processes. However, the lack of consultation with direct care staff led to logistical challenges around visitation and ignited conflict around visitation rules and procedures.

DISCUSSION AND IMPLICATIONS

Insights into the complexities of implementing family visitation programs during a pandemic are discussed, and opportunities for improvement are identified. Our results reveal the importance of proactively including direct care staff and family in planning for future outbreaks.

"Geriatric Proximity" Intervention in COVID-19 Context: Contribution to Reducing Loneliness and Improving Affectivity

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a "Geriatric Proximity" intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the "Geriatric Proximity" intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention "Geriatric Proximity" showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State

PURPOSE

The COVID-19 pandemic-related disruptions in health care delivery might have affected end-of-life care in patients with cancer. We examined changes in place of death and hospice support for Medicaid and commercially insured patients during the pandemic.

PATIENTS AND METHODS

We linked Washington State cancer registry records with claims from Medicaid and two commercial insurers for patients with solid tumor age 18-64 years. The study included 322 Medicaid and 162 commercial patients who died between March 2017 and June 2019 (pre-COVID-19), along with 90 Medicaid and 47 commercial patients who died between March and June 2020 (COVID-19). Place of death was categorized as hospital, hospice (home or nonhospital facility), and home without hospice. Place of death was compared using adjusted multinomial logistic regressions stratified by payer and time period (pre-COVID-19 v COVID-19). The clinical and sociodemographic factors associated with dying at home without hospice were examined, and adjusted marginal effects (ME) are reported.

RESULTS

In the adjusted pre-COVID-19 analysis, Medicaid patients were more likely than commercially insured patients to die in hospital (48% v 36%; adjusted ME, 11%; P = .02). In the pre-COVID-19/COVID-19 analysis, Medicaid patients' place of death shifted from hospital (48% v 32%; ME, -16%; P < .01) to home without hospice (19.9% v 38.0%; ME, 16.5%; P < .01). However, there were no statistically significant changes pre-COVID-19/COVID-19 for commercial patients. As a result, during COVID-19, Medicaid patients were more likely than commercial patients to die at home without hospice (38% v 22%; ME, 16%; P = .04) as were male versus female patients (ME, 16%; P < .01).

CONCLUSION

The pandemic might have disproportionately worsened the end-of-life experience for Medicaid enrollees with cancer. Attention should be paid to societal and health system factors that decrease access to care for Medicaid patients.

Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

Effects of the COVID-19 Pandemic on Animal-Assisted Activities in Pediatric Hospitals

INTRODUCTION

The goal of this study was to document current hospital-based animal-assisted activities (AAA) practices.

METHOD

We contacted 20 hospitals and asked about their AAA programs, including COVID-19 precautions.

RESULTS

Eighteen of 20 hospitals responded. Before 2020, all offered either in-person only (n = 17) or both in-person and virtual AAA visits (n = 1). In early 2022, 13 provided in-person visits; the five hospitals that had not resumed in-person visits planned to restart. Most hospitals stopped group visits. Most required that patients and handlers be free of COVID-19 symptoms and that handlers be vaccinated and wear masks and eye protection. Most did not require COVID-19 vaccination for patients. None required handlers to test negative for COVID-19.

DISCUSSION

The COVID-19 pandemic impacted hospital-based pediatric AAA. Future studies should assess the effectiveness of virtual AAA and of precautions to prevent COVID-19 transmission between patients and AAA volunteers.

Impact of the COVID-19 Pandemic on the Experiences of Hospitalized Patients: A Scoping Review

OBJECTIVE

This study aimed to identify the factors that exerted an impact on the experiences of hospitalized patients during the COVID-19 pandemic from the quality and safety perspectives.

METHOD

A scoping review that followed the 5 stages described by Arksey and O'Malley was used. A systematized search of original studies was conducted in 9 databases: PubMed/MEDLINE, BDENF, CINAHL, LILACS, SciELO, Embase, Scopus, Web of Science, and Google Scholar. The factors that exerted an impact on patients' experiences were summarized, considering the perspective of quality and patient safety in health institutions. The factors were categorized using the Content Analysis technique.

RESULTS

A total of 6950 studies were screened, and 32 met the eligibility criteria. The main factors that exerted an impact on the patients' experience were as follows: caregiver/family concern with the patients' well-being during hospitalization, search for alternative communication and interaction means between the patients and their family, and changes in health care organization. The restrictions inherent to the policy regarding visits and companions exerted a negative impact on the experiences, increasing the patients' feelings of loneliness and isolation. Negative impacts were also evidenced in the hospital admission and discharge process and in the limitation of treatment possibilities offered to the patients, because of contact restrictions.

CONCLUSIONS

The factors that exerted an impact on the patients' experiences permeate communication between professionals, patients, and family members, with implications for health care quality.

Variation in Communication and Family Visiting Policies in Italian Intensive Care Units during the COVID-19 Pandemic: A Secondary Analysis of the COVISIT International Survey

BACKGROUND

During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies in Italian ICUs during the pandemic.

METHODS

A secondary analysis from the COVISIT international survey was conducted, focusing on data from Italy.

RESULTS

Italian ICUs provided 118 (18%) responses out of 667 responses collected worldwide. A total of 12 Italian ICUs were at the peak of COVID-19 admissions at the time of the survey and 42/118 had 90% or more of patients admitted to ICU affected by COVID-19. During the COVID-19 peak, 74% of Italian ICUs adopted a no-in-person-visiting policy. This remained the most common strategy (67%) at the time of the survey. Information to families was provided by regular phone calls (81% in Italy versus 47% for the rest of the world). Virtual visiting was available for 69% and most commonly performed using devices provided by the ICU (71% in Italy versus 36% outside Italy).

CONCLUSION

Our study showed that restrictions to the ICU applied during the COVID-19 pandemic were still in use at the time of the survey. The main means of communication with caregivers were telephone and virtual meetings.

Importance of telemedicine in mild cognitive impairment and Alzheimer disease patients population during admission to emergency departments with COVID-19

In March 2020, the World Health Organization declared a global pandemic due to the new coronavirus SARS-CoV-2, and several governments have planned a national quarantine to control the spread of the virus. Acute psychological effects during hospitalization in frail elderly individuals with special needs, such as patients with dementia, have been little studied. The greatest distress manifested by these kinds of patients was isolation from their families during hospitalization. Thus, structured video call interventions were carried out to family caregivers of patients diagnosed with dementia during their hospitalization in the COVID-19 ward. The purpose of this quasi-experimental study was to assess changes in cognitive and behavioral symptoms in both patients and caregivers. All study participants underwent psychological assessments. Specifically, the psychological well-being states of patients and their caregivers were measured at admission (T0) and discharge (T1) using psychometric tests and clinical scales. Each participant received an electronic device to access video calls in addition meetings were scheduled with the psychologist and medical team to keep caregivers updated on the health status of their relatives. A psychological support and cognitive rehabilitation service was also provided. Significant differences were found in all clinical variables of the caregiver group. Results showed a significant relationship in the quality of life score between the patient and caregiver groups. The results of this study has highlighted the importance of maintaining significantly effective relationships during the hospitalization period of patients admitted to COVID wards.

High Prevalence of Alternative Diagnoses in Children and Adolescents with Suspected Long COVID-A Single Center Cohort Study

BACKGROUND

Long COVID (LC) is a diagnosis that requires exclusion of alternative somatic and mental diseases. The aim of this study was to examine the prevalence of differential diagnoses in suspected pediatric LC patients and assess whether adult LC symptom clusters are applicable to pediatric patients.

MATERIALS AND METHODS

Pediatric presentations at the Pediatric Infectious Diseases Department of the University Hospital Essen (Germany) were assessed retrospectively. The correlation of initial symptoms and final diagnoses (LC versus other diseases or unclarified) was assessed. The sensitivity, specificity, negative and positive predictive values of adult LC symptom clusters were calculated.

RESULTS

Of 110 patients, 32 (29%) suffered from LC, 52 (47%) were diagnosed with alternative somatic/mental diseases, and 26 (23%) remained unclarified. Combined neurological and respiratory clusters displayed a sensitivity of 0.97 (95% CI 0.91-1.00) and a negative predictive value of 0.97 (0.92-1.00) for LC.

DISCUSSION/CONCLUSIONS

The prevalence of alternative somatic and mental diseases in pediatric patients with suspected LC is high. The range of underlying diseases is wide, including chronic and potentially life-threatening conditions. Neurological and respiratory symptom clusters may help to identify patients that are unlikely to be suffering from LC.

Use of Digital Technologies to Maintain Older Adults' Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review

BACKGROUND

Digital technologies were implemented to address the disruption of long-term care facility residents' socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents' social ties.

OBJECTIVE

Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions.

METHODS

Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions.

RESULTS

Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them.

CONCLUSIONS

The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents' perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints.

TRIAL REGISTRATION

OSF Registries osf.io/yhpx3; https://osf.io/yhpx3.