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

Family presence during patient acute deterioration: A survey of nurses' attitudes and reflection on COVID-19 in an African setting

Introduction

Acute deterioration refers to a patient who has become physiologically unstable requiring acute care. Family presence during resuscitation efforts has been widely supported by literature. Nurses are often the primary contact for the families of patients in the emergency centre, playing an important role in facilitating family presence during acute care. To describe nurses’ attitudes regarding family presence during the management of acutely deteriorating patients in the emergency centre.

Methods

A descriptive quantitative study was conducted in the emergency centres of three public hospitals in the Eastern Cape, South Africa. A total sample of professional nurses (n = 57) were recruited, to complete the Emergency Department Family Presence (EDFP) survey. Statements about the negative effects of family presence during acute care of a deteriorating patient were presented and respondents were required to agree or disagree. Data were analysed using univariable and multivariable logistic regression.

Results

The majority of the nurses agreed with the items in the EDFP survey agreeing that present relatives may misinterpret activities of health care professionals (92.8%) which can result in complaints about the quality of care (91.1%). Nurses with more years of experience (11–21 years) were more likely to disagree with the statements on family presence having negative effects on patient care than nurses with fewer years of experience (0–10 years) (OR:6.92; 95%CI: 1.29–37.28).

Discussion

Nurses have the perception that family presence has a largely negative effect on patients, patient care and the families present during acute care. The contextual application of the practice of family presence during acute deterioration in an African setting needs investigation and the need for continued professional education on family centred care is emphasised. Alternative methods of facilitating family presence during the COVID-19 Pandemic must be considered as we advocate for the self determination of families and patients.

The influence of the down- and upscaling of activities in long-term care facilities during the COVID-19 visitor ban on caregivers’ exhaustion and ability to provide care and support: A questionnaire study

In the Netherlands, a national visitor-ban was in place in LTCFs during the first outbreak of COVID-19 in 2020. Meaningful activities were cancelled or downscaled, while others were performed more often. It is known that a lack of activities has several negative effects on residents, while the impact on caregivers remains largely unexplored. Here we investigate the influence of the down- and upscaling of activities on caregivers’ physical and emotional exhaustion and their perceived ability to provide care and support. Downscaling of activities for residents, in particular watching television and musical activities, had a negative impact on caregivers’ emotional exhaustion. The downscaling of watching television increased caregivers ‘physical exhaustion. Furthermore, the downscaling of both activities had a negative impact on caregivers’ perceived ability to provide ADL care and emotional support. This study triggers the need for more knowledge about the function of meaningful activities for residents, from a LTCF caregivers’ perspective.

Sacrifice and solidarity: a qualitative study of family experiences of death and bereavement in critical care settings during the pandemic

BACKGROUND

Pandemic-related restrictions are expected to continue to shape end-of-life care and impact the experiences of dying hospitalised patients and their families.

OBJECTIVE

To understand families' experiences of loss and bereavement during and after the death of their loved one amidst the SARS-CoV-2 (COVID-19) pandemic.

DESIGN

Qualitative descriptive study.

SETTING

Three acute care units in a Canadian tertiary care hospital.

PARTICIPANTS

Family members of 28 hospitalised patients who died from March-July 2020.

MAIN OUTCOME MEASURES

Qualitative semistructured interviews conducted 6-16 months after patient death inquired about family experiences before and beyond the death of their loved one and garnered suggestions to improve end-of-life care.

RESULTS

Pandemic restrictions had consequences for families of dying hospitalised patients. Most family members described an attitude of acquiescence, some framing their experience as a sacrifice made for the public good. Families appreciated how clinicians engendered trust in the name of social solidarity while trying to mitigate the negative impact of family separation. However, fears about the patient's experience of isolation and changes to postmortem rituals also created despair and contributed to long-lasting grief.

CONCLUSION

Profound loss and enduring grief were described by family members whose final connections to their loved one were constrained by pandemic circumstances. Families observed solidarity among clinical staff and experienced a sense of unity with staff, which alleviated some distress. Their suggestions to improve end-of-life care given pandemic restrictions included frequent, flexible communication, exceptions for family presence when safe, and targeted efforts to connect patients whose isolation is intensified by functional impairment or limited technological access.

TRIAL REGISTRATION NUMBER

NCT04602520; Results.

Navigating Professional and Personal Knowing Through Reflective Storytelling Amidst Covid-19

The paper offers space for dialogue illustrating reflection as lived, exploring both my personal and professional experiences of grief and loss surrounding the death of my Dad from Covid −19. In my role as a nurse educator, I share understandings of reflection in facilitating learning and person centered practices with students. I illustrate my approach with two stories generating a narrative giving testimony to those who have died and highlighting the ensuing grief for those who have cared for older people during the pandemic. The first reflective story has been shared with students and snapshots of student responses during virtual sessions are incorporated. The second story shifts to a more personal focus reflecting personal knowing. Insights emerge bringing forth personal and professional knowing, about the art and science of holistic nursing. I explore the challenges in separating ourselves from personal knowledge and experience in reflective writing. I invite readers to take time to pause amidst a global healthcare pandemic to consider the potential of reflection to support nurses in recovering from suffering experienced during a pandemic.

Retrospective feelings of loneliness during the COVID-19 pandemic among residents of long-term care facilities

The novel coronavirus disease (COVID-19) has had an incisive effect on residents living in long-term care facilities (LTCFs). Local governments have introduced restrictive measures because of the danger posed by this virus. One increasing negative effect of these implementations among residents living in LTCFs is their subjective feelings of loneliness. This study assumed that these measures weighed heavily particularly on residents living in LTCFs, as this group of older people could not decide for themselves whether or how they should be implemented. Thus, this study investigated the retrospectively reported subjective loneliness of residents living in LTCFs. On a large-scale Swiss survey (N = 828; mean age: 87.78, 75% female), residents of 22 LTCFs filled out a questionnaire on their subjective feelings of loneliness during the pandemic. The retrospective loneliness scores of the residents living in LTCFs were found to exceed those reported in other studies focusing on community-dwelling older people. Multivariate regression analyses showed that females, individuals with lower values of joy in life and life satisfaction, and individuals who were not satisfied with the manner in which their care home coped with the COVID-19 measures significantly felt lonelier. Therefore, the subjective feelings of loneliness of residents in LTCFs should be monitored very carefully. As the measures have still not been completely lifted, residents of LTCFs are assumed to still experience social isolation and be at high risk of encountering prolonged feelings of loneliness, which can be detrimental to their mental health and well-being.

COVID-19 pandemic: the impact on Canada’s intensive care units

The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity.

The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces.

Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions.

This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.

When 'Being There' Is Disallowed: Disruptions to Knowing and Caring During COVID-19 Visitor Restrictions

This qualitative study explored the accounts of five health professionals working in hospitals in Hamilton, Ontario, Canada who provided end-of-life care during the COVID-19 pandemic. The study goal was to understand how palliative care providers experienced and responded to the significant change in family presence when visitors were restricted to slow the spread of the virus. Identified was the loss and disruption of important forms of knowing including observational and embodied knowing. Family members' knowledge of how their person was faring was curtailed, as was providers' capacities to know families personally. Family members' less obvious needs did not come forward as readily in the absence of informal encounters with providers. Constraints on knowing and embodied actions often meant phone and video meetings failed to provide meaningful connection. Providers adapted their practice in a range of ways, including by offering verbal and visual images of the person in the setting, paying attention differently, and conveying to family members their knowledge of patients as individuals. The changes and challenges health providers remarked on and the ways they adapted and extended themselves reveal in a new way how the regular presence of family in the care setting shapes the quality of end-of-life care.

A scoping review of the experiences and well-being of siblings of children with chronic kidney disease: implications for practice and research

BACKGROUND

Children with chronic kidney disease (CKD) and their families deal with challenging circumstances. While numerous studies have shown that both patients and parents in these families can experience a variety of challenges and concerns, the experience of siblings is less well understood. The focus of this scoping review was on research addressing the experiences and well-being of siblings of children with CKD.

METHODS

Following scoping review methodology, five databases were searched for peer-reviewed research or graduate theses published in English that addressed the experience or well-being of siblings aged 25 years or younger (biological, step or foster) of children with CKD; studies from any year or location were included. Two independent coders identified relevant studies. Findings were summarized and synthesized.

RESULTS

Of the 2990 studies identified, 19 were chosen for full text review and eight fit the inclusion criteria. Five of the selected studies were qualitative, two were quantitative and one used mixed-methods. Four broad themes across studies were identified including family functioning, significant relationships, psychological well-being, and coping strategies. While there was some convergence between qualitative and quantitative findings, these linkages were weak.

CONCLUSIONS

Several unmet needs of siblings were uncovered by this review. Sibling perceptions of differential parental treatment and desire for information about CKD emerged as priorities for practice. Using a strength-based approach in order to better understand sibling experiences and well-being was also recommended for future research. A higher resolution version of the Graphical abstract is available as Supplementary information.

Nurse perceptions of a nurse family liaison implemented during the COVID-19 pandemic: A qualitative thematic analysis

Objective

Stress among family members of hospitalised intensive care unit patients may be amplified in the context of a global pandemic and strict visitor restrictions. A nurse family liaison role in the COVID-19 units was implemented to serve as a connection between the care team and a designated family member. Our objective was to describe the experience of a nurse family liaison role implemented during the COVID-19 pandemic from the perspective of nurses who functioned in the liaison role and intensive care nurses who worked with the liaisons.

Research method/design

This was a qualitative study using thematic analysis involving a one-time semi-structured interview. A convenience sample of nurses were invited to participate. The analytic approach involved (1) becoming familiar with the data; (2) finding meaning in the data; (3) organising meaningful statements into patterns to generate themes.

Setting/participants

Nurses who functioned in the liaison role and intensive care nurses who worked with the liaisons in an adult academic health center in the Midwest United States.

Main outcome measure

To describe the psychosocial experience of nurse family liaison role implementation.

Findings

The sample (n = 11) mean age was 36 years (range 26–49) and the majority were female (n = 10; 90%), White/non-Hispanic (n = 11; 100%), Bachelor prepared (n = 10; 90%), and had an average of 10 years of experience as a nurse (range 4–25). The major themes identified by participants were living in a pandemic, establishing the role and workflow and experiencing human connection.

Conclusion

Hospital organisations should consider how they can provide family-centred care, specifically within the context of a global crisis such as a pandemic. Participant descriptions of the role indicate that liaison implementation alleviated nurse moral distress and fostered development of close family connections. Findings can help inform implementation of similar roles in hospital settings.

Impact of the COVID-19 pandemic on developmental care practices for infants born preterm

OBJECTIVES

To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm.

METHODS

We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 (n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates.

RESULTS

Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p = 0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p = 0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p = 0.001). In 2020, developmental care activities were 5 min shorter, on average, than in 2019, p = 0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies.

CONCLUSIONS

The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.

Can paternalistic leaders enhance knowledge sharing? The roles of organizational commitment and Islamic work ethics

Purpose

This paper aims to investigate the effect of paternalistic leadership (benevolent, moral and authoritarian) on knowledge sharing of nurses through the mediation of organizational commitment (affective, continuance and normative). Further, the study examines the moderating role of Islamic work ethics on the association between organizational commitment and knowledge sharing.

Design/methodology/approach

In this quantitative study, data was collected from 312 nurses working in the health-care sector of Pakistan through “Google Forms” in two waves. Moreover, structural equation modeling was used to test the proposed hypotheses.

Findings

The study noted affective and normative commitment as mediators between the associations of benevolent, moral and authoritarian leadership with knowledge sharing, whereas continuance commitment was not found as an explaining variable. In addition, Islamic work ethics was found to strengthen the association of affective and normative commitment with knowledge sharing. However, Islamic work ethics was found to weaken the association between continuance commitment and knowledge sharing.

Practical implications

This study offers practical insights for health-care executives to act as fatherly figures to enhance the knowledge sharing of their nurses. The study recommends that managers in the health-care system build such an environment that helps nurses follow Islamic work ethics. It may enhance their level of organizational commitment and encourage them to engage in knowledge sharing behaviors to have a successful work environment.

Originality/value

To the best of the authors’ knowledge, this research is the first to extend the literature on paternalistic leadership. More specifically, this study investigated how various dimensions of paternalistic leadership (benevolent, moral and authoritarian) effects three-dimensional commitment (affective, continuance and normative) to enhance knowledge sharing behavior among nurses.

The Impact of Visiting Restrictions During the COVID-19 Pandemic on Pediatric Patients

Visitor restriction policies have been implemented on many hospital units as a result of the Covid-19 pandemic. These policies are integral to the strategies that hospitals are using to limit exposure risks during the pandemic. However, visitor restriction policies disproportionally affect hospitalized children. The trauma caused by lack of family at the bedside of adult patients during the Covid-19 pandemic has been studied but there is a lack of primary research on the impact of the Covid-19 visiting policy restrictions on pediatric patients. Long term studies are needed to understand the effect of this separation on children and their caregivers.