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Ku Carbonell SE, Ogba P, Vanstone M, Gombay C, Darling EK. Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review. Midwifery 2024; 136:104065. [PMID: 38963995 DOI: 10.1016/j.midw.2024.104065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
PROBLEM Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises. BACKGROUND Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances. AIM To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care. STUDY METHODS Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework. FINDINGS We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice. CONCLUSION The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.
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Affiliation(s)
- Susana E Ku Carbonell
- McMaster Midwifery Research Center, McMaster University, 1280 Main St W, HSC 4H24, Hamilton, ON L8S 4K1, Canada; Global Health Graduate Programs, McMaster University, 1280 Main Street W, MDCL 3500, Hamilton, ON L8S 4K1, Canada
| | - Patricia Ogba
- Global Health Graduate Programs, McMaster University, 1280 Main Street W, MDCL 3500, Hamilton, ON L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON L8P 1H6, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, HSC 2C, Hamilton, ON L8S 4K1, Canada
| | - Christy Gombay
- Global Health Graduate Programs, McMaster University, 1280 Main Street W, MDCL 3500, Hamilton, ON L8S 4K1, Canada
| | - Elizabeth K Darling
- McMaster Midwifery Research Center, McMaster University, 1280 Main St W, HSC 4H24, Hamilton, ON L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, HSC 2C, Hamilton, ON L8S 4K1, Canada; Department of Obstetrics and Gynaecology, McMaster University, 1280 Main St W, HSC 2F, Hamilton, ON L8S 4K1, Canada.
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Shaw CA, Lee KR, Williams A, Shaw NA, Weeks D, Jackson L, Williams KN. Best practices for communication while wearing facemasks: A scoping review. J Nurs Scholarsh 2024; 56:227-238. [PMID: 37937861 PMCID: PMC10922106 DOI: 10.1111/jnu.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Facemasks are an important piece of personal protective equipment (PPE) to mitigate the spread of respiratory illnesses, but they can impede communication between patients and healthcare providers. The purpose of this scoping review is to identify effective communication practices while wearing facemasks. DESIGN Scoping review using a systematic search of articles from the PubMed, CINAHL, and Embase databases. METHODS The PEO (population, exposure, outcome) methodology was selected for this systematic scoping review. The population of interest (P) includes humans of all ages (children, adults, and older adults); the exposure of interest (E) is PPE that covers the mouth (i.e., facemasks); and the outcome of interest (O) is successful or unsuccessful communication practices. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals appraisal guidelines were used to determine the level and quality of the research. RESULTS Thirty-nine articles met the inclusion criteria. Seventeen of these were high- or good-quality research studies, and the remaining 22 were non-research articles included with separate analysis as part of the scoping review. The 17 articles encompassed 2656 participants. The highest quality evidence indicated that standard surgical masks have the least impact on speech perception compared to other non-transparent mask types, and that recognizing emotions is less accurate with facemasks, necessitating compensatory actions (i.e., reducing extraneous noise, using a microphone to amplify voice, and employing clear speech). Evidence was contradictory regarding the use of transparent masks. Evidence was of limited quality for other non-verbal and verbal communication strategies. CONCLUSION Awareness of communication challenges is crucial when wearing facemasks. More high-quality studies are needed to evaluate communication techniques when speakers are wearing facemasks. Basic strategies such as selecting an appropriate mask type, reducing extraneous noise, using microphones, verbalizing emotions, and employing clear speech appear to be beneficial. CLINICAL RELEVANCE The findings of this scoping review highlight the importance of considering communication challenges while wearing facemasks in the healthcare settings. The review suggests that selecting an appropriate mask type, reducing extraneous noise, verbalizing emotions, and employing clear speech are some strategies that may be effective in mitigating the impact of facemasks on communication between patients and healthcare providers.
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Affiliation(s)
- Clarissa A. Shaw
- University of Iowa, College of Nursing, Division of Acute and Critical Care
| | | | | | - Nathan A. Shaw
- University of Iowa, Carver College of Medicine, Department of Family Medicine
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Rendon L, Taifour T, Ventrella CR, Seara A, Donovan AA. Personal Protective Equipment Portraits Canada (PPC)-Humanization and surveying mask-wearing nationally. PLoS One 2024; 19:e0298052. [PMID: 38394148 PMCID: PMC10889603 DOI: 10.1371/journal.pone.0298052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Personal Protective Equipment (PPE) Portraits is a hybridized art and medical intervention that lessens the alienating appearance of PPE through wearable, smiling headshot pictures. During the pandemic, the use of these portraits was expanded, but Canadian initiatives offered portraits only to immediate stakeholders. PPE Portraits Canada (PPC) aimed to provide PPE portraits to any Canadian healthcare institution and surveyed healthcare workers (HCW) regarding these portraits' impact. METHODS University student volunteers founded PPC via online platforms and coast-to-coast collaborations that allowed any HCW nationwide to request a free portrait via an accessible online form. PPC has gathered feedback from participating HCWs directly via an anonymous and bilingual survey. RESULTS 70% of HCWs wore their portraits "always" or "usually", 69% of HCWs "definitely would" recommend their portrait, 89.5% of HCWs found that the PPE portraits made a difference in their experiences with patients and 74% found the same for their colleagues. The pre- and post-effect of the portraits, led to a 37.5% greater likelihood that HCWs felt "connected" or "very connected" to patients/residents. For the thematic analysis, 70% or more of the comments were rated as positive, with less than 5% of comments being rated as negative. CONCLUSION This model's logistical framework can be expanded beyond PPE portraits to other initiatives with limited resources, allowing them to reach and positively impact diverse populations. HCW feedback was predominantly positive. The optimal design and impact of PPE portraits on patients and HCWs should be studied further to improve portrait adoption.
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Affiliation(s)
- Laura Rendon
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Tarek Taifour
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | | | - Ana Seara
- Veterans Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adamo A. Donovan
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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Price A, Lin YL, Levin AS, Tumietto F, Almeida R, Almeida A, Ciofi-Silva CL, Fontana L, Oliveira N, Parisi NF, Mainardi GM, Cordeiro L, Roselli M, Shepherd P, Morelli L, Mehrabi N, Price K, Chan W, Srinivas S, Harrison TK, Chu M, Padoveze MC, Chu L. Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study. JMIR Res Protoc 2022; 11:e36549. [PMID: 36454625 PMCID: PMC9756122 DOI: 10.2196/36549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. OBJECTIVE This study will assess whether the L-PAPR improves health care professionals' comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. METHODS This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user's perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. RESULTS We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. CONCLUSIONS The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/36549.
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Affiliation(s)
- Amy Price
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Anna S Levin
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Tumietto
- Unit of Antimicrobial Stewardship, Local Health Authority, City of Bologna, Bologna, Italy
| | | | - Ana Almeida
- Federal University of Itajubá, Minas Gerais, Brazil
| | | | | | - Naila Oliveira
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paul Shepherd
- Animation and Media Arts Concentration, Academy of Film, Hong Kong Baptist University, Hong Kong, China
| | | | | | - Kathleen Price
- College of Health Sciences and Technology, St Thomas University, Miami, FL, United States
| | - Whitney Chan
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Shrinidhy Srinivas
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - May Chu
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | - Larry Chu
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
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McCool N, Reidy J, Steadman S, Nagpal V. The Buddy System: An Intervention to Reduce Distress and Compassion Fatigue and Promote Resilience on a Palliative Care Team During the COVID-19 Pandemic. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:302-324. [PMID: 36129825 DOI: 10.1080/15524256.2022.2122650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The SARS-CoV-2 pandemic (COVID-19) dramatically increased the number of stressors on healthcare workers, including palliative care practitioners. Restrictions and increased demands on time made it difficult for the UMass Memorial Health palliative care team to utilize preexisting wellness strategies. In response to team members' stress reactions, a buddy system intervention was conceived and implemented to restore a sense of connection and self-efficacy (Phase 1). Our objective with this quality improvement project was to assess the feasibility and effectiveness of the buddy system and evaluate staff attitudes toward this intervention. After four months, feedback from team members informed redesign to a more structured buddy system (Phase 2). A mixed-methods design of this project included a qualitative online survey along with quantitative data collection with the Professional Quality of Life Scale V (ProQOL V) and the Brief Resilience Scale (BRS) during Phase 1. Phase 2 was also evaluated quantitatively with ProQOL V and BRS. Semi-structured interviews were conducted at the end of this project to enhance qualitative data on staff attitudes and beliefs. Of the 12 study participants, 10 completed all phases of the study. Participants reported the buddy system was a useful, easy-to-implement intervention for mitigating personal distress and compassion fatigue (CF) by providing a strong sense of support and connection to team members.
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Affiliation(s)
- Nancy McCool
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Jennifer Reidy
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Shawna Steadman
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Vandana Nagpal
- Division of Palliative Care, UMass Chan Medical School, UMass Memorial Health, Worcester, MA, USA
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Hansen-Barkun C, Kherad O, Donovan AA, Prashad AJ, Sewitch MJ. Personal protective equipment portraits in the era of COVID-19. Eur J Intern Med 2022; 102:125-127. [PMID: 35660324 PMCID: PMC9132790 DOI: 10.1016/j.ejim.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Omar Kherad
- Department of Internal Medicine, Hôpital de la Tour and University of Geneva, Switzerland
| | | | | | - Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Canada; Division of Clinical Epidemiology, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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Curtin M, Richards HL, Fortune DG. Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies. Clin Psychol Rev 2022; 95:102173. [PMID: 35636130 PMCID: PMC9126830 DOI: 10.1016/j.cpr.2022.102173] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 12/23/2022]
Abstract
Background Aim Method Results Conclusion
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Affiliation(s)
- Mariah Curtin
- Department of Psychology, University of Limerick, Limerick V94 T9P, Ireland
| | - Helen L Richards
- Department of Psychology, University of Limerick, Limerick V94 T9P, Ireland; Department of Clinical Health Psychology, Mercy University Hospital, Cork T12 WE28, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Limerick V94 T9P, Ireland; Clinical Psychology, Health Service Executive, CHO3 Mid West, Ireland.
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Differential Impacts of the COVID-19 Pandemic on Mental Health Symptoms and Working Conditions for Senior and Junior Doctors in Australian Hospitals. J Occup Environ Med 2022; 64:e291-e299. [PMID: 35121691 DOI: 10.1097/jom.0000000000002505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study investigated severity, prevalence, and predictors of workplace disruption and mental health symptoms in Australian junior and senior hospital medical staff during the COVID-19 pandemic. METHODS A cross-sectional survey collected data on demographics, workplace disruption, personal relationships, and mental health. RESULTS One thousand twenty-one (62.1%) senior and 745 (37.9%) junior medical staff, located primarily in Victoria, completed the survey. Work disruptions were common but varied by seniority, withjunior staff more frequently exposed to COVID- 19 (P < 0.001). Symptoms of anxiety, depression, post-traumatic stress disorder and burnout were common but significantly higher in junior doctors (P = 0.011 to < 0.001). Common predictors for experiencing mental health symptoms were identified, including prior mental health diagnoses and worsening personal relationships. CONCLUSIONS COVID-19 has had significant but varied impacts on junior and senior doctors, with junior doctors particularly susceptible to harm to mental health. Interventions to safeguard hospital medical staff and prevent attrition of this important workforce are urgently needed.
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Miyazaki Y, Kamatani M, Suda T, Wakasugi K, Matsunaga K, Kawahara JI. Effects of wearing a transparent face mask on perception of facial expressions. Iperception 2022; 13:20416695221105910. [PMID: 35782828 PMCID: PMC9243485 DOI: 10.1177/20416695221105910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
Abstract
Wearing face masks in public has become the norm in many countries post-2020. Although mask-wearing is effective in controlling infection, it has the negative side effect of occluding the mask wearer's facial expressions. The purpose of this study was to investigate the effects of wearing transparent masks on the perception of facial expressions. Participants were required to categorize the perceived facial emotion of female (Experiment 1) and male (Experiment 2) faces with different facial expressions and to rate the perceived emotion intensity of the faces. Based on the group, the participants were assigned to, the faces were presented with a surgical mask, a transparent mask, or without a mask. The results showed that wearing a surgical mask impaired the performance of reading facial expressions, both with respect to recognition and perceived intensity of facial emotions. Specifically, the impairments were robustly observed in fear and happy faces for emotion recognition, and in happy faces for perceived intensity of emotion in Experiments 1 and 2. However, the impairments were moderated by wearing a transparent mask instead of a surgical mask. During the coronavirus disease 2019 (COVID-19) pandemic, the transparent mask can be used in a range of situations where face-to-face communication is important.
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Affiliation(s)
- Yuki Miyazaki
- />Department of Psychology, Fukuyama University, Fukuyama, Japan
| | - Miki Kamatani
- />Graduate School of Letters, Hokkaido University, Sapporo, Japan
| | | | | | - Kaori Matsunaga
- />Global Research & Development Division, Unicharm Corporation, Kanonji,
Japan
| | - Jun I. Kawahara
- />Graduate School of Letters, Hokkaido University, Sapporo, Japan
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Istanboulian L, Rose L, Yunusova Y, Dale C. Barriers to and facilitators for supporting patient communication in the adult ICU during the COVID-19 pandemic: A qualitative study. J Adv Nurs 2022; 78:2548-2560. [PMID: 35266178 PMCID: PMC9111498 DOI: 10.1111/jan.15212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Harvitz Brain Sciences Program, Sunnybrook Research Institute Wellness Way, Toronto, Ontario, Canada
| | - Craig Dale
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Baratta J, Amano A, Parsons PK, Vilendrer S, Winter SG, Verano MR, Perez C, Kalanithi L, Asch SM, Heffernan MB, Brown-Johnson C. Developing best practices for PPE Portraits across 25 sites: a systematic assessment of implementation and spread of adaptations using FRAME. BMC Health Serv Res 2021; 21:1182. [PMID: 34717597 PMCID: PMC8556769 DOI: 10.1186/s12913-021-06922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adaptation, a form of modification that aims to improve an intervention's acceptability and sustainability in each context, is essential to successful implementation in some settings. Due to the COVID-19 pandemic, clinicians have rapidly adapted how they deliver patient care. PPE Portraits are a form of adaptation, whereby health workers affix a postcard size portrait of themselves to the front of their personal protective equipment (PPE) to foster human connection during COVID-19. METHODS We used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) method to better understand the reasoning behind and results of each adaptation. We hypothesized that using the FRAME in conjunction with design-thinking would lead to emerging best practices and that we would find adaptation similarities across sites. Throughout multiple implementations across 25 institutions, we piloted, tracked, and analyzed adaptations using FRAME and design thinking. For each adaptation, we assessed the stage of implementation, whether the change was planned, decision makers involved, level of delivery impacted, fidelity to original intervention, and the goal and reasoning for adaptation. We added three crucial components to the FRAME: original purpose of the adaptation, unintended consequences, and alternative adaptations. RESULTS When implementing PPE Portraits across settings, from a local assisted living center's memory unit to a pediatric emergency department, several requests for adaptations arose during early development stages before implementation. Adaptations primarily related to (1) provider convenience and comfort, (2) patient populations, and (3) scale. Providers preferred smaller portraits and rounded (rather than square) laminated edges that could potentially injure a patient. Affixing the portrait with a magnet was rejected given the potential choking hazard the magnetic strip presented for children. Other adaptations, related to ease of dissemination, included slowing the process down during early development and providing buttons, which could be produced easily at scale. CONCLUSIONS The FRAME was used to curate the reasoning for each adaptation and to inform future dissemination. We look forward to utilizing FRAME including our additions and design thinking, to build out a range of PPE Portrait best practices with accompanying costs and benefits.
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Affiliation(s)
- Juliana Baratta
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Alexis Amano
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | | | - Stacie Vilendrer
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Shira G Winter
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Mae-Richelle Verano
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Cynthia Perez
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Lucy Kalanithi
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Steven M Asch
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA
| | - Mary Beth Heffernan
- Occidental College Department of Art and Art History, 1600 Campus Rd, CA, 90041, Los Angeles, USA
| | - Cati Brown-Johnson
- Stanford Division of Primary Care and Population Health, 1265 Welch Rd, CA, 94305, Palo Alto, USA.
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