A novel conceptual model of trauma-informed care for patients with post-acute sequelae of SARS-CoV-2 illness (PASC)

COVID-19 and collective trauma: Implementing a trauma-informed model of care for post-COVID patients

AIM

To describe the implementation of a trauma-informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW.

DESIGN

Discussion paper.

DATA SOURCES

Evidence gathered from a literature search (2008-2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews.

DISCUSSION

The literature highlights the high prevalence of trauma in patients following COVID-19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma-informed model of care was implemented.

CONCLUSION

Reconceptualizing COVID-19 as a 'collective trauma' can help healthcare workers understand the needs of post-COVID patients and enable them to respond empathetically. A trauma-informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic.

IMPLICATIONS FOR NURSING AND PATIENT CARE

Frontline healthcare workers, particularly nurses, are well positioned to implement trauma-informed care due to their high-level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided.

IMPACT

The COVID-19 pandemic has led to adverse physical and mental health outcomes for many. Trauma-informed care is a way to promote reengagement with the healthcare system in this group. Post COVID patients globally may benefit from this approach, as it aims to build trust and independence.

PATIENT OR PUBLIC CONTRIBUTION

Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post-COVID patient.

Sociolocation: A Proposed Conceptual Element in Lifespan Development

Individual identity as a function of human development significantly intersects with and is necessarily influenced by the social world. To describe this intersection and its effects, the term sociolocation was proposed, initially in the context of adolescent development, and defined as "self-identification and recognition of social integration through relationships." Almost a decade later, it is apparent that the processes of sociolocation may continue and repeat through the rest of the lifespan. The purpose of this, therefore, paper is to present an expanded definitional and conceptual analysis of sociolocation using the techniques described by Chinn, Kramer, and Sitzman. Such an analysis is important across nursing science, practice, and education, since in all three domains the nurse may encounter individuals engaged in sociolocation. Understanding what this process is and when and how it may occur can be helpful in care planning, learning, and research endeavors.

"None of us are lying": an interpretive description of the search for legitimacy and the journey to access quality health services by individuals living with Long COVID

BACKGROUND

Understanding of Long COVID has advanced through patient-led initiatives. However, research about barriers to accessing Long COVID services is limited. This study aimed to better understand the need for, access to, and quality of, Long COVID services. We explored health needs and experiences of services, including ability of services to address needs.

METHODS

Our study was informed by the Levesque et al.'s (2013) "conceptual framework of access to health care." We used Interpretive Description, a qualitative approach partly aimed at informing clinical decisions. We recruited participants across five settings. Participants engaged in one-time, semi-structured, virtual interviews. Interviews were transcribed verbatim. We used reflexive thematic analysis. Best practice to ensure methodological rigour was employed.

RESULTS

Three key themes were generated from 56 interviews. The first theme illustrated the rollercoaster-like nature of participants' Long COVID symptoms and the resulting impact on function and health. The second theme highlighted participants' attempts to access Long COVID services. Guidance received from healthcare professionals and self-advocacy impacted initial access. When navigating Long COVID services within the broader system, participants encountered barriers to access around stigma; appointment logistics; testing and 'normal' results; and financial precarity and affordability of services. The third theme illuminated common factors participants liked and disliked about Long COVID services. We framed each sub-theme as the key lesson (stemming from all likes and dislikes) that, if acted upon, the health system can use to improve the quality of Long COVID services. This provides tangible ways to improve the system based directly on what we heard from participants.

CONCLUSION

With Long COVID services continuously evolving, our findings can inform decision makers within the health system to better understand the lived experiences of Long COVID and tailor services and policies appropriately.

How do the Social Determinants of Health Impact the Post-Acute Sequelae of COVID-19: A Critical Review

The review critically analyzes the social determinants of health (SDOH) variables in the current literature of patients with post-acute sequelae (PASC) of COVID-19 in the United States. Race, gender, and age were discussed as well as health outcomes, severity of illness, and phenotypes of long-COVID. Most research was retrospectively with samples that had access to health insurance, which did not capture populations with poor or no access to health care. More research is needed that directly addresses the impact on SDOH on PASC. The current literature is sparse and provides little actionable information.

Integration of Trauma-informed Care Into the Doctor of Pharmacy Curriculum

Trauma-informed care (TIC) is a framework based on understanding and responding to individuals' experiences of psychological trauma (defined as harmful circumstances that have a lasting impact on emotional well-being), as well as fostering their sense of safety and empowerment. Health profession degree programs are increasingly integrating TIC training into their curricula. Although literature is scarce regarding TIC education in academic pharmacy, student pharmacists will likely encounter patients, co-workers, and peers who have experienced psychological trauma. Students may also have experienced psychological trauma themselves. Therefore, student pharmacists would benefit from TIC learning, and pharmacy educators should consider implementing trauma-informed education. This commentary defines the TIC framework, explores its benefits, and considers an approach to implementing the TIC framework in pharmacy education with little disruption to existing curricula.

The effect of SARS-CoV-2 variant on respiratory features and mortality

SARS-CoV-2 (COVID-19) has caused over 80 million infections 973,000 deaths in the United States, and mutations are linked to increased transmissibility. This study aimed to determine the effect of SARS-CoV-2 variants on respiratory features, mortality, and to determine the effect of vaccination status. A retrospective review of medical records (n = 55,406 unique patients) using the University of California Health COvid Research Data Set (UC CORDS) was performed to identify respiratory features, vaccination status, and mortality from 01/01/2020 to 04/26/2022. Variants were identified using the CDC data tracker. Increased odds of death were observed amongst unvaccinated individuals and fully vaccinated, partially vaccinated, or individuals who received any vaccination during multiple waves of the pandemic. Vaccination status was associated with survival and a decreased frequency of many respiratory features. More recent SARS-CoV-2 variants show a reduction in lower respiratory tract features with an increase in upper respiratory tract features. Being fully vaccinated results in fewer respiratory features and higher odds of survival, supporting vaccination in preventing morbidity and mortality from COVID-19.