How COVID-19 pandemic changed our communication with families: losing nonverbal cues

If instruments could talk: Trace-based communication and its implications in the curriculum for trainee-supervisor interactions

Contrary to common belief, effective communication is not only achieved via verbal exchanges of information. It requires a thoughtful combination of verbal and non-verbal cues since, in some circumstances, verbal communication in healthcare may be impossible, unfavourable or ineffective. The semiotics literature suggests that effective non-verbal communication goes beyond body language and gestures. It also includes the use of objects (i.e. traces) to transmit a message. We call this trace-based communication (TBC). In this perspective paper, we offer some reflections from our experience researching and using trace-based communication for training purposes. Our intention was to bring further awareness to the opportunities that trace-based communication might enable, including opportunities to enhance trainee-supervisor interactions, and consequently inform curriculum design.

Learning to Communicate: A Photovoice Study With Intensive Care Residents During Night Shifts in the Intensive Care Unit

This study explored the learning experiences of intensive care residents in an intensive care unit (ICU) during night shifts and the development of communication skills in this community of practice. This action research qualitative study used the photovoice method in four workshops. A group of nine residents shared their learning experiences and collectively analyzed, built, and presented proposals to improve residents' communication skills in the community of practice in which they become intensivists. Participatory thematic analysis was conducted. Students concluded that night shifts in the ICU offered a perfect situational learning environment for communication with one-on-one resident-teacher relationships, less administrative work, and more resident responsibility, improving intensivist identity. Role models, reflective thinking, and teamwork are essential for fostering communication skills among intensivist community members and are all trainable. The results and student suggestions were presented to teachers and decision-makers in the clinic. These photovoice strategies developed students' abilities to share their critical views and suggestions with decision-makers for subsequent implementation, enhancing their confidence in their learning process, strengthening trust-based relationships with teachers, and improving future intensivists' practice communities.

Challenges for palliative care in times of COVID-19: a scoping review

Introduction

Many of the essential practices in palliative care (PC) had to be adapted to the COVID-19 pandemic. This global spread of the infectious respiratory disease, caused by SARS-CoV-2, created unprecedented obstacles. The aim of this research was to comprehensively assess the experiences and perceptions of healthcare professionals, individuals, and families in palliative and end-of-life situations during the COVID-19 pandemic.

Methods

A scoping review was conducted using the databases CINAHL Complete, MEDLINE, Scopus, SciELO, Cochrane Central Register of Controlled Trials, Psychology and Behavioral Sciences, MEDIClatina, and Portugal's Open Access Scientific Repository. The review followed the JBI® methodological approach for scoping reviews.

Results

Out of the initially identified 999 articles, 22 studies were included for analysis. The deprivation of relationships due to the safety protocols required to control the spread of COVID-19 was a universally perceived experience by healthcare professionals, individuals in PC, and their families. Social isolation, with significant psychological impact, including depersonalization and despair, was among the most frequently reported experiences by individuals in palliative situation. Despite healthcare professionals' efforts to mitigate the lack of relationships, the families of these individuals emphasized the irreplaceability of in-person bedside contact.

Systematic review registration

https://osf.io/xmpf2/.

Telehealth program for symptomatic COVID-19 patients in Mindanao, Philippines: a whole-of-system, pragmatic interventional study on patient monitoring from isolation facilities to community reintegration

The COVID-19 pandemic is impacting individuals and society's physical and mental health. Despite the lack of any definite and effective therapeutic regimen, public health measures such as quarantine and isolation have been instituted to contain this pandemic. However, these mitigating measures have also raised issues regarding isolated patients' mental and psychological well-being. Several stakeholders were engaged in this approach, including the university, the local health office, the tertiary hospital, and the local communities. This intervention addresses concerns regarding the health status of isolated individuals due to COVID-19 infection, making the program available to anyone who agrees to participate. This was done through telehealth services delivered via phone calls and SMS. The university provided technical support and telehealth manpower through medical students. The local health unit manages the isolation facilities, while the referral hospital offers specialty care for isolated patients through teleconsultation. Finally, the local community is the one that reintegrates discharged patients into their communities. Three hundred forty-four (344) participants were provided seven sessions on telehealth education and tracking of their COVID-19 prescribed practices and mental health. The mean age of the patients was 37 years; half were females, and 15% had comorbidities. Regarding their mental health status, the level of depression dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% (p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the first day of admission to 2 weeks after discharge. Moreover, a general trend of statistically significant increase in various practices was noted: wearing face masks, physical distancing, disinfecting frequently held objects, hand hygiene, and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of COVID-19 were referred immediately to the referral hospital. There were also no reports of complications of co-morbidities during their stay in the isolation facilities or social isolation upon community reintegration. The study concludes that telehealth services have the potential to address many challenges in providing continuous healthcare services to isolated patients until they are reintegrated into their community. Furthermore, a whole-of-society approach is necessary to provide holistic care to patients affected by the pandemic.

Environmental concerns and bioaccumulation of psychiatric drugs in water bodies - Conventional versus biocatalytic systems of mitigation

The COVID-19 pandemic has brought increments in market sales and prescription of medicines commonly used to treat mental health disorders, such as depression, anxiety, stress, and related problems. The increasing use of these drugs, named psychiatric drugs, has led to their persistence in aquatic systems (bioaccumulation), since they are recalcitrant to conventional physical and chemical treatments typically used in wastewater treatment plants. An emerging environmental concern caused by the bioaccumulation of psychiatric drugs has been attributed to the potential ecological and toxicological risk that these medicines might have over human health, animals, and plants. Thus, by the application of biocatalysis-assisted techniques, it is possible to efficiently remove psychiatric drugs from water. Biocatalysis, is a widely employed and highly efficient process implemented in the biotransformation of a wide range of contaminants, since it has important differences in terms of catalytic behavior, compared to common treatment techniques, including photodegradation, Fenton, and thermal treatments, among others. Moreover, it is noticed the importance to monitor transformation products of degradation and biodegradation, since according to the applied removal technique, different toxic transformation products have been reported to appear after the application of physical and chemical procedures. In addition, this work deals with the discussion of differences existing between high- and low-income countries, according to their environmental regulations regarding waste management policies, especially waste of the drug industry.

The Role of Psychological Safety in Enhancing Medical Students' Engagement in Online Synchronous Learning

Background

The COVID-19 pandemic instigated a global change in the delivery of undergraduate medical education, with an eminent shift from in-person to online teaching. The virtual methods that were utilised to a limited extent previously have now become the mainstay in education. The concept of psychological safety has been studied previously within medical education, but not in the distance learning context. The aim of the study was to explore students' experiences of online learning and to gain an understanding of the factors affecting psychological safety and its subsequent impact on their learning.

Methods

A qualitative, social constructivist approach was adopted in this research. Data collection involved semi-structured interviews with 15 medical students from the University of Dundee. There was a representation from each year group on the undergraduate medical course. Data was transcribed verbatim and analysed thematically.

Results

Five key themes were identified as motivation for learning, engagement with learning, fear of judgement, group learning and adjustment to online learning. Each of these comprised of interlinked subthemes related to peer and tutor interactions.

Conclusions

Drawing on students' experiences, the paper presents the significant interplay of group interactions and tutor attributes operating in the virtual synchronous learning environment. The relevance of psychological safety in student learning and experience, and strategies to foster it in online classrooms are discussed in the context of existing literature and proposed future developments.

Patient and Family Perpetrated Cyber-Incivility and Cyber-Aggression Within Healthcare: A Cross-Sectional Descriptive Study

Introduction

Verbal violence may manifest in written form as cyber incivility within patient portal communications. As a form of digital technology, patient portal messages create a physical and emotional distance leading the sender to be disinhibited and disassociated from the recipient nurse. Written patient portal messages may contain uncivil language deemed verbally violent when the content escalates beyond professional standards. When these messages are encountered as part of patient care, they may lead to nurses' psychological distress. Although cyber-incivility has been studied within social media and business, little is known about cyber-incivility within healthcare.

Objectives

The purpose of the study was to define cyber-incivility as it manifests within healthcare compared to business, determine sender demographics, and quantify the impact on nurses.

Methods

A cross-sectional descriptive study was conducted to analyze portal communications. Nurses forwarded aggressive messages to leadership and quantified their level of distress after receiving the message. Sender demographics were tracked, and content was analyzed using Braun and Clarke's Thematic Analysis.

Results

Of the 31 included messages, senders were of varying ages, genders, and marital statuses. Messages rarely related to medications and rarely contained expletives. The most distressing messages were ad hominem, demanding, accusatory, or contained threats. These messages illustrated how healthcare cyber-incivility manifested and deviated from appropriate professional standards to become a form of verbal workplace violence. Message content also identified antecedents; related to unmet expectations, patient accountability, or difficulty navigating healthcare.

Conclusions

Written incivil/uncivil/aggressive patient portal messages contained personal attacks and professionally degrading content, which were distressing to nurses. A healthcare-specific framework was created and provided context to understand the difficult and aggressive messages nurses received while providing digital patient care. Awareness of cyber-incivility within healthcare allows for better support of nurses who are exposed to this form of workplace violence and is foundational to future intervention development.

Family Communication and Psychological Distress in the Era of COVID-19 Pandemic: Mediating Role of Coping

This study aims to examine the association between family communication and psychological distress with coping as a potential mediator. The study also developed and validated the Family Communication Scale (FCS) in the context of COVID-19 pandemic. Participants (n = 658; 74.9% female) were general public ranged in age between 18 and 58 years (mean age = 26.38, SD = 10.01). The results showed that family communication directly influenced psychological distress and indirectly influenced through approach coping. However, avoidant coping was not directly associated with psychological distress, nor did it mediate the association between family communication and psychological distress. The findings suggest that people, who have better family communication, highly engage in approach coping which in turn leads to better psychological health in face of adversity. The findings have important empirical and theoretical implications.

Family Satisfaction in Intensive Care during the COVID-19 Pandemic Using the FS-ICU24 Questionnaire

INTRODUCTION

The COVID-19 pandemic caused an abrupt change in the pattern of communication involving patients, family members, and healthcare professionals. This study aimed to evaluate family member satisfaction with intensive care units (ICU) care and communication strategies during the COVID-19 pandemic. Secondary objectives included identification of areas requiring improvement, and assessment of the impact of both COVID-19 diagnosis and in-person visits on overall satisfaction.

MATERIAL AND METHODS

A prospective, observational single-center study was conducted among family members of ICU patients admitted between March and September 2020. During this period, ICU visiting policies suffered changes, ranging from full restrictions to eased limitations, which impacted ICU communication procedures and patient contact with family members. Three months after ICU discharge, the designated family members of patients were contacted and invited to fill in a questionnaire that assessed family satisfaction using a Likert response scale.

RESULTS

There was a total of 168 family members contacted (response rate of 57.7%). Most participants were globally satisfied with the care provided by the ICU staff and, apart from communication between nurses and family members, all other questions scored a satisfaction rate above 80%. The study found a statistically significant association between satisfaction and the consistency of clinical information provided and the possibility of having visits (p = 0.046). The odds ratio of being satisfied with information consistency was found to be 0.22 times lower in family members that were able to visit the patient in the ICU during the COVID-19 pandemic [OR = 0.22 (95% CI: 0.054 - 0.896)] compared with families that were unable to presential visit their family member. No statistically significant differences were found in the satisfaction rates between COVID-19 and non-COVID-19 admissions.

CONCLUSION

This is one of the first studies to assess satisfaction among family members of ICU patients during COVID-19 restrictions and the first, as far as we know, performed in the Portuguese population. The overall satisfaction levels were similar to the estimates found in previous studies. A lower degree of satisfaction with information consistency was found in family members who had in-person visits, possibly related with heterogeneity of senior doctors delivering information. COVID-19 diagnosis was not associated with decreased satisfaction.

Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers

Older people and health care workers in residential care homes are particularly vulnerable to the adverse impacts of the COVID-19 pandemic. As COVID-19 has been spreading around the world for more than two years, the nature of care delivery has been substantially transformed. This study aims at understanding the long-term and ongoing impacts of COVID-19 on the delivery of care in residential care homes. It investigates how the delivery of care has been transformed by the COVID-19 pandemic and how health care workers adapted to these changes from the perspectives of frontline health care workers. Semi-structured interviews were conducted from February to December 2021 with a purposive sample of 30 health care workers from six residential care homes in Hong Kong. Thematic analysis identified three themes, including (1) enhancing infection prevention and control measures; (2) maintaining the psychosocial wellbeing of residents; and (3) developing resilience. Discussions and implications were drawn from these findings.

Family satisfaction with intensive care unit communication during the COVID-19 pandemic: a prospective multicentre Australian study Family Satisfaction - COVID ICU

BACKGROUND

Virtual communication has become common practice during the coronavirus disease 2019 (COVID-19) pandemic because of visitation restrictions.

AIMS

The authors aimed to evaluate overall family satisfaction with the intensive care unit (FS-ICU) care involving virtual communication strategies during the COVID-19 pandemic period.

METHODS

In this prospective multicentre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all eligible ICU patients between 1 July 2020 and 31 October 2020 were requested to complete an adapted version of the FS-ICU 24-questionnaire. Group comparisons were analysed and calculated for family satisfaction scores: ICU/care (satisfaction with care), FS-ICU/dm (satisfaction with information/decision-making) and FS-ICU/total (overall satisfaction with the ICU). The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses.

RESULTS

Seventy-three of the 227 patients' NOK who initially agreed completed the FS-ICU questionnaire (response rate 32.2%). The mean FS-ICU/total was 63.9 (standard deviation [SD], 30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [SD, 30.3) vs 65.4 (SD, 31.4); P < 0.001]. There was no difference in mean FS-ICU/total scores between survivors (n = 65; 89%) and non-survivors (n = 8, 11%). Higher patient Acute Physiology and Chronic Health Evaluation III score, female NOK and the patient dying in the ICU were independent predictors for FS-ICU/total score, while a telephone call at least once a day by an ICU doctor was related to family satisfaction for FS-ICU/dm.

CONCLUSIONS

There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Efforts should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.

How Are You Feeling? Interpretation of Emotions through Facial Expressions of People Wearing Different Personal Protective Equipment: An Observational Study

(1) Background: The perception of others’ emotions based on non-verbal cues, such as facial expressions, is fundamental for interpersonal communication and mutual support. Using personal protection equipment (PPE) in a work environment during the SAR-CoV-2 pandemic challenged health professionals’ ability to recognise emotions and expressions while wearing PPE. The working hypothesis of this study was that the increased limitation of facial visibility, due to the use of a personal protective device, would interfere with the perception of basic emotions in the participants. (2) Methods: Through a cross-sectional descriptive study, the present research aimed to analyse the identification of four basic emotions (happiness; sadness; fear/surprise; and disgust/anger) through three types of PPE (FFP2 respirator, protective overall and powered air-purifying respirator (PAPR)), by using 32 photographs. The study was conducted using volunteer participants who met the inclusion criteria (individuals older than 13 without cognitive limitations). Participants had to recognise the emotions of actors in photographs that were randomly displayed in an online form. (3) Results: In general, the 690 participants better recognised happiness and fear, independently of the PPE utilised. Women could better identify different emotions, along with university graduates and young and middle-aged adults. Emotional identification was at its worst when the participants wore protective overalls (5.42 ± 1.22), followed by the PAPR (5.83 ± 1.38); the best scores were obtained using the FFP2 masks (6.57 ± 1.20). Sadness was the least recognised emotion, regardless of age. (4) Conclusions: The personal protective devices interfere in the recognition of emotions, with the protective overalls having the greatest impact, and the FFP2 mask the least. The emotions that were best recognised were happiness and fear/surprise, while the least recognised emotion was sadness. Women were better at identifying emotions, as well as participants with higher education, and young and middle-aged adults.

A Survey on Change in Communication Between Healthcare Professionals and Patients Before and During Coronavirus Disease-19 Pandemic

The World Health Organization declared the Coronavirus Disease 2019 (COVID-19) pandemic a public health emergency of international concern on 30 January, which caused difficulties among the healthcare professionals (HCPs). Since this pandemic led to strict use of rules and regulations in maintaining physical distancing, a turn was experienced in communication. This study is aimed at assessing communication skills between HCPs and patients before, during and to compare communication skills between them before and during the COVID-19 pandemic. A descriptive cross-sectional study was conducted at Pravara Rural Hospital, Loni, Maharashtra. Samples were included based upon the inclusion and exclusion criteria. Results were obtained with the help of statistical analysis. The present study shows that certain components of communication are changed when comparing before and during the COVID-19 pandemic. To curb the fear of HCP, certain measures can be implemented to reduce anxiety such as informative videos, images, brochures and many more.

Making knowledge clips with patients: What learning mechanisms are triggered in medical students?

OBJECTIVE

To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course.

METHODS

In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis.

RESULTS

We identified four learning mechanisms: Challenging assumptions about patients' information needs; Becoming aware of the origin of patients' information needs; Taking a patient's perspective; Analyzing language to adapt to patients' needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students.

CONCLUSION

Collaborating with patients helped students to recognize and understand patients' perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients.

PRACTICE IMPLICATION

Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients' perspectives.

Video calls did not reduce PTSD symptoms in relatives during restricted ICU visits in the COVID-19 pandemic

To help reduce the spread of the SARS-CoV-2 virus during the COVID-19 pandemic, ICU visits were banned or restricted. Therefore, family-centered care as usually practiced was not feasible Video calls were recommended to meet relatives’ needs. The aim of this study was to investigate the effect of video calls on symptoms of post-traumatic stress disorder (PTSD) in relatives of ICU patients. This single-center study was performed during the first wave (15.03.2020‒30.04.2020; visits banned) and the second wave (01.10.20‒08.02.21: visits restricted) of the COVID-19 pandemic. The Impact of Event Scale-Revised (IES-R) was used to assess PTSD symptoms and an adapted version of the Family Satisfaction in the Intensive Care Unit 24-Item-Revised questionnaire (aFS-ICU 24R) to assess family satisfaction 3 months after ICU stay. The primary outcome was the difference in IES-R score at 3 months between the video call group (VCG) and the standard care group (SCG, no video calls). In addition, inductive content analysis of relatives’ comments regarding their satisfaction with decision-making and ICU care was performed. Fifty-two relatives (VCG: n = 26, SCG: n = 26) were included in this study. No significant difference in IES-R scores was observed between the VCG and the SCG (49.52 ± 13.41 vs. 47.46 ± 10.43, p = 0.54). During the ICU stay (mean 12 days, range 5.25‒18.75 days), the members of the VCG made a median of 3 (IQR 1‒10.75) video calls. No difference between the groups was found for conventional telephone calls during the same period (VCG: 9 calls, IQR 3.75‒18.1; SCG: 5 calls, IQR 3‒9; p = 0.12). The aFS-ICU 24R scores were high for both groups: 38 (IQR 37‒40) in the VCG and 40 (IQR 37‒40: p = 0.24) in the SCG. Video calls appeared largely ineffective in reducing PTSD symptoms or improving satisfaction among relatives affected by banning/restriction of ICU visits during the COVID-19 pandemic. Further investigations are needed to acquire more data on the factors involved in PTSD symptoms experienced by relatives of ICU patients during the COVID-19 pandemic.

Implementations and strategies of telehealth during COVID-19 outbreak: a systematic review

Background

Telehealth is an effective option to fight the outbreak of COVID-19. This review aims to systematically characterize the utilization and applications of telehealth during the COVID-19 pandemic focusing mainly on technology implementations.

Methods

This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The literature search was conducted in Science Direct, IEEE XPLORE, Scopus, and Web of Science databases from January 2020 until July 2021, with an English language restriction. A quality assessment was based on the Critical Appraisal Skills Programs checklist.

Results

The included studies focused on the implementation of technology for telehealth, multidisciplinary approach, service satisfaction, guidelines, and medical training. They provided illustrative insight into the strategy of telehealth in different medical specialties, such as pediatric gastroenterology, oncology, ophthalmology, and laryngology. Nonsurgical specialties had the greatest number of telehealth visits. Clinicians showed positive attitudes toward the implementation of video telehealth visits; patients report high levels of satisfaction with this care and strong interest in continuing this modality as a significant portion of clinical practice.

Conclusions

This systematic review provided an illustrative insight into the strategy of telehealth for different purposes. According to our findings, telehealth may be used in different medical area with a clear strategy of intervention according to patients’ and doctors’ needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08235-4.

"Patient's Family Wants an Update": A Curriculum for Senior Medical Students to Deliver Telephone Updates for Hospitalized Patients

Introduction

Residents have the important task of updating family members of hospitalized patients, often by telephone. There are limited curricula dedicated to preparing medical students for this task, which will become their responsibility as residents.

Methods

We created a virtual workshop, including four patient cases, to facilitate teaching senior medical students enrolled in an internal medicine residency preparation course. Students alternated role-playing either physician or family member. We assessed performance using a self-assessment rubric before (preworkshop) and after (postworkshop) a didactic session. We compared pre- and postworkshop scores using t tests. We also used a retrospective pre-post survey with a 5-point Likert scale to assess each participant's comfort level, knowledge, and perceived ability.

Results

Thirty-nine students completed the pre- and postworkshop evaluation (response rate: 70%). The mean score on the preworkshop self-assessment was 83% (SD = 9%) and on the postworkshop self-assessment was 94% (SD = 8%; p < .01), with a large effect size of 1.22. Among the 31 students (62%) who completed the survey, there was improvement in comfort level (2.9 vs. 3.7, p < .001), knowledge (2.7 vs. 3.8, p < .001), and perceived ability (2.9 vs. 3.7, p < .001).

Discussion

Our workshop was effective in teaching medical students a structured format for providing telephone updates and was well received. The workshop was also effective when delivered virtually (with videos off) to mimic the non-face-to-face communication that occurs when delivering family updates by telephone. The curriculum could be expanded to other learner groups.

Use of Video Technology in End-of-Life Care for Hospitalized Patients During the COVID-19 Pandemic

BACKGROUND

Infection control protocols, including visitor restrictions, implemented during the COVID-19 pandemic threatened the ability to provide compassionate, family-centered care to patients dying in the hospital. In response, clinicians used videoconferencing technology to facilitate conversations between patients and their families.

OBJECTIVES

To understand clinicians' perspectives on using videoconferencing technology to adapt to pandemic policies when caring for dying patients.

METHODS

A qualitative descriptive study was conducted with 45 clinicians who provided end-of-life care to patients in 3 acute care units at an academically affiliated urban hospital in Canada during the first wave of the pandemic (March 2020-July 2020). A 3-step approach to conventional content analysis was used to code interview transcripts and construct overarching themes.

RESULTS

Clinicians used videoconferencing technology to try to bridge gaps in end-of-life care by facilitating connections with family. Many benefits ensued, but there were also some drawbacks. Despite the opportunity for connection offered by virtual visits, participants noted concerns about equitable access to videoconferencing technology and authenticity of technology-assisted interactions. Participants also offered recommendations for future use of videoconferencing technology both during and beyond the pandemic.

CONCLUSIONS

Clinician experiences can be used to inform policies and practices for using videoconferencing technology to provide high-quality end-of-life care in the future, including during public health crises.

Survey on the effectiveness of telephone-based communication with relatives of hospitalized cancer patients in COVID-19 era in Italy

Objective

Methods

Results

Conclusion

Protocols of Anesthesia Management in Parturients with SARS-CoV-2 Infection

Background: Our hospital became a referral center for COVID-19-positive obstetric patients from 1 May 2020. The aim of our study is to illustrate our management protocols for COVID-19-positive obstetric patients, to maintain safety standards for patients and healthcare workers. Methods: Women who underwent vaginal or operative delivery and induced or spontaneous abortion with a SARS-CoV-2-positive nasopharyngeal swab using real-time PCR (RT-PCR) were included in the study. Severity and onset of new symptoms were carefully monitored in the postoperative period. All the healthcare workers received a nasopharyngeal swab for SARS-CoV-2 using RT-PCR serially every five days. Results: We included 152 parturients with COVID-19 infection. None of the included women had general anesthesia, an increase of severe symptoms or onset of new symptoms. The RT-PCR test was “negative” for the healthcare workers. Conclusions: In our study, neuraxial anesthesia for parturients’ management with SARS-CoV-2 infection has been proven to be safe for patients and healthcare workers. Neuraxial anesthesia decreases aerosolization during preoxygenation, face-mask ventilation, endotracheal intubation, oral or tracheal suctioning and extubation. This anesthesia management protocol can be generalizable.

Conditions and strategies to meet the challenges imposed by the COVID-19-related visiting restrictions in the intensive care unit: A Scandinavian cross-sectional study

OBJECTIVES

To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional survey.

SETTING

Adult intensive care units in Denmark, Norway and Sweden.

MAIN OUTCOME MEASURES

Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives.

RESULTS

The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March-June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described.

CONCLUSION

Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care.

A questionnaire-based study on quality and adequacy of clinical communication between physician and family members of admitted Covid-19 patients

OBJECTIVE

To assess adequacy of present means of clinical communication between physicians and (Covid-19) patients' family members, to analyse their perspectives and recommend felicitous practices for virtual conversation during ongoing pandemic.

METHODS

Cross-sectional questionnaire-based (20 questions) anonymous online survey was conducted including patient's relatives (Group-1) and treating physicians (Group-2), through Google Forms.

RESULTS

Response Rate was 82.5%. Group-1 and Group-2 included 155 and 204 respondents respectively. Group-1 preferred update by resident doctors (39%), twice a day (41.9%), daily case-summaries (80%) and hand-written document/electronic messages (53%,31%) as consent. Whereas Group-2 favored update by senior consultants (63%), daily one appraisal (55.9%) and scanned copies of hand written consent (81%) before high-risk procedures. The groups broadly agreed on the desired duration for a fruitful discussion (5-10 min) and designating one responsible person from the family for daily appraisal.

CONCLUSION

Use of modern techniques/technologies of communication (voice/video calls, texts) during the ongoing pandemic is acceptable to majority.

PRACTICE IMPLICATIONS

Study proposes a senior physician should communicate to a designated responsible family member at-least once a day for stable and twice a day for critical covid patients (more if patient's health condition changes), either by voice or video calls for 5-10 min.

A review of key strategies to address the shortage of analgesics and sedatives in pediatric intensive care

IMPORTANCE

Targeted analgosedation is a challenge in critically ill children, and this challenge becomes even more significant with drug shortages.

OBSERVATIONS

Published guidelines inform the provision of analgosedation in critically ill children. This review provides insights into general approaches using these guidelines during drug shortages in Pediatric Intensive Care Units as well as strategies to optimize both pharmacological and non-pharmacological approaches in these situations.

CONCLUSIONS AND RELEVANCE

Considering that drug shortages are a recurrent worldwide problem, this review may guide managing these drugs in critically ill children in situations of scarcity, such as in pandemics or disasters.

The Impact of COVID-19 on Palliative Care: Perspective of Healthcare Professionals

The COVID-19 pandemic has negatively impacted the provision of Palliative Care (PC), challenging the teams aiming to provide adequate care.

This is a qualitative study that intends to know, from the perspective of health professionals of a Palliative Care Unit (PCU), the main challenges in providing PC during a pandemic and describes the strategies to be adopted to solve the identified difficulties. We utilized the content analysis, according to Bardin, for data analysis of written narratives of health professionals from a PCU (n=14). In the analysis of the difficulties in providing PC, from the perspective of health professionals, were identified five themes: 1) Altered relationship between healthcare professional and patients, 2) altered relationship between healthcare professional and family, 3) altered communication with patients and their family, 4) altered working dynamic within the PCU, and 5) altered use of healthcare resources. Concerning the strategies to be implemented, the health professionals identified two themes: 1) Strategies to implement between the patient and family members and 2) strategies to implement for the healthcare professionals.

The provision of PC is affected by changes in the relationship between the health professional and the patient/caregiver or family, in communication with the patient/caregiver or family, and the use of health resources. In an attempt to lessen the impact of these changes, participants identified strategies to improve PC delivery in these circumstances. During this pandemic, it is imperative to implement rigorous strategies for managing specialized human resources. Physical distance and personal protective equipment are barriers to communication and emotional support, which is essential in PC and this barrier is further accentuated by the required physical distance from family members and caregivers. PC´s main aim continues to be the mitigation of suffering.

Impact of Restricted Visitation Policies During the First Wave of the COVID-19 Pandemic on Communication Between Critically Ill Patients, Families and Clinicians: A Qualitative Interview Study

Rationale

Restricted visitation policies during the first wave of the coronavirus disease (COVID-19) pandemic have had a major impact on the ways that intensive care unit (ICU) clinicians communicated with patients and their families, requiring the use of innovative strategies to adapt to new communication structures.

Objectives

The purpose of this study is to describe the impact of restricted visitation policies on communication and to identify strategies that could be used to facilitate better communication within Canadian ICUs from the perspective of those affected.

Methods

We conducted semistructured individual interviews with critically ill patients, their families, and clinicians from 23 Canadian ICUs during the first wave of the COVID-19 pandemic between July 2020 and October 2020. We used inductive thematic analysis to identify relevant themes and subthemes.

Results

Forty-one interviews were conducted with 3 patients, 8 family members, 17 nurses, and 13 physicians. Five themes were identified from the analysis: 1) patient and family psychosocial and information needs; 2) communication tools; 3) quality of communication; 4) changing roles and responsibilities of patients and nurses/physicians; and 5) facilitators or barriers to implementing alternative communication. Participants identified strategies to leverage new videoconference technology and communication structures to preserve the quality of communication.

Conclusions

Our study identified challenges and opportunities related to communication between critically ill patients, families, and ICU clinicians due to the restricted hospital visitation policies during the first wave of the COVID-19 pandemic. The use of videoconference technology and changes to communication structure were important strategies to facilitate effective communication within the ICU.

Lived Experiences of Hospitalized COVID-19 Patients: A Qualitative Study

The COVID-19 pandemic has resulted in many hospitalized patients and deaths worldwide. Coronavirus patients were isolated from their relatives and visits were banned to prevent contagion. This has brought about a significant change in deeply rooted care habits in Mediterranean and Latin American countries where the family normally accompanies vulnerable hospitalized patients. The aim of this qualitative study was to examine the hospitalization experience of COVID-19 patients and their family members. A phenomenological qualitative approach was used. Data collection included inductive, in-depth interviews with 11 COVID-19 hospitalized patients. The mean age of patients was 55.4 years and 45% were female. Nearly 50% required Intensive Care Unit (ICU) admission. Ten meaningful statements were identified and grouped in three themes: Positive and negative aspects of the care provided, the patient’s perspective, and perception of the experience of the disease. In conclusion, COVID-19 patients, aware of the severity of the pandemic, were very adaptable to the situation and had full confidence in health professionals. Patient isolation was perceived as necessary. Technology has helped to maintain communication between patients and relatives.

Commonly used terminology in oral surgery and oral medicine: the patient's perspective

Introduction Dentistry is progressing into person-centred care and away from a paternal approach. Effective verbal and written communication are crucial to allow this collaboration; however, misunderstanding of terminology can lead to confusion, poor decision-making and poor health outcomes.

Methods A voluntary questionnaire with multiple-choice and short-answer questions was given to patients attending the NHS Lothian Oral Surgery and Oral Medicine Department over two weeks; 137 were completed. Eighteen terms were assessed, including: ulcer, local anaesthetic, impacted tooth, radiograph, sedation, biopsy, mucosa and benign. Exclusion criteria were non-English speakers who required a translator.

Results The multiple-choice questions revealed that terms such as 'blister' and 'local anaesthetic' are relatively well understood. Other terms, such as mucosa, were poorly understood. Over a third of patients confused 'sedation' with general anaesthetic. Short-answer questions revealed a wide range of answers. 'Biopsy' and 'radiograph' were generally better understood compared to other terms. Demographics, educational background and English as a first language appeared to have an influence on understanding.

Conclusion Patients had a varied understanding of terminology. Incorrect interpretation of words may lead to ill-informed decision-making or unnecessary concern. It is essential that challenging terminology is identified and explained at an understandable level.

Gives an insight into terminology that has the potential to cause confusion or concern to patients.

Outlines importance of written and verbal communication.

Highlights how demographics and first language can influence health literacy.

Clinician Perspectives on Caring for Dying Patients During the Pandemic : A Mixed-Methods Study

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff.

OBJECTIVE

To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic.

DESIGN

Mixed-methods embedded study. (ClinicalTrials.gov: NCT04602520).

SETTING

3 acute care medical units in a tertiary care hospital from 16 March to 1 July 2020.

PARTICIPANTS

45 dying patients, 45 family members, and 45 clinicians.

INTERVENTION

During the pandemic, clinicians continued an existing practice of collating personal information about dying patients and "what matters most," eliciting wishes, and implementing acts of compassion.

MEASUREMENTS

Themes from semistructured clinician interviews that were summarized with representative quotations.

RESULTS

Many barriers to end-of-life care arose because of infection control practices that mandated visiting restrictions and personal protective equipment, with attendant practical and psychological consequences. During hospitalization, family visits inside or outside the patient's room were possible for 36 patients (80.0%); 13 patients (28.9%) had virtual visits with a relative or friend. At the time of death, 20 patients (44.4%) had a family member at the bedside. Clinicians endeavored to prevent unmarked deaths by adopting advocacy roles to "fill the gap" of absent family and by initiating new and established ways to connect patients and relatives.

LIMITATION

Absence of clinician symptom or wellness metrics; a single-center design.

CONCLUSION

Clinicians expressed their humanity through several intentional practices to preserve personalized, compassionate end-of-life care for dying hospitalized patients during the SARS-CoV-2 pandemic.

PRIMARY FUNDING SOURCE

Canadian Institutes of Health Research and Canadian Critical Care Trials Group Research Coordinator Fund.

Opportunities to improve COVID-19 provider communication resources: A systematic review

OBJECTIVE

Communication related to COVID-19 between provider and the patient/family is impacted by isolation requirements, time limitations, and lack of family/partner access. Our goal was to determine the content of provider communication resources and peer-reviewed articles on COVID-19 communication in order to identify opportunities for developing future COVID-19 communication curricula and support tools.

METHODS

A systematic review was conducted using the UpToDate clinical decision support resource database, CINAHL, PubMed, PsycInfo, and Web of Science. The grey literature review was conducted in September 2020 and articles published between January-September 2020 written in English were included.

RESULTS

A total of 89 sources were included in the review, (n = 36 provider communication resources, n = 53 peer-reviewed articles). Resources were available for all providers, mainly physicians, and consisted of general approaches to COVID-19 communication with care planning as the most common topic. Only four resources met best practices for patient-centered communication. All but three articles described physician communication where a general emphasis on patient communication was the most prevalent topic. Reduced communication channels, absence of family, time, burnout, telemedicine, and reduced patient-centered care were identified as communication barriers. Communication facilitators were team communication, time, patient-centered and family communication, and available training resources.

CONCLUSIONS

Overall, resources lack content that address non-physician providers, communication with family, and strategies for telehealth communication to promote family engagement. The gaps identified in this review reveal a need to develop more materials on the following topics: provider moral distress, prevention communication, empathy and compassion, and grief and bereavement. An evidence-base and theoretical grounding in communication theory is also needed.

PRACTICE IMPLICATIONS

Future development of COVID-19 communication resources for providers should address members of the interdisciplinary team, communication with family, engagement strategies for culturally-sensitive telehealth interactions, and support for provider moral distress.