1
|
Cliff B, Keiser E, Malinowski S, Wilson M. A survey of nurses' experiences with patient visitation restrictions during the COVID-19 pandemic. Nursing 2024; 54:52-57. [PMID: 39051961 DOI: 10.1097/nsg.0000000000000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To characterize nurses' experiences of restrictive visitation during the COVID-19 pandemic. METHODS In early 2023, an exploratory study investigated professional RNs' perceptions of restrictive visitation policies and end-of-life care during the COVID-19 pandemic, focusing on experiences between March and September 2020. An 11-question online survey containing qualitative and quantitative elements was sent to postlicensure nursing students and alumni of American Public University System (American Military University/American Public University). RESULTS Among the 41 survey respondents (response rate of 4%), 75.6% observed patients dying alone due to visitation restrictions during March-September 2020, with 87.8% noting strict no-visitation policies, yet only 10% found it effective. A majority (68.3%) supported allowing some family presence, reflecting negative sentiments toward strict policies; suggestions for enhancing family involvement included technology (78%) and employing volunteers or liaisons (34.1%) to improve patient/family well-being and alleviate nurse burden. CONCLUSION The findings revealed insights into nurses' experiences and perspectives on end-of-life care and visitation limitations during the pandemic. While the isolation of patients during times of strict visitation restrictions has some merit, exploring options for modified family visitation at the end of life is critical.
Collapse
Affiliation(s)
- Barbara Cliff
- At the American Public University System, Barbara Cliff is a professor, Elina Keiser is an associate professor, Stacey Malinowski is an associate dean, and Meagan Wilson is the Healthcare Administration & Health Sciences Department Chair
| | | | | | | |
Collapse
|
2
|
Shennan S, Coyle N, Lockwood B, DiDiodato G. Visitor Restrictions During the COVID-19 Pandemic and Increased Falls With Harm at a Canadian Hospital: An Exploratory Study. J Patient Saf 2024:01209203-990000000-00235. [PMID: 38917342 DOI: 10.1097/pts.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors. Their relationship with falls has not been previously studied. METHODS This is a retrospective, single-site, 12-month before pandemic-12-month after pandemic, observational study. Multiple logistic regression analysis was used to model FWH outcome and associations with isolation and visitor restrictions. RESULTS There were 4369 isolation events and 385 FWH among 22,505 admissions during the study period. Unadjusted analysis demonstrated a FWH risk of 1.33% (95% CI 0.99, 1.67) in those who were placed in isolation compared to 1.80% (95% CI 1.60, 2.00) in those without an isolation event (χ2 = 4.73,P = 0.03). The FWH risk during the different visitor restriction periods was significantly higher compared to the prepandemic period (χ2 = 20.81, P < 0.001), ranging from 1.28% (95% CI 1.06, 2.50) in the prepandemic period to 2.03% (95% 1.66, 2.40) with no visitors permitted (phase A) in the pandemic period. After adjusting for potential confounders and selection bias, only phase A visitor restrictions were associated with an increased FWH risk of 0.75% (95% CI 0.32, 1.18) compared to no visitor restrictions. INTERPRETATION Our results suggest a moderately strong association between hospitalized patient FWH risk and severe visitor restrictions. This association was muted in phases with even minor allowances for visitation. This represents the first report of the adverse effects of visitor restriction policies on patients' FWH risks.
Collapse
Affiliation(s)
- Stephanie Shennan
- From the Centralized Workforce Scheduling and Timekeeping, Royal Victoria Regional Health Centre
| | - Natalie Coyle
- Patient Safety & Experience, Royal Victoria Regional Health Centre
| | - Brittany Lockwood
- Decision Support & Data Quality, Royal Victoria Regional Health Centre
| | - Giulio DiDiodato
- Chief Research Scientist & Critical Care Medicine, Royal Victoria Regional Health Centre, Barrie, Canada
| |
Collapse
|
3
|
Mailer J, Ward K, Aspinall C. The impact of visiting restrictions in intensive care units for families during the COVID-19 pandemic: An integrative review. J Adv Nurs 2024; 80:1355-1369. [PMID: 37897120 DOI: 10.1111/jan.15915] [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: 06/03/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
AIM To synthesize current evidence about the impact visiting restrictions in adult intensive care units have on family members during the COVID-19 pandemic. DESIGN Integrative literature review. METHODS A total of 104 articles were retrieved. Screening yielded a total of 23 articles which were appraised for quality. Reflexive thematic analysis was applied to synthesize findings and extract themes. DATA SOURCES CINAHL Plus, Ovid MEDLINE, PubMed and ProQuest databases were searched for articles between January 2020 and November 2022. RESULTS The findings were grouped into two main themes with six subthemes. Theme 1: not being present at the bedside, and Theme 2: altered communication added to family members' distress. Findings indicate that visiting restrictions imposed during the COVID-19 pandemic had negative consequences for family members. CONCLUSION The patient and their family are inherently connected, prioritizing family presence with the return of flexible, open visitation policies in ICU must be a priority to mitigate further harm and adverse outcomes for all. REPORTING METHOD The review complies with the PRISMA guidelines for reporting systematic reviews. IMPLICATIONS FOR PROFESSION Nursing leaders must be included in the development of future pandemic policies that advocate family-centred care. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was included in this review.
Collapse
Affiliation(s)
- Jackie Mailer
- Te Whatu Ora Waikato, Hamilton, Waikato, New Zealand
| | - Kim Ward
- University of Auckland, Auckland, New Zealand
| | - Cathleen Aspinall
- University of Auckland, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| |
Collapse
|
4
|
Honda A, Liu Y, Ono M, Nishida T, Tsukigi T, Fauth EB, Honda S. Impact of visitation restrictions on the mental health of family caregivers during the COVID-19 pandemic: A mixed methods study. J Adv Nurs 2024; 80:1652-1665. [PMID: 37902113 DOI: 10.1111/jan.15918] [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: 02/18/2023] [Revised: 09/15/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
AIM To examine the mental health conditions of family caregivers residing away from their loved ones who experienced visitation restrictions during the coronavirus disease 2019 pandemic. DESIGN A mixed-methods design applying the Kessler Scale-10 for the quantitative measurement of psychological distress and an open-ended question for qualitative analysis. METHODS The participants were recruited from care facilities between February and September 2021. This cross-sectional study included 197 family caregivers who were utilizing formal residential care services for their loved ones. Using thematic analyses, open-ended responses regarding the impact of visitation restrictions were coded. These themes were then examined to determine thematic patterns across caregiver characteristics. RESULTS Thirteen themes were identified regarding the impact of visitation restrictions. Many participants reported primary harmful effects as follows: 'inability to confirm the type of care and lifestyle assistance provided to an older relative' and 'difficulty communicating with an older relative because of the inability to converse face-to-face'. Younger age, being employed, poor sleep, poor relationship quality with the care recipient and experiencing harmful effects from the visitation restrictions were associated with psychological distress. CONCLUSION Our findings suggest that to maintain positive mental health after a care transition, it is important for family caregivers to take part in the care of their loved ones and ensure information sharing between the care recipient's family and institution. IMPACT These findings suggest that both residents and family caregivers living outside facilities may feel distressed due to separation. Therefore, institutional care staff needs to consider how to adjust facility procedures or communication with family caregivers. PATIENT OR PUBLIC CONTRIBUTION The comments obtained from the participants in this survey helped to shape the study design and are expected to contribute to the further development of quality facility care.
Collapse
Affiliation(s)
- Ayumi Honda
- Department of Nursing, St. Mary's College, Fukuoka, Japan
| | - Yin Liu
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Mayo Ono
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Nishida
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tatsuya Tsukigi
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Sumihisa Honda
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
5
|
Abstract
Objective: Internal medicine (IM) residents discuss a patient's goals of care (GOC) as part of their initial consultation. Residents have described inexperience, general discomfort, limited formal teaching, and prognostic uncertainty as barriers to effective GOC conversations. The early COVID-19 pandemic resulted in rapid changes to the healthcare system on the individual, patient, and systemic level that might exacerbate and/or introduce new barriers to IM residents' GOC conversations. This qualitative study examines how the early COVID-19 pandemic challenged IM residents' ability to have effective GOC conversations. Methods: Using a constructivist grounded theory approach, participants (n=11) completed a semi-structured interview. Data collection and analysis occurred simultaneously using an open coding, constant comparison process. Interviews were completed until no new themes were identified. Results: Residents self-described their GOC conversations in 5 steps: normalization of the conversation, introduction of expected clinical course, discussion of possible care plans, exploration of the patient's values, and occasionally providing a recommendation. Residents described limited structured teaching around GOC conversations and instead relied on observed role-modelling and self-practice to hone their skillset. Residents described an increased sense of urgency to have GOC conversations due to the uncertainty of clinical course and potential for rapid deterioration of patients with COVID-19. Residents identified restrictive visitor policies as a significant barrier that contributed to feelings of dehumanization. Residents felt that these limitations affected their GOC conversations and potentially resulted in discordant care plans which contributed to moral distress. Conclusion: The early COVID-19 pandemic resulted in several barriers that challenged residents' ability to conduct effective GOC conversations. This is on the background of previously reported discomfort and limited formal training in conducting GOC conversations. Based on our findings, we present a conceptual model involving teaching validated GOC frameworks, positive role-modelling, and experiential learning to support GOC conversation education in post-graduate medical education.
Collapse
Affiliation(s)
- Alison T. Lai
- Faculty of Medicine, University of
Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| | - Nadine Abdullah
- Faculty of Medicine, University of
Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| |
Collapse
|
6
|
Wasilewski MB, Szigeti Z, Sheppard CL, Minezes J, Hitzig SL, Mayo AL, Robinson LR, Lung M, Simpson R. "You want them to be partners in therapy, but that's tricky when they're not there": A qualitative study exploring caregiver involvement across the continuum of care during the early COVID pandemic. Clin Rehabil 2024; 38:109-118. [PMID: 37518867 PMCID: PMC10631287 DOI: 10.1177/02692155231191011] [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: 01/26/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Widespread visitor restrictions were implemented during the COVID-19 pandemic at acute and inpatient rehabilitation hospitals. Family caregivers were physically isolated from their loved ones, which challenged engagement in patient care and readiness for their role. Thus, we aimed to explore the involvement of family caregivers in COVID-19 patients as they journeyed across the care continuum during the early phase of the COVID-19 pandemic. DESIGN We employed a qualitative descriptive approach. PARTICIPANTS We conducted interviews with family caregivers, COVID-19 patients, and healthcare providers between August 2020 and February 2021. SETTING Participants were recruited from a single hospital network in Toronto, Ontario, Canada. Interviews were recorded and transcribed. Data were analyzed thematically. RESULTS A total of 27 participants were interviewed-12 healthcare providers, 10 patients, and 5 family caregivers. Four themes were identified: (a) Caregivers were shut out in acute COVID care, (b) Patient discharge from inpatient rehabilitation was turbulent for caregivers, (c) Caregivers were unprepared to support loved ones in the community, and (d) Patient discharge to home was heavily dependent on caregiver availability. CONCLUSIONS Visitor restrictions prevent family caregivers from being physically present at patients' bedside, leading to complex and detrimental impacts such as caregivers feeling that they were not engaged in their loved one's care planning until they were discharged. In turn, discharge to the community was met with several challenges including caregivers feeling underprepared and unsupported to meet their loved one's unique care requirements. This was exacerbated by a lack of community-based resources due to ongoing pandemic restrictions.
Collapse
Affiliation(s)
- Marina B Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zara Szigeti
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christine L Sheppard
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jacqueline Minezes
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lawrence R Robinson
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria Lung
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Simpson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Ng G, Desai C, Gagliardi L, Donaghy S, Prospero LD. Implementing digital devices to maintain family connections during the COVID-19 pandemic: Experience of a large academic urban hospital. J Med Imaging Radiat Sci 2023; 55:101344. [PMID: 38040496 DOI: 10.1016/j.jmir.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic lockdown imposed drastic measures at hospitals internationally to rapidly pivot their approaches to patient care. Early on when the pandemic was declared, hospitals responded to local public health restrictions by limiting all non-essential visits for their patients. Digital devices allowed Canadians to remain connected with their friends and families during the imposed isolation restrictions. The aim of this clinical perspective is to share the experience with the immediate implementation of digital connections for patients by exploring the impact as well as to describe key learnings from the initiative. METHODS 150 iPads were distributed to clinical teams for use by patients, for either clinical care or for social connection. An iterative evaluation process, guided by quality improvement methodology, was followed which ensured that any changes to the iPad implementation process were responsive in real time. The evaluation measures included a clinician survey and collection of narratives from patients and clinicians. RESULTS All clinician respondents (n=7) indicated that the iPads were a valuable tool to support patients and families. Narratives from patients indicated that virtual connections brought joy to them especially given that they were isolated from their support systems during the initial days of COVID-19. Key learnings for the Implementation Team were: the importance in maintaining cognitive stimulation as an enabler to recovery for patients; staff members provide support beyond direct clinical care; technology needs to be harnessed to facilitate clinical care; technology should be leveraged to support clinical care; and interprofesssional collaboration of the entire Implementation Team is a key enabler of success. CONCLUSION Since implementation, iPads have been integrated as a supporting digital tool for both social connections as well as clinical care as a result of the benefits seen during this initiative. The iPads have also been recognized as a tool to complement patient connection and care and currently being expanded as part of services to patients, families and their clinicians.
Collapse
Affiliation(s)
- Genny Ng
- Quality and Patient Safety, Sunnybrook Health Sciences Centre, Toronto ON.
| | - Chaitali Desai
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto ON
| | - Lina Gagliardi
- Social Work and Spiritual & Religious Care, Sunnybrook Health Sciences Centre, Toronto ON
| | - Siobhan Donaghy
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto ON; Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto ON
| | - Lisa Di Prospero
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto ON; Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
| |
Collapse
|
8
|
Kortes-Miller K, Natale M, Wilson K, Stinchcombe A. The Perpetual Pivot: Understanding Care Partner Experiences in Ontario Long-Term Care Homes during the COVID-19 Pandemic. Geriatrics (Basel) 2023; 8:90. [PMID: 37736890 PMCID: PMC10514792 DOI: 10.3390/geriatrics8050090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners' roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs.
Collapse
Affiliation(s)
| | - Maïa Natale
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|
9
|
Thilges S, Egbert J, Jakuboski S, Qeadan F. Associations between delirium and SARS-CoV-2 pandemic visitor restrictions among hospitalized patients. Public Health 2023; 222:45-53. [PMID: 37517161 PMCID: PMC10293895 DOI: 10.1016/j.puhe.2023.06.031] [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: 03/03/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Delirium is associated with increased morbidity and mortality, but environmental and behavioral factors may decrease the risk of developing delirium and thus must be considered. To investigate trends in delirium prevalence and examine associations of visitor restrictions with delirium diagnoses among all patients hospitalized during and prior to the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. STUDY DESIGN Retrospective epidemiological assessment. METHODS The medical records of all patients (n = 33,141) hospitalized within a three-hospital academic medical center system in a large Midwestern metropolitan area from March 20, 2019, through March 19, 2021, were analyzed. RESULTS The overall prevalence of delirium during COVID-19 was 11.26% (confidence interval [CI]: 10.79%, 11.73%) compared to 9.28% (CI: 8.82%, 9.73%) before COVID-19. From our adjusted logistic regression analyses, we observed that the odds of delirium among non-isolated patients were significantly higher during COVID-19 visitor restrictions (adjusted odds ratio [aOR]: 1.354; 95% CI: 1.233, 1.488; P < 0.0001) than before. The odds of delirium among isolated patients were not significantly higher during COVID-19 visitor restrictions (aOR: 1.145; 95% CI: 0.974, 1.346; P = 0.1006) than before. CONCLUSIONS Medically isolated patients remained at high risk of developing delirium both prior to and during COVID-19 era visitor restrictions. However, non-medically isolated patients had a significantly increased risk of delirium during the social isolation of visitor restrictions compared to prior to visitor restrictions.
Collapse
Affiliation(s)
- S Thilges
- Loyola University Medical Center, Department of Psychiatry and Behavioral Neurosciences, 2160 South First Avenue, Maywood, IL, United States.
| | - J Egbert
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, 2160 South First Avenue, Maywood, IL, United States.
| | - S Jakuboski
- Loyola University Chicago, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL, United States.
| | - F Qeadan
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, 2160 South First Avenue, Maywood, IL, United States.
| |
Collapse
|
10
|
Brewer KC, Horning MA, Walker MS, Ness MM. Analyzing the Effects of Family Presence and Visitation Restrictions During the COVID-19 Pandemic Among Nurse Leaders and Non-Nurse Leaders. J Nurs Adm 2023; 53:132-137. [PMID: 36753455 DOI: 10.1097/nna.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
AIM This analysis seeks to identify the effect of family presence and visitation during COVID-19 pandemic among nurses and nurse leaders. BACKGROUND Visitation restrictions were widespread during the initial months of the COVID-19 pandemic and were a potential source of distress for nurses. Few studies have examined sources of distress, such as visitation restrictions, among nurse leaders and non-nurse leaders. METHODS Secondary analysis was performed using a national survey of nurses conducted by the American Nurses Foundation. RESULTS More nurse leaders than nonleaders reported that nurses were involved in policy decisions/discussions and that visitation restrictions created additional burdens. There was similar level of agreement among nurse leaders and nonleaders that restrictions were not in the best interest of the patients. Many nurses reported the restrictions impacted their own well-being. CONCLUSION Visitation restrictions were a likely source of distress. Improvements to communication, planning, and transparency should be considered in preparation for future emergencies that may require visitation restrictions.
Collapse
Affiliation(s)
- Katherine C Brewer
- Author Affiliations: Assistant Professors, Department of Nursing, Towson University, Maryland
| | | | | | | |
Collapse
|
11
|
Campbell-Yeo M, Dol J, McCulloch H, Hughes B, Hundert A, Bacchini F, Whitehead L, Afifi J, Alcock L, Bishop T, Dorling J, Earle R, Elliott Rose A, Inglis D, Leighton C, MacRae G, Melanson A, Simpson CD, Smit M. The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey. JOURNAL OF FAMILY NURSING 2023; 29:18-27. [PMID: 35915967 PMCID: PMC9850074 DOI: 10.1177/10748407221114326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jehier Afifi
- Dalhousie University, Halifax, NS,
Canada
- IWK Health, Halifax, NS, Canada
| | | | | | - Jon Dorling
- University Hospital Southampton NHS
Foundation Trust, Southampton, UK
| | | | | | | | | | | | | | - C. David Simpson
- Dalhousie University, Halifax, NS,
Canada
- IWK Health, Halifax, NS, Canada
| | | |
Collapse
|
12
|
Marmo S, Milner KA. From Open to Closed: COVID-19 Restrictions on Previously Unrestricted Visitation Policies in Adult Intensive Care Units. Am J Crit Care 2023; 32:31-41. [PMID: 36175358 DOI: 10.4037/ajcc2023365] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND In March 2020, rising numbers of COVID-19 infections contributed to changes in intensive care unit visitation policies, with some facilities allowing no visitors. OBJECTIVE To compare visitation policies of Magnet and Pathway to Excellence hospitals with prepandemic open visitation in adult intensive care units. METHODS A mixed-methods study was conducted from January through March 2021. Quantitative data on visitation policies were extracted from websites of 96 Magnet and Pathway to Excellence hospitals that had allowed unrestricted visits in adult intensive care units before the pandemic. Qualitative data were collected via semistructured interviews with 9 nurse leaders from these hospitals. RESULTS More than 1 year after the start of the pandemic, all of the hospitals had instituted restricted visitation policies. The policies varied, with little to no evidence-based justification. Restrictions included 83% of hospitals (n = 80) allowing just 1 visitor per day and 69% of hospitals (n = 50 of 72) allowing no visits at all for patients with COVID-19 in the intensive care unit. Five themes were found when nurse leaders' interviews were analyzed: visitors not welcome, doing harm, external decisions at system level, visiting within limits, and changes in critical care nursing work. CONCLUSION Results of the study suggest that despite the vast amount of evidence supporting the benefits of visitation and the harms of restricted visitation and expert recommendations for returning safe visitation to hospitals, Magnet and Pathway to Excellence hospitals continue to enforce restricted visitation policies in intensive care units. Patients, families, and nursing and health care staff must partner to create pandemic-proof visitation policies.
Collapse
Affiliation(s)
- Suzanne Marmo
- Suzanne Marmo is an assistant professor of social work at Sacred Heart University, Fairfield, Connecticut
| | - Kerry A Milner
- Kerry A. Milner is a professor of nursing at Sacred Heart University, Fairfield, Connecticut
| |
Collapse
|
13
|
Hospital-acquired coronavirus disease 2019 (COVID-19) among patients of two acute-care hospitals: Implications for surveillance. Infect Control Hosp Epidemiol 2022; 43:1761-1766. [PMID: 35438067 PMCID: PMC9947044 DOI: 10.1017/ice.2021.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We quantified hospital-acquired coronavirus disease 2019 (COVID-19) during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition. DESIGN Retrospective observational study during early phases of the COVID-19 pandemic, March 1-November 30, 2020. We identified laboratory-detected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) from 30 days before admission through discharge. All cases detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired cases, or possible or probable hospital-acquired cases. SETTING The study was conducted in 2 acute-care hospitals in Chicago, Illinois. PATIENTS The study included all hospitalized patients including an inpatient rehabilitation unit. INTERVENTIONS Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient and staff cohort protocols, universal masking, and restricted visitation policies. RESULTS Among 2,667 patients with SARS-CoV-2, detection before hospital day 6 was most common (n = 2,612; 98%); detection during hospital days 6-14 was uncommon (n = 43; 1.6%); and detection after hospital day 14 was rare (n = 16; 0.6%). By chart review, most cases after day 5 were categorized as community acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6-14 and 53% of cases after day 14). The incidence rates of possible and probable hospital-acquired cases per 10,000 patient days were similar for ICU- and non-ICU patients at hospital A (1.2 vs 1.3 difference, 0.1; 95% CI, -2.8 to 3.0) and hospital B (2.8 vs 1.2 difference, 1.6; 95% CI, -0.1 to 4.0). CONCLUSIONS Most patients were protected by early and sustained application of infection-control precautions modified to reduce SARS-CoV-2 transmission. Using solely temporal criteria to discriminate hospital versus community acquisition would have misclassified many "late onset" SARS-CoV-2-positive cases.
Collapse
|
14
|
Denbow-Burke O, Burke N, Norris M. Cultural Competence-Lessons From an Exceptional Case of Care Delivery to My Mom. Can Geriatr J 2022; 25:407-409. [PMID: 36505919 PMCID: PMC9684027 DOI: 10.5770/cgj.25.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Neville Burke
- Department of Anesthesia, Pain Management & Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Mireille Norris
- Division of Geriatrics, Faculty of Medicine, University of Toronto, Toronto, ON
| |
Collapse
|
15
|
Gotlib Conn L, Coburn NG, Di Prospero L, Hallet J, Legere L, MacCharles T, Slutsker J, Tagger R, Wright FC, Haas B. Restricted family presence for hospitalized surgical patients during the COVID-19 pandemic: How hospital care providers and families navigated ethical tensions and experiences of institutional betrayal. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100147. [PMID: 35937964 PMCID: PMC9344808 DOI: 10.1016/j.ssmqr.2022.100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 01/12/2023]
Abstract
Early in the COVID-19 pandemic restricted family presence in hospitals was a widespread public health intervention to preserve critical resources and mitigate the virus's spread. In this study, we explore the experiences of surgical care providers and family members of hospitalized surgical patients during the period of highly restricted visiting (March 2020 to April 2021) in a large Canadian academic hospital. Thirty-four interviews were completed with hospital providers, family members and members of the hospital's visitor task force. To understand hospital providers' experiences, we highlight the ethical tensions produced by the biomedical and public health ethics frameworks that converged during COVID-19 in hospital providers' bedside practice. Providers grappled with mixed feelings in support of and against restricted visiting, while simultaneously experiencing gaps in resources and care and acting as patient gatekeepers. To understand family members' experiences of communication and care, we use the theory of institutional betrayal to interpret the negative impacts of episodic and systemic communication failures during restricted visiting. Family members of the most vulnerable patients (and patients) experienced short- and long-term effects including anxiety, fear, and refusal of further care. Our analysis draws attention to the complex ways that hospital care providers and families of hospitalized surgical patients sought to establish and reconfigure how trust and patient-centeredness could be achieved under these unprecedented conditions. Practical learnings from this study suggest that if family presence in hospitals must be limited in the future, dedicated personnel for communication and emotional support for patients, families and staff must be prioritized.
Collapse
Affiliation(s)
- Lesley Gotlib Conn
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Corresponding author. Sunnybrook Research Institute, 2075 Bayview Avenue, Suite K3W-13, Toronto, ON, M4N3M5, Canada
| | - Natalie G. Coburn
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Lisa Di Prospero
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Julie Hallet
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Laurie Legere
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Tracy MacCharles
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Jessica Slutsker
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Ru Tagger
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Frances C. Wright
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Barbara Haas
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| |
Collapse
|
16
|
Dragoi L, Munshi L, Herridge M. Visitation policies in the ICU and the importance of family presence at the bedside. Intensive Care Med 2022; 48:1790-1792. [PMID: 35976409 PMCID: PMC9381998 DOI: 10.1007/s00134-022-06848-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Margaret Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Rehabilitation Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Jones A, Mowbray FI, Falk L, Stall NM, Brown KA, Malikov K, Malecki SL, Lail S, Jung HY, Costa AP, Verma AA, Razak F. Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario. PLoS One 2022; 17:e0264240. [PMID: 36331926 PMCID: PMC9635742 DOI: 10.1371/journal.pone.0264240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. METHODS We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. RESULTS Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04). CONCLUSIONS AND IMPLICATIONS Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies.
Collapse
Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- * E-mail: (AJ); (FR)
| | - Fabrice I. Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lindsey Falk
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Nathan M. Stall
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital Research Institute, Toronto, Ontario, Canada
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kamil Malikov
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada
| | - Sarah L. Malecki
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharan Lail
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Hae Young Jung
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Amol A. Verma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- * E-mail: (AJ); (FR)
| |
Collapse
|
18
|
Jones A, Goodarzi Z, Lee J, Norman R, Wong E, Dasgupta M, Liu B, Watt J. Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis. PLoS One 2022; 17:e0276504. [PMID: 36288382 PMCID: PMC9604990 DOI: 10.1371/journal.pone.0276504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83). Conclusions The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.
Collapse
Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University Hamilton, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- * E-mail: (AJ); (JW)
| | - Zahra Goodarzi
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Justin Lee
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Norman
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Monidipa Dasgupta
- Division of Geriatric Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Barbara Liu
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Watt
- ICES, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail: (AJ); (JW)
| |
Collapse
|
19
|
Fiest KM, Krewulak KD, Jaworska N, Spence KL, Mizen SJ, Bagshaw SM, Burns KEA, Cook DJ, Fowler RA, Olafson K, Patten SB, Rewa OG, Rochwerg B, Spence S, West A, Stelfox HT, Parsons Leigh J. Impact of restricted visitation policies during COVID-19 on critically ill adults, their families, critical care clinicians, and decision-makers: a qualitative interview study. Can J Anaesth 2022; 69:1248-1259. [PMID: 35978160 PMCID: PMC9385091 DOI: 10.1007/s12630-022-02301-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/22/2022] [Accepted: 04/11/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE During the first wave of the COVID-19 pandemic, restricted visitation policies were enacted at acute care facilities to reduce the spread of COVID-19 and conserve personal protective equipment. In this study, we aimed to describe the impact of restricted visitation policies on critically ill patients, families, critical care clinicians, and decision-makers; highlight the challenges faced in translating these policies into practice; and delineate strategies to mitigate their effects. METHOD A qualitative description design was used. We conducted semistructured interviews with critically ill adult patients and their family members, critical care clinicians, and decision-makers (i.e., policy makers or enforcers) affected by restricted visitation policies. We transcribed semistructured interviews verbatim and analyzed the transcripts using inductive thematic analysis. RESULTS Three patients, eight family members, 30 clinicians (13 physicians, 17 nurses from 23 Canadian intensive care units [ICUs]), and three decision-makers participated in interviews. Thematic analysis was used to identify five themes: 1) acceptance of restricted visitation (e.g., accepting with concerns); 2) impact of restricted visitation (e.g., ethical challenges, moral distress, patients dying alone, intensified workload); 3) trust in the healthcare system during the pandemic (e.g., mistrust of clinical team); 4) modes of communication (e.g., communication using virtual platforms); and 5) impact of policy implementation on clinical practice (e.g., frequent changes and inconsistent implementation). CONCLUSIONS Restricted visitation policies across ICUs during the COVID-19 pandemic negatively affected critically ill patients and their families, critical care clinicians, and decision-makers.
Collapse
Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sara J Mizen
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Karen E A Burns
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kendiss Olafson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
20
|
Iness AN, Abaricia JO, Sawadogo W, Iness CM, Duesberg M, Cyrus J, Prasad V. The Effect of Hospital Visitor Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review. Am J Med 2022; 135:1158-1167.e3. [PMID: 35472383 PMCID: PMC9035621 DOI: 10.1016/j.amjmed.2022.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
Health care policymaking during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and health care provider well-being. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported 1 or more prespecified main or secondary outcome (coronavirus disease 2019 [COVID-19] disease transmission, global well-being, mortality, morbidity, or health care resource utilization). Two authors independently extracted data into a standardized form with a third author resolving discrepancies. A total of 1153 abstracts were screened, and 26 final full-text articles were included. Ten studies were qualitative, with 7 cohort studies, and no randomized controlled trials. Critically ill patients were the most represented (12 out of 26 studies). Blanket hospital visitor policies were associated with failure to address the unique needs of patients, their visitors, and health care providers in various clinical environments. Overall, a patient-centered, thoughtful, and nuanced approach to hospital visitor policies is likely to benefit all stakeholders while minimizing potential harms.
Collapse
Affiliation(s)
- Audra N Iness
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, Va; Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Jefferson O Abaricia
- Department of Bioengineering, College of Engineering, Virginia Commonwealth University, Richmond, Va
| | - Wendemi Sawadogo
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Va
| | - Caleb M Iness
- School of Medicine, California Northstate University, Elk Grove, Calif
| | - Max Duesberg
- School of Medicine, California Northstate University, Elk Grove, Calif
| | - John Cyrus
- Health Sciences Library, Research and Education Department, Virginia Commonwealth University, Richmond, Va
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| |
Collapse
|
21
|
Perspectives from designated family caregivers of critically ill adult patients during the COVID-19 pandemic: A qualitative interview study. PLoS One 2022; 17:e0275310. [PMID: 36166458 PMCID: PMC9514636 DOI: 10.1371/journal.pone.0275310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background Family visitation in intensive care units (ICU) has been impacted by the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic. While studies report on perceptions of families completely restricted from ICUs, little is known about the burden experienced by designated family caregivers allowed to visit their critically ill loved one. This study sought the perspectives of family caregivers of critically ill patients on the impact of one-person designated visitor policies mandated in ICUs during the COVID-19 pandemic. Methods Throughout the study period a restricted visitation policy was mandated capturing the first (April 2020) and second (December 2020) waves of the pandemic that allowed one designated family caregiver (i.e., spouses or adult children) per patient to visit the ICU. Designated family caregivers of critically ill patients admitted to ICU September 2020 to November 2020 took part in individual 60-minute, semi-structured interviews at 6-months after discharge from the index ICU admission. Themes from family interviews were summarized with representative quotations. Results Key themes identified following thematic analysis from six participants included: one visitor rule, patient advocate role, information needs, emotional distress, strategies for coping with challenges, practicing empathy, and appreciation of growth. Conclusion Designated family caregivers of critically ill patients admitted to ICU during the COVID-19 pandemic perceived a complex and highly stressful experience. Support from ICU family liaisons and psychologists may help ameliorate the impact.
Collapse
|
22
|
Correia TSP, Martins MMFPS, Barroso FF, Valentim O, Fonseca C, Lopes M, Pinho LG. Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members. J Pers Med 2022; 12:jpm12101546. [PMID: 36294685 PMCID: PMC9605370 DOI: 10.3390/jpm12101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. Methods: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin’s methodology. Results and Conclusions: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.
Collapse
Affiliation(s)
- Tânia S. P. Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal
- Escola Superior de Saúde Ribeiro Sanches (ERISA)–IPLUSO, 1950-396 Lisboa, Portugal
- Correspondence:
| | - Maria Manuela F. P. S. Martins
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal
- Escola Superior de Enfermagem do Porto (ESEP), 4050-313 Porto, Portugal
| | | | - Olga Valentim
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), 1600-096 Lisboa, Portugal
| | - César Fonseca
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - Manuel Lopes
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - Lara G. Pinho
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| |
Collapse
|
23
|
Cassidy C, Sim M, Somerville M, Crowther D, Sinclair D, Elliott Rose A, Burgess S, Best S, Curran JA. Using a learning health system framework to examine COVID-19 pandemic planning and response at a Canadian Health Centre. PLoS One 2022; 17:e0273149. [PMID: 36103510 PMCID: PMC9473619 DOI: 10.1371/journal.pone.0273149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 pandemic has presented a unique opportunity to explore how health systems adapt under rapid and constant change and develop a better understanding of health system transformation. Learning health systems (LHS) have been proposed as an ideal structure to inform a data-driven response to a public health emergency like COVID-19. The aim of this study was to use a LHS framework to identify assets and gaps in health system pandemic planning and response during the initial stages of the COVID-19 pandemic at a single Canadian Health Centre. Methods This paper reports the data triangulation stage of a concurrent triangulation mixed methods study which aims to map study findings onto the LHS framework. We used a triangulation matrix to map quantitative (textual and administrative sources) and qualitative (semi-structured interviews) data onto the seven characteristics of a LHS and identify assets and gaps related to health-system receptors and research-system supports. Results We identified several health system assets within the LHS characteristics, including appropriate decision supports and aligned governance. Gaps were identified in the LHS characteristics of engaged patients and timely production and use of research evidence. Conclusion The LHS provided a useful framework to examine COVID-19 pandemic response measures. We highlighted opportunities to strengthen the LHS infrastructure for rapid integration of evidence and patient experience data into future practice and policy changes.
Collapse
Affiliation(s)
- Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Izaak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
| | - Meaghan Sim
- Research, Innovation & Discovery, Nova Scotia Health, Halifax, NS, Canada
| | - Mari Somerville
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Daniel Crowther
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | | | - Stacy Burgess
- Izaak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
| | - Shauna Best
- Izaak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
| | - Janet A. Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Izaak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
- * E-mail:
| |
Collapse
|
24
|
Singh H, Gray CS, Nelson MLA, Nie JX, Thombs R, Armas A, Fortin C, Molla Ghanbari H, Tang T. A qualitative study of hospital and community providers’ experiences with digitalization to facilitate hospital-to-home transitions during the COVID-19 pandemic. PLoS One 2022; 17:e0272224. [PMID: 35980960 PMCID: PMC9387844 DOI: 10.1371/journal.pone.0272224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic has triggered substantial changes to the healthcare context, including the rapid adoption of digital health to facilitate hospital-to-home transitions. This study aimed to: i) explore the experiences of hospital and community providers with delivering transitional care during the COVID-19 pandemic; ii) understand how rapid digitalization in healthcare has helped or hindered hospital-to-home transitions during the COVID-19 pandemic; and, iii) explore expectations of which elements of technology use may be sustained post-pandemic. Methods Using a pragmatic qualitative descriptive approach, remote interviews with healthcare providers involved in hospital-to-home transitions in Ontario, Canada, were conducted. Interviews were analyzed using a team-based rapid qualitative analysis approach to generate timely results. Visual summary maps displaying key concepts/ideas were created for each interview and revised based on input from multiple team members. Maps that displayed similar concepts were then combined to create a final map, forming the themes and subthemes. Results Sixteen healthcare providers participated, of which 11 worked in a hospital, and five worked in a community setting. COVID-19 was reported to have profoundly impacted healthcare providers, patients, and their caregivers and influenced the communication processes. There were several noted opportunities for technology to support transitions. Interpretation Several challenges with technology use were highlighted, which could impact post-pandemic sustainability. However, the perceived opportunities for technology in supporting transitions indicate the need to investigate the optimal role of technology in the transition workflow.
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L. A. Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason X. Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Rachel Thombs
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christian Fortin
- Hennick Bridgepoint Hospital, Sinai Health, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Hedieh Molla Ghanbari
- Division of Hospital Medicine, Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
Collart C, Craighead C, Rose S, Frankel R, Tucker Edmonds B, Perni U, Chien EK, Coleridge M, Ranzini A, Farrell RM. The Impact of Outpatient Prenatal Care Visitor Restrictions on Pregnant Patients and Partners During the COVID-19 Pandemic. WOMEN'S HEALTH REPORTS 2022; 3:718-727. [PMID: 36147830 PMCID: PMC9436262 DOI: 10.1089/whr.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/13/2022]
Abstract
Introduction: Methods: Results: Conclusions:
Collapse
Affiliation(s)
- Christina Collart
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Caitlin Craighead
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susannah Rose
- Center for Patient Experience, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Frankel
- Department of the Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | | | - Uma Perni
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward K. Chien
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marissa Coleridge
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Personalized Genetic Healthcare, Department of Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Angela Ranzini
- Department of OB/GYN, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ruth M. Farrell
- Subspecialty Care for Women's Health, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Personalized Genetic Healthcare, Department of Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
26
|
Bansal R, Jezrawi R, Greenwald A, Sandhanwalia S, Luo E, Greenwald I, Saeed H, Mondoux S, Chan T, Lokker C. Frontline connect: Evaluating a virtual technology program to enhance patient and provider communication during COVID-19. J Eval Clin Pract 2022; 28:641-649. [PMID: 34970832 DOI: 10.1111/jep.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE Since the beginning of the COVID-19 pandemic, many hospitals have reduced in-hospital visitation. In these situations, virtual communication tools have helped maintain interaction between parties. The Frontline Connect program was designed to address communication and patient care challenges by providing data-enabled devices to clinical staff in hospitals. OBJECTIVE This study aimed to identify areas of improvement for the Frontline Connect program by: (a) evaluating communication needs, user experience, and program satisfaction; and (b) identifying potential barriers to device access or use. METHODS We administered pre-implementation needs assessment, post-use, and exit surveys to healthcare staff at a pilot hospital site in Ontario. Recruitment was through email lists and site champions using convenience sampling. We descriptively analysed survey responses and compared the initial need statements to post-implementation use-cases identified by users. RESULTS We received 139 needs assessments, 31 user experience assessments, and 47 exit survey responses. Most device use occurred in the emergency department and intensive care units and was facilitated by social workers, nurses, and physicians to connect patients, families, and care providers. Pre-implementation concerns were related to infection control, data security, and device privacy. In the exit survey, these were replaced by other concerns including Internet connectivity and time-intensiveness. Device utility and ease-of-use were rated 9.7/10 and 9.6/10 respectively in the user experience survey, though overall experience was rated 7.2/10 in the exit survey. Overall, respondents viewed the devices as useful and we agree with participants who suggested increased program promotion and training would likely improve adoption. CONCLUSIONS We found that our virtual technology program for facilitating communication was positively perceived. Survey feedback indicates that a rapid rollout in response to urgent pandemic-related needs was feasible, though program logistics could be improved. The current work supports the need to improve, standardize, and sustain virtual communication programs in hospitals.
Collapse
Affiliation(s)
- Rishi Bansal
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rita Jezrawi
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ari Greenwald
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simerpreet Sandhanwalia
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emmy Luo
- College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Ilana Greenwald
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Humaira Saeed
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shawn Mondoux
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Teresa Chan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
27
|
Correia TSP, Martins MMFPS, Barroso FF, Pinho LG, Fonseca C, Valentim O, Lopes M. The Implications of Family Members’ Absence from Hospital Visits during the COVID-19 Pandemic: Nurses’ Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158991. [PMID: 35897362 PMCID: PMC9330113 DOI: 10.3390/ijerph19158991] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/20/2022]
Abstract
Background: In response to the COVID-19 pandemic, several measures were taken to prevent the transmission of infection in the hospital environment, including the restriction of visits. Little is known about the consequences of these directives, but it is expected that they will have various implications. Thus, this study aimed to understand the consequences of measures to restrict visits to hospitalized individuals. Methods: A qualitative interpretive study was conducted through semistructured interviews with 10 nurses chosen by convenience. Content analysis was performed using Atlas.ti software, version 22 (Berlin, Germany). Results: Twenty-two categories and eight subcategories were identified and grouped according to their scope: implications for the patient, implications for the family, and implications for care practice. Conclusions: The identified categories of implications of restricting hospital visits (implications for patients, relatives, and care practices) are incomparably more negative than positive and have a strong potential to cause safety events in the short to long term, also jeopardizing the quality of care. There is the risk of stagnation and even setback due to this removal of families from the hospital environment, not only in terms of safety and quality of care but also with regard to person- and family-centered care.
Collapse
Affiliation(s)
- Tânia Sofia Pereira Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal; (M.M.F.P.S.M.); (O.V.)
- Escola Superior de Saúde Ribeiro Sanches (ERISA), Instituto Politécnico da Lusofonia(IPLUSO), 1950-396 Lisboa, Portugal
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Correspondence:
| | - Maria Manuela F. P. S. Martins
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal; (M.M.F.P.S.M.); (O.V.)
- Escola Superior de Enfermagem do Porto (ESEP), 4050-313 Porto, Portugal
| | | | - Lara G. Pinho
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - César Fonseca
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - Olga Valentim
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal; (M.M.F.P.S.M.); (O.V.)
- Escola Superior de Saúde Ribeiro Sanches (ERISA), Instituto Politécnico da Lusofonia(IPLUSO), 1950-396 Lisboa, Portugal
- Escola Superior de Saúde de Leiria (ESSLei), Instituto Politécnico de Leiria (IPLeiria), 2411-901 Leiria, Portugal
| | - Manuel Lopes
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| |
Collapse
|
28
|
Wasilewski MB, Szigeti Z, Sheppard CL, Minezes J, Hitzig SL, Mayo AL, Robinson LR, Lung M, Simpson R. Infection prevention and control across the continuum of COVID-19 care: A qualitative study of patients', caregivers' and providers' experiences. Health Expect 2022; 25:2431-2439. [PMID: 35818850 PMCID: PMC9350031 DOI: 10.1111/hex.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Healthcare facilities adopted restrictive visitor policies as a result of the COVID‐19 (COVID) pandemic. Though these measures were necessary to promote the safety of patients, families and healthcare providers, it led to isolation and loneliness amongst acute care inpatients that can undermine patient rehabilitation and recovery. The study objectives were to (1) explore how infection prevention and control (IP&C) measures impacted stakeholders' perceptions of care quality and interactions with others and (2) investigate how these experiences and perceptions varied across stakeholder groups and care settings. Methods A qualitative descriptive study was conducted. Patients and their families from an inpatient COVID rehabilitation hospital and healthcare providers from an acute or rehabilitation COVID hospital were interviewed between August 2020 and February 2021. Results A total of 10 patients, 5 family members and 12 healthcare providers were interviewed. Four major themes were identified: (1) IP&C measures challenged the psychosocial health of all stakeholders across care settings; (2): IP&C measures precipitated a need for greater relational care from HCPs; (3) infection prevention tenets perpetuated COVID‐related stigma that stakeholders experienced across care settings; and (4) technology was used to facilitate human connection when IP&C limited physical presence. Conclusion IP&C measures challenged psychosocial health and maintenance of vital human connections. Loneliness and isolation were felt by all stakeholders due to physical distancing and COVID‐related stigma. Some isolation was mitigated by the relational care provided by HCPs and technological innovations used. The findings of the study underscore the need to balance safety with psychosocial well‐being across care settings and beyond the patient–provider dyad. Patient and Public Contribution This study was informed by the Patient‐Oriented Research Agenda and developed through consultations with patients and family caregivers to identify priority areas for rehabilitation research. Priority areas identified that informed the current study were (1) the need to focus on the psychosocial aspects of recovery from illness and injury and (2) the importance of exploring patients' recovery experiences and needs across the continuum of care. The study protocol, ethics submission, analysis and manuscript preparation were all informed by healthcare providers with lived experience of working in COVID care settings.
Collapse
Affiliation(s)
- Marina B Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zara Szigeti
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Christine L Sheppard
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jacqueline Minezes
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence R Robinson
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Lung
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Simpson
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Helmers AJ, Anderson JA, Kirsch RE. Caregiver COVID-19 Vaccination Status in Pediatric Hospitals-Ethics of Exclusion. JAMA Pediatr 2022; 176:441-442. [PMID: 35226057 DOI: 10.1001/jamapediatrics.2021.6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew J Helmers
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roxanne E Kirsch
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Kho ME, Rewa OG, Boyd JG, Choong K, Stewart GCH, Herridge MS. Outcomes of critically ill COVID-19 survivors and caregivers: a case study-centred narrative review. Can J Anaesth 2022; 69:630-643. [PMID: 35102495 PMCID: PMC8802985 DOI: 10.1007/s12630-022-02194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Critical illness is a transformative experience for both patients and their family members. For COVID-19 patients admitted to the intensive care unit (ICU), survival may be the start of a long road to recovery. Our knowledge of the post-ICU long-term sequelae of acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome (SARS) may inform our understanding and management of the long-term effects of COVID-19. SOURCE We identified international and Canadian epidemiologic data on ICU admissions for COVID-19, COVID-19 pathophysiology, emerging ICU practice patterns, early reports of long-term outcomes, and federal support programs for survivors and their families. Centred around an illustrating case study, we applied relevant literature from ARDS and SARS to contextualize knowledge within emerging COVID-19 research and extrapolate findings to future long-term outcomes. PRINCIPAL FINDINGS COVID-19 is a multisystem disease with unknown long-term morbidity and mortality. Its pathophysiology is distinct and unique from ARDS, SARS, and critical illness. Nevertheless, based on initial reports of critical care management for COVID-19 and the varied injurious supportive practices employed in the ICU, patients and families are at risk for post-intensive care syndrome. The distinct incremental risk of COVID-19 multiple organ dysfunction is unknown. The risk of mood disorders in family members may be further exacerbated by imposed isolation and stigma. CONCLUSION Emerging literature on COVID-19 outcomes suggests some similarities with those of ARDS/SARS and prolonged mechanical ventilation. The pathophysiology of COVID-19 is presented here in the context of early outcome data and to inform an agenda for longitudinal research for patients and families.
Collapse
Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J Gordon Boyd
- Centre for Neuroscience Studies, Kingston Health Sciences Centre, and Department of Critical Care, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Karen Choong
- Department of Pediatrics and the Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, ON, Canada
| | | | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto and University Health Network, Toronto General Hospital, Toronto, ON, Canada
| |
Collapse
|
31
|
Nasa P, Azoulay E, Chakrabarti A, Divatia JV, Jain R, Rodrigues C, Rosenthal VD, Alhazzani W, Arabi YM, Bakker J, Bassetti M, De Waele J, Dimopoulos G, Du B, Einav S, Evans L, Finfer S, Guérin C, Hammond NE, Jaber S, Kleinpell RM, Koh Y, Kollef M, Levy MM, Machado FR, Mancebo J, Martin-Loeches I, Mer M, Niederman MS, Pelosi P, Perner A, Peter JV, Phua J, Piquilloud L, Pletz MW, Rhodes A, Schultz MJ, Singer M, Timsit JF, Venkatesh B, Vincent JL, Welte T, Myatra SN. Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method. THE LANCET. INFECTIOUS DISEASES 2022; 22:e74-e87. [PMID: 34774188 PMCID: PMC8580499 DOI: 10.1016/s1473-3099(21)00626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
Collapse
Affiliation(s)
- Prashant Nasa
- NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis Teaching Hospital, APHP, University of Paris, Paris, France
| | | | | | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Camilla Rodrigues
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University Grossman School of Medicine, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Erasmus University Medical Center, Rotterdam, Netherlands; Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - George Dimopoulos
- Attikon University Hospital, Athens, Greece; National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Imperial College London, London, UK
| | - Claude Guérin
- University de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Newton, Adelaide, SA, Australia
| | - Samir Jaber
- Hôpital Saint-Éloi, Montpellier University Hospital, Montpellier, France
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Younsuck Koh
- College of Medicine, University of Ulsan College of Medicine, University of Ulsan, Seoul, South Korea
| | - Marin Kollef
- Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Mitchell M Levy
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Flavia R Machado
- Hospital Sao Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Anders Perner
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jason Phua
- Alexandra Hospital, National University Health System, Singapore; National University Hospital, National University Health System, Singapore
| | - Lise Piquilloud
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Schultz
- Amsterdam University Medical Centers, Locatie AMC, Amsterdam, Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Tobias Welte
- German Center of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| |
Collapse
|
32
|
Gold S, Clarfield L, Johnstone J, Diambomba Y, Shah PS, Whittle W, Abbasi N, Arzola C, Ashraf R, Biringer A, Chitayat D, Czikk M, Forte M, Franklin T, Jacobson M, Keunen J, Kingdom J, Lapinsky S, MacKenzie J, Maxwell C, Preisman M, Ryan G, Selk A, Sermer M, Silversides C, Snelgrove J, Watts N, Young B, De Castro C, D'Souza R. Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review. BMC Pregnancy Childbirth 2022; 22:119. [PMID: 35148698 PMCID: PMC8840792 DOI: 10.1186/s12884-022-04409-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction. Method Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations. Results We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options. Interpretation There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04409-4.
Collapse
Affiliation(s)
- Shira Gold
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | | | - Jennie Johnstone
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Yenge Diambomba
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Nimrah Abbasi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Cristian Arzola
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rizwana Ashraf
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Anne Biringer
- Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - David Chitayat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Marie Czikk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Milena Forte
- Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Tracy Franklin
- Department of Family and Community Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Michelle Jacobson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Johannes Keunen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - John Kingdom
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | | | - Joanne MacKenzie
- Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
| | - Cynthia Maxwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Mary Preisman
- Department of Psychiatry, Mount Sinai Hospital, Toronto, ON, Canada
| | - Greg Ryan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Amanda Selk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Mathew Sermer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Candice Silversides
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - John Snelgrove
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Nancy Watts
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Beverly Young
- Department of Psychiatry, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Rohan D'Souza
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada.
| |
Collapse
|
33
|
|
34
|
Tingey JL, Dasher NA, Bunnell AE, Starosta AJ. Intensive Care-Related Cognitive Impairment: A Biopsychosocial Overview. PM R 2022; 14:259-272. [PMID: 35077003 DOI: 10.1002/pmrj.12773] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/10/2022]
Abstract
Advancements in critical care medicine have improved survival rates for patients experiencing critical illness in intensive care units (ICUs). While mortality has declined, more than half of ICU survivors experience functional impairments that persist beyond discharge. Of particular concern is ICU-related cognitive impairment, which can extend across the care continuum, ranging from acute and transient presentations in the ICU (eg, delirium) to long-term impairments years after discharge. ICU-related cognitive impairment has received increased attention in the literature, particularly as it relates to ICU survivors who have received and survived critical care in the context of SARS-CoV-2 pandemic and are now experiencing post-acute sequelae of SARS-CoV-2 infection. The medical complexity and heterogeneity of ICU survivors, coupled with the multifactorial etiology of ICU-related cognitive impairments, lead to challenges in how to optimize care for ICU survivors at various stages of recovery. This review aims to provide an overview of cognitive outcomes associated with critical illness by integrating recent literature focused on etiology, assessment, and interventions in the context of ICU-related cognitive impairments. The narrative review employs a biopsychosocial framework to comprehensively evaluate the multifactorial nature of ICU-related cognitive outcomes. Authors also highlight multidisciplinary teams composed of key rehabilitation providers are likely best suited for optimizing recovery trajectories of ICU survivors. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jamie L Tingey
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Nickolas A Dasher
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
35
|
Tripp L, Vanstone M, Canfield C, Leslie M, Levasseur MA, Panday J, Rowland P, Wilson G, You J, Abelson J. The impact of COVID-19 on patient engagement in the health system: Results from a Pan-Canadian survey of patient, family and caregiver partners. Health Expect 2022; 25:744-753. [PMID: 35023267 PMCID: PMC8957734 DOI: 10.1111/hex.13421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/01/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had an impact on all aspects of the health system. Little is known about how the activities and experiences of patient, family and caregiver partners, as a large group across a variety of settings within the health system, changed due to the substantial health system shifts catalysed by the pandemic. This paper reports on the results of a survey that included questions about this topic. METHODS Canadian patient, family and caregiver partners were invited to participate in an online anonymous survey in the Fall of 2020. A virtual snowballing approach to recruitment was used. Survey invitations were shared on social media and emailed to health system and governmental organizations with the request that they share the survey with patient partners. This paper focuses on responses to two questions related to patient partner experiences during the COVID-19 pandemic. RESULTS The COVID-19 questions were completed by 533 respondents. Over three quarters of respondents (77.9%, n = 415) indicated their patient engagement activities had been impacted by COVID-19. The majority (62.5%, n = 230) experienced at least a temporary or partial reduction in their patient engagement activities. Some respondents did see increases in their patient engagement activities (11.4%, n = 42). Many respondents provided insights into their experience with virtual platforms for engagement (n = 194), most expressed negative or mixed experiences with this shift. CONCLUSIONS This study provides a snapshot of Canadian patient, family and caregiver partners' perspectives on the impact of COVID-19 on their engagement activities. Understanding how engagement unfolded during a crisis is critical for our future planning if patient engagement is to be fully integrated into the health system. Identifying how patient partners were engaged and not engaged during this time period, as well as the benefits and challenges of virtual engagement opportunities, offers instructive lessons for sustaining patient engagement, including the supports needed to engage with a more diverse set of patient, family and caregiver partners. PATIENT CONTRIBUTION Patient partners were important members of the Canadian Patient Partner Study research team. They were engaged from the outset, participating in all stages of the research project. Additional patient partners were engaged to develop and pilot test the survey, and all survey respondents were patient, family or caregiver partners. The manuscript is coauthored by two patient partners.
Collapse
Affiliation(s)
- Laura Tripp
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Carolyn Canfield
- Patient Advisors Network (PAN), Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Janelle Panday
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paula Rowland
- Department of Occupational Science and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,The Wilson Centre, University of Toronto/University Health Network, Toronto, Ontario, Canada
| | - Geoff Wilson
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jeonghwa You
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
36
|
Singh H, Tang T, Thombs R, Armas A, Nie JX, Nelson MLA, Gray CS. Methodological Insights From a Virtual, Team-Based Rapid Qualitative Method Applied to a Study of Providers' Perspectives of the COVID-19 Pandemic Impact on Hospital-To-Home Transitions. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2022; 21:16094069221107144. [PMID: 35721871 PMCID: PMC9189180 DOI: 10.1177/16094069221107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, rapid virtual qualitative methods have gained attention in applied health research to produce timely, actionable results while complying with the pandemic restrictions. However, rigour and analytical depth may be two areas of concern for rapid qualitative methods. METHODS In this paper, we present an overview of a virtual team-based rapid qualitative method within a study that explored health care providers' perspectives of how the COVID-19 pandemic has impacted hospital-to-home transitions, lessons learned in applying this method, and recommendations for changes. Using this method, qualitative data were collected and analyzed using the Zoom Healthcare videoconferencing platform and telephone. Visual summary maps were iteratively created from the audio recordings of each interview through virtual analytic meetings with the team. Maps representing similar settings (e.g. hospital providers and community providers) and Sites were combined to form meta-maps representing that group's experience. The combinations of data that best fit together were used to form the final meta-map through discussion. RESULTS This case example is used to provide a description of how to apply a virtual team-based rapid qualitative method. This paper also offers a discussion of the opportunities and challenges of applying this method, in particular how the virtual team-based rapid qualitative method could be modified to produce timely results virtually while attending to rigour and depth. CONCLUSIONS We contend that the virtual team-based rapid qualitative data collection and analysis method was useful for generating timely, rigorous, and in-depth knowledge about transitional care during the COVID-19 pandemic. The recommended modifications to this method may enhance its utility for researchers to apply to their qualitative research studies.
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science
& Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation
Institute, University Health
Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health
Partners, Mississauga, ON, Canada
| | - Rachel Thombs
- Bridgepoint Collaboratory for
Research and Innovation, Toronto, ON, Canada
- University of Toronto Institute of
Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for
Research and Innovation, Toronto, ON, Canada
- University of Toronto Institute of
Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Jason X Nie
- Institute for Better Health, Trillium Health
Partners, Mississauga, ON, Canada
| | | | - Carolyn Steele Gray
- Bridgepoint Collaboratory for
Research and Innovation, Toronto, ON, Canada
- University of Toronto Institute of
Health Policy Management and Evaluation, Toronto, ON, Canada
| |
Collapse
|
37
|
Stenman L, Högberg L, Engström Å. Critical Care Nurses' Experiences Caring for Patients When Relatives Were not Allowed in the ICUs due to COVID-19 Pandemic. SAGE Open Nurs 2022; 8:23779608221103627. [PMID: 35669888 PMCID: PMC9163743 DOI: 10.1177/23779608221103627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Health care workers faced new challenges during the COVID-19 pandemic when physical contact with relatives more or less disappeared. Objectives The aim of this study is to describe the experiences of critical care nurses (CCNs) working in intensive care units (ICUs) under the visiting restrictions imposed as a result of COVID-19. Method This study followed a qualitative design. The purposive sample included CCNs with at least 1 year of experience working in an ICU with a visiting policy affected by the pandemic. Data collection was carried out via semi-structured interviews and analyzed through a qualitative content analysis with an inductive approach. Results The study results are presented in three categories with 10 subcategories. CCNs value the presence of patients’ relatives at the bedside and described many challenges when relatives could not be present with the patient during the pandemic. Conclusion Close relatives are able to share essential information about the patients and provide much-needed emotional support to them, the relatives’ role is of central importance and CCNs value their presence in ICUs more than any positive consequences of them not being there.
Collapse
Affiliation(s)
- Lina Stenman
- Critical Care Nurse, Skellefteå Hospital, Skellefteå, Sweden
| | - Lisa Högberg
- Critical Care Nurse, Lycksele Hospital, ICU, Lycksele, Sweden
| | - Åsa Engström
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
| |
Collapse
|
38
|
McCulloch H, Campbell-Yeo M, Richardson B, Dol J, Hundert A, Dorling J, Whitehead L, MacRae G, Bishop T, Afifi J, Earle R, Rose AE, Foye S, Inglis D, Kim T, Leighton C, Melanson A, Simpson DC, Smit M. The Impact of Restrictive Family Presence Policies in Response to COVID-19 on Family Integrated Care in the NICU: A Qualitative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:49-62. [PMID: 34931565 PMCID: PMC9072949 DOI: 10.1177/19375867211065178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: To conduct a needs assessment with families and their healthcare team to understand the impact of restrictive family presence policies in the neonatal intensive care unit (NICU) in response to COVID-19. Background: In response to the COVID-19 pandemic, significant restrictive family presence policies were instituted in most NICUs globally intended to protect infants, families, and HCPs. However, knowledge on the impact of the stress of the pandemic and policies restricting family presence in the NICU on vulnerable neonates and their families remains limited. Methods: Individuals were eligible to participate if they were a caregiver of an infant requiring NICU care or a healthcare provider (HCP) in the NICU after March 1, 2020. Semi-structured interviews were conducted using a virtual communication platform, and transcripts were analyzed using inductive thematic qualitative content analysis. Results: Twenty-three participants were interviewed (12 families and 11 HCPs). Three themes emerged: (1) successes (family-integrated care, use of technology), (2) challenges (lack of standardized messaging and family engagement, impact on parental wellbeing, institutional barriers, and virtual care), and (3) moving forward (responsive and supportive leadership). Conclusions: Our findings highlight the significant impact of family restrictions on the mental well-being of families, physical closeness with parents, and empathetic stress to HCPs. Further study of potential long-term impact is warranted.
Collapse
Affiliation(s)
| | - Marsha Campbell-Yeo
- IWK Health, Halifax, Nova Scotia, Canada.,Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brianna Richardson
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Justine Dol
- IWK Health, Halifax, Nova Scotia, Canada.,Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | - Sarah Foye
- IWK Health, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Mike Smit
- School of Information Management, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
39
|
Loneliness among adolescents and young adults with cancer during the COVID-19 pandemic: a cross-sectional survey. Support Care Cancer 2021; 30:2215-2224. [PMID: 34708310 PMCID: PMC8549808 DOI: 10.1007/s00520-021-06628-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
Background Adolescents and young adults (AYAs) diagnosed with cancer are at an increased risk of experiencing social isolation and loneliness secondary to their cancer and its treatment. The physical distancing measures implemented during the COVID-19 pandemic may have further increased loneliness among this group. This study examined the prevalence of loneliness and factors associated with loneliness among AYAs with cancer during this pandemic. Methods We conducted a self-administered, online, cross-sectional survey of Canadian AYAs diagnosed with cancer between 15 and 39 between January and February 2021. Loneliness was measured using the 3-item UCLA Loneliness Scale. Factors associated with higher levels of loneliness were identified using multiple logistic regression. Results The analysis included 805 AYAs. The prevalence of loneliness was 52.2% [N = 419, 95% CI (confidence interval) 48.7 to 55.6%]. Individuals who were 18–25 years old [AOR (adjusted odds ratio)1.60, CI 1.03–2.47, p = 0.035], currently undergoing cancer therapy (AOR 1.46, 95% CI 1.03–2.07, p = 0.035), who self-disclosed the presence of a pre-pandemic mental health condition (AOR 2.09, 95% CI = 1.22–3.58, p = 0.007), or were not in a relationship (AOR 2.22, 95% CI 1.57–3.14, p < 0.001) were more likely to report loneliness than others. Participants that lived in rural or remote locations were less likely to experience loneliness (AOR 0.59, 95%CI 0.40–0.87, p = 0.008). Conclusion One in two AYAs with cancer are feeling lonely during the COVID-19 pandemic. Future studies for developing interventions to target loneliness, particularly for those at greater risk, are necessary to improve the health and quality of life of AYAs with cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06628-5.
Collapse
|
40
|
Sadlonova M, Gerecke B, Herrmann-Lingen C, Kutschka I. Heart transplantation in the era of COVID-19 pandemic: delirium, post-transplant depression, and visitor restrictions; the role of liaison and inpatient psychosomatic treatment-a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab355. [PMID: 34632264 PMCID: PMC8497879 DOI: 10.1093/ehjcr/ytab355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/03/2021] [Accepted: 08/31/2021] [Indexed: 11/14/2022]
Abstract
Background Heart transplant recipients show a high risk of developing major depression with an increased risk of post-transplant morbidity and mortality. Heart transplant specialists and patients face unprecedented challenges during the COVID-19 pandemic, which have enormous clinical implications such as the increased risk of COVID-19 as well as visitor restrictions with social isolation during the post-transplant inpatient treatment. Case summary We present a case of a 64-year-old woman with end-stage heart failure caused by non-compaction cardiomyopathy who received an orthotopic heart transplant (OHT) without any intra-operative complications. Post-operatively, she showed acute psychotic symptoms in the intensive care unit (ICU) with improvement after switching intravenous tacrolimus treatment to an oral intake. Furthermore, the patient developed severe depressive symptoms with malnutrition and had a prolonged hospitalization. Standard medical care was complemented by intensive psychocardiological treatment to overcome the crisis. Conclusion High complexity of the post-transplant management after OHT underlines the importance of multidisciplinary teamwork, involving heart transplant specialists and allied mental health professionals. This collaboration led to an excellent long-term result. Facing the COVID-19 pandemic, the hospital visitor policies may be scrutinized, carefully looking at the role of social isolation, post-operative experience in the ICU, and medical complications after OHT.
Collapse
Affiliation(s)
- Monika Sadlonova
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Birgit Gerecke
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Ingo Kutschka
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| |
Collapse
|
41
|
Fiest KM, Krewulak KD, Makuk K, Jaworska N, Hernández L, Bagshaw SM, Burns KE, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler RA, Kho ME, Parhar KKS, Rewa OG, Rochwerg B, Sept BG, Soo A, Spence S, West A, Stelfox HT, Parsons Leigh J. A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic. Crit Care Explor 2021; 3:e0562. [PMID: 34712955 PMCID: PMC8547909 DOI: 10.1097/cce.0000000000000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics. DESIGN Three rounds of a remote modified Delphi consensus process. SETTING Online survey and virtual polling from February 2, 2021, to April 8, 2021. SUBJECTS Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic. MEASUREMENTS AND MAIN RESULTS During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1-not significant, 9-significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1-not essential, 9-essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7-9 or 1-3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4-6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0-100 points). Participants prioritized 11 experiences (e.g., variability of family's comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies. CONCLUSIONS We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.
Collapse
Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Karen E Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
42
|
Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM, Burns KEA, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler R, Hernández L, Kho ME, Kredentser M, Makuk K, Murthy S, Niven DJ, Olafson K, Parhar KKS, Patten SB, Rewa OG, Rochwerg B, Sept B, Soo A, Spence K, Spence S, Straus S, West A, Parsons Leigh J, Fiest KM. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:347. [PMID: 34563234 PMCID: PMC8465762 DOI: 10.1186/s13054-021-03763-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Abstract
Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals.
Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03763-7.
Collapse
Affiliation(s)
- Stephana J Moss
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie C Anglin
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Maia Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Manitoba, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kendiss Olafson
- Department of Medicine, University of Manitoba, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Krista Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Chinook Regional Hospital, Lethbridge County, Alberta, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
43
|
“Be Their Advocate”: Families’ Experience with a Relative in LTC during the COVID-19 Pandemic. Can J Aging 2021. [DOI: 10.1017/s0714980821000398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractShortly after the COVID-19 pandemic was declared, strict visitor restrictions were issued for long-term care facilities (LTCFs). A year later, restrictions are still in place and they continue to impact family members who have limited or no in-person contact with their relative in LTCFs. The goal of this qualitative longitudinal focused ethnography was to understand the experience of family members who have a relative in a LTCF where visiting has been restricted during the pandemic. Seventeen family members participated in two interviews that were 6 months apart. Data analysis highlighted five key drivers, defined as the workforce, communication deficits, characteristics of care, public health directives, and autonomy of relative which in turn resulted in three main themes: psychological distress, surveillance, and visiting challenges. This study provides a glimpse into the difficult experiences of families with a relative residing in a LTCF in the province of New Brunswick.
Collapse
|
44
|
Voices From the Pandemic: A Qualitative Study of Family Experiences and Suggestions Regarding the Care of Critically Ill Patients. Ann Am Thorac Soc 2021; 19:614-624. [PMID: 34436977 PMCID: PMC8996268 DOI: 10.1513/annalsats.202105-629oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale Intensive care unit (ICU) visitation restrictions during the coronavirus disease (COVID-19) pandemic have drastically reduced family-engaged care. Understanding the impact of physical distancing on family members of ICU patients is needed to inform future policies. Objectives To understand the experiences of family members of critically ill patients with COVID-19 when physically distanced from their loved ones and to explore ways clinicians may support them. Methods This qualitative study of an observational cohort study reports data from 74 family members of ICU patients with COVID-19 at 10 United States hospitals in four states, chosen based on geographic and demographic diversity. Adult family members of patients admitted to the ICU with COVID-19 during the early phase of the pandemic (February–June 2020) were invited to participate in a phone interview. Interviews followed a semistructured guide to assess four constructs: illness narrative, stress experiences, communication experiences, and satisfaction with care. Interviews were transcribed verbatim and analyzed using an inductive approach to thematic analysis. Results Among 74 interviewees, the mean age was 53.0 years, 55% were white, and 76% were female. Physical distancing contributed to substantial stress and harms (nine themes). Participants described profound suffering and psychological illness, unfavorable perceptions of care, and weakened therapeutic relationship between family members and clinicians. Three communication principles emerged as those most valued by family members: contact, consistency, and compassion (the 3Cs). Family members offered suggestions to guide clinicians faced with communicating with physically distanced families. Conclusions Visitation restrictions impose substantial psychological harms upon family members of critically ill patients. Derived from the voics of family members, our findings warrant strong consideration when implementing visitation restrictions in the ICU and advocate for investment in infrastructure (including staffing and videoconferencing) to support communication. This study offers family-derived recommendations to operationalize the 3Cs to guide and improve communication in times of physical distancing during the COVID-19 pandemic and beyond.
Collapse
|
45
|
Johnstone J, Duncan D. Coronavirus: the 7th C affecting the 6Cs. A focus on compassion, care and touch. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:928-933. [PMID: 34379479 DOI: 10.12968/bjon.2021.30.15.928] [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: 06/13/2023]
Abstract
The C0VID-19 pandemic has challenged everyone in society, from children who are no longer able to attend school and nursery to adults trying to juggle working at home and vulnerable members of society who have needed to self-isolate. NHS staff and key workers also need to juggle their family situations and many will have to adapt their practice and ways of working to address the demands placed on the NHS during this time. The current pandemic has altered the nature of services being provided to patients, and staff are now wearing personal protective equipment, with many being redeployed to ward areas. This article considers the 6Cs of nursing and the challenges faced by staff during the COVID-19 pandemic, with a primary focus on care and compassion. The vital role that touch has in the care of the patient and family is also considered.
Collapse
Affiliation(s)
| | - Debbie Duncan
- Lecturer in Nursing, Queen's University Belfast, Northern Ireland
| |
Collapse
|
46
|
Bolton KC, Lawler M, Hauptman J, Madden M, DeVoe SG, Kennedy AG, Tomkins BJ, Hodde NM. Patient Experience on a Hospital Oncology Service Before and After Implementation of a No-Visitor Policy During COVID-19. J Patient Exp 2021; 8:23743735211034620. [PMID: 34377777 PMCID: PMC8323412 DOI: 10.1177/23743735211034620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hospital visitor restriction policies prompted by Coronavirus Disease 2019
(COVID-19) may lead to a less comfortable or informed inpatient experience for
oncology patients admitted for non-COVID-19 conditions. We surveyed oncology
inpatients before (n = 47) and after (n = 65) implementation of a no-visitor
policy using a validated questionnaire to measure patient experience. Results
revealed no significant difference in the percentage of patients reporting “no
problems” (P < .05) in all questions. Patient experience was
not adversely impacted by visitor restrictions enacted in response to COVID-19
on an oncology service, as measured by a questionnaire capturing common concerns
among inpatients.
Collapse
Affiliation(s)
- Kenyon C Bolton
- The University of Vermont Medical Center, Burlington, VT, USA
| | - Michael Lawler
- The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | | | - Marissa Madden
- The University of Vermont Medical Center, Burlington, VT, USA
| | - Stephen G DeVoe
- Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Amanda G Kennedy
- Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Bradley J Tomkins
- Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Naomi M Hodde
- The University of Vermont Medical Center, Burlington, VT, USA.,The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| |
Collapse
|
47
|
Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
Collapse
Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
48
|
Honarmand K, Mehta S. Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic. Can J Anaesth 2021; 68:1465-1470. [PMID: 34212307 PMCID: PMC8247615 DOI: 10.1007/s12630-021-02048-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Division of Critical Care, Western University, London, ON, Canada.
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
49
|
Law S, Ormel I, Babinski S, Kuluski K, Quesnel-Vallée A. "Caregiving is like on the job training but nobody has the manual": Canadian caregivers' perceptions of their roles within the healthcare system. BMC Geriatr 2021; 21:404. [PMID: 34193054 PMCID: PMC8243301 DOI: 10.1186/s12877-021-02354-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Stepping into the role of an unpaid caregiver to offer help is often considered a natural expectation of family members or friends. In Canada, such contributions are substantial in terms of healthcare provision but this comes at a considerable cost to the caregivers in both health and economic terms. Methods In this study, we conducted a secondary analysis of a collection of qualitative interviews with 39 caregivers of people with chronic physical illness to assess how they described their particular roles in caring for a loved one. We used a model of caregiving roles, originally proposed by Twigg in 1989, as a guide for our analysis, which specified three predominant roles for caregivers – as a resource, as a co-worker, and as a co-client. Results The caregivers in this collection spoke about their roles in ways that aligned well with these roles, but they also described tasks and activities that fit best with a fourth role of ‘care-coordinator’, which required that they assume an oversight role in coordinating care across institutions, care providers and often advocate for care in line with their expectations. For each of these types of roles, we have highlighted the limitations and challenges they described in their interviews. Conclusions We argue that a deeper understanding of the different roles that caregivers assume, as well as their challenges, can contribute to the design and implementation of policies and services that would support their contributions and choices as integral members of the care team. We provide some examples of system-level policies and programs from different jurisdictions developed in recognition of the need to sustain caregivers in their role and respond to such limitations.
Collapse
Affiliation(s)
- Susan Law
- Trillium Health Partners - Institute for Better Health, 100 Queensway West, 6th Floor CA Building, Mississauga, ON, L5B 1B8, Canada. .,University of Toronto - Institute for Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada.
| | - Ilja Ormel
- St. Mary's Research Centre, 3830 avenue Lacombe, Montreal, QC, H3T 1M5, Canada.,Department of Family Medicine, McGill University, 5858 Cote-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Stephanie Babinski
- Ryerson University, Faculty of Community Services, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.,ELLICSR Health, Wellness & Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Kerry Kuluski
- Trillium Health Partners - Institute for Better Health, 100 Queensway West, 6th Floor CA Building, Mississauga, ON, L5B 1B8, Canada.,University of Toronto - Institute for Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| |
Collapse
|
50
|
Mistraletti G, Giannini A, Gristina G, Malacarne P, Mazzon D, Cerutti E, Galazzi A, Giubbilo I, Vergano M, Zagrebelsky V, Riccioni L, Grasselli G, Scelsi S, Cecconi M, Petrini F. Why and how to open intensive care units to family visits during the pandemic. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:191. [PMID: 34078445 PMCID: PMC8171999 DOI: 10.1186/s13054-021-03608-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.
Collapse
Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. .,SC Anesthesia and Intensive Care, San Paolo Hospital - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Gristina
- Italian Society of Anaesthesia, Analgesia, Reanimation, and Intensive Care Medicine (SIAARTI) Ethics, Rome, Italy
| | | | - Davide Mazzon
- UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy
| | - Elisabetta Cerutti
- Department of Anesthesia and Transplant, Surgical Intensive Care, AOU Ospedali Riuniti, Ancona, Italy
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, AULSS 3 Serenissima Veneto, Venice, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Vladimiro Zagrebelsky
- Director, Laboratorio dei Diritti Fondamentali, Collegio Carlo Alberto, Turin, Italy
| | | | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Scelsi
- Chair Aniarti, Director of Health Profession Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Flavia Petrini
- SIAARTI President - Retired Full Professor of Anesthesia and Intensive Care, Chieti-Pescara University, Chieti, Italy
| |
Collapse
|