Nurses' coping strategies caring for patients during severe viral pandemics: A mixed-methods systematic review

BACKGROUND

Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.

AIM

To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.

DESIGN

A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.

METHODS

A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.

RESULTS

In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.

CONCLUSIONS

It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.

RELEVANCE TO CLINICAL PRACTICE

Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a literature review study.

In-field detection and characterization of B/Victoria lineage deletion variant viruses causing early influenza activity and an outbreak in Louisiana, 2019

Background

In 2019, the Louisiana Department of Health reported an early influenza B/Victoria (B/VIC) virus outbreak.

Method

As it was an atypically large outbreak, we deployed to Louisiana to investigate it using genomics and a triplex real-time RT-PCR assay to detect three antigenically distinct B/VIC lineage variant viruses.

Results

The investigation indicated that B/VIC V1A.3 subclade, containing a three amino acid deletion in the hemagglutinin and known to be antigenically distinct to the B/Colorado/06/2017 vaccine virus, was the most prevalent circulating virus within the specimens evaluated (86/88 in real-time RT-PCR).

Conclusion

This work underscores the value of portable platforms for rapid, onsite pathogen characterization.

Serological Evidence of Backyard Pig Exposure to Highly Pathogenic Avian Influenza H5N8 Virus during 2016-2017 Epizootic in France

In autumn/winter 2016-2017, HPAI-H5N8 viruses belonging to the A/goose/Guandong/1/1996 (Gs/Gd) lineage, clade 2.3.4.4b, were responsible for outbreaks in domestic poultry in Europe, and veterinarians were requested to reinforce surveillance of pigs bred in HPAI-H5Nx confirmed mixed herds. In this context, ten pig herds were visited in southwestern France from December 2016 to May 2017 and serological analyses for influenza A virus (IAV) infections were carried out by ELISA and hemagglutination inhibition assays. In one herd, one backyard pig was shown to have produced antibodies directed against a virus bearing a H5 from clade 2.3.4.4b, suggesting it would have been infected naturally after close contact with HPAI-H5N8 contaminated domestic ducks. Whereas pigs and other mammals, including humans, may have limited sensitivity to HPAI-H5 clade 2.3.4.4b, this information recalls the importance of implementing appropriate biosecurity measures in pig and poultry farms to avoid IAV interspecies transmission, a prerequisite for co-infections and subsequent emergence of new viral genotypes whose impact on both animal and human health cannot be predicted.

Epidemiology of 2017 influenza outbreaks in nine Australian Aged care facilities

Background

The 2017 A/H3N2 influenza season was the most severe season since the 2009 influenza pandemic. There were over 591 influenza outbreaks in institutions across the state of New South Wales (NSW) in Australia.

Aim

To describe the epidemiology of influenza outbreaks in nine Sydney aged care facilities in 2017.

Methods

Study data were collected from nine Sydney aged care facilities for 2017 influenza season. Descriptive epidemiological analysis was conducted.

Results

From the nine sites included, with a total of 716 residents, four sites reported laboratory‐confirmed influenza outbreaks during the study period, with an attack rate in residents ranging from 6% to 29%. The outbreaks resulted in lockdowns in two facilities and hospitalisation of seven residents. No deaths were reported as a result of influenza infection. Influenza A was the most common influenza type reported across the facilities. The duration of outbreak lasted for 1‐4 weeks varied by site.

Conclusion

The 2017 season was a severe influenza season recorded in Australia. About half of the facilities studied experienced outbreaks of influenza, with a high attack rate among residents. Infection prevention and control measures and outbreak management plans are crucial for aged care facilities, including vaccination of staff and visitors to prevent outbreaks among the vulnerable residents.

The financial burden of an influenza outbreak in a small rehabilitation centre

We report an influenza outbreak in a 75-bed rehabilitation centre and present the detailed microeconomic impact that it had during the season 2016/2017. The direct medical, direct non-medical and indirect costs were calculated. The outbreak included 18 patients with influenza and 8 contact patients, leading to 86 days with isolation precautions. During the outbreak month, 25 (15%) employees were absent from work for 89 days (mean 3.6 days, SD ± 1.8), and during the entire influenza season 33 for 175 (5.3 ± SD 4.6) days, respectively. The economic burden related to the outbreak was 114 373 CHF (106 890 €, 112 131 $).

Influenza A (H3) Outbreak at a Hurricane Harvey Megashelter in Harris County, Texas: Successes and Challenges in Disease Identification and Control Measure Implementation

ABSTRACTWhen Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly "cot-to-cot" resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101).

Detecting early-warning signals of influenza outbreak based on dynamic network marker

The seasonal outbreaks of influenza infection cause globally respiratory illness, or even death in all age groups. Given early‐warning signals preceding the influenza outbreak, timely intervention such as vaccination and isolation management effectively decrease the morbidity. However, it is usually a difficult task to achieve the real‐time prediction of influenza outbreak due to its complexity intertwining both biological systems and social systems. By exploring rich dynamical and high‐dimensional information, our dynamic network marker/biomarker (DNM/DNB) method opens a new way to identify the tipping point prior to the catastrophic transition into an influenza pandemics. In order to detect the early‐warning signals before the influenza outbreak by applying DNM method, the historical information of clinic hospitalization caused by influenza infection between years 2009 and 2016 were extracted and assembled from public records of Tokyo and Hokkaido, Japan. The early‐warning signal, with an average of 4‐week window lead prior to each seasonal outbreak of influenza, was provided by DNM‐based on the hospitalization records, providing an opportunity to apply proactive strategies to prevent or delay the onset of influenza outbreak. Moreover, the study on the dynamical changes of hospitalization in local district networks unveils the influenza transmission dynamics or landscape in network level.

Containing influenza outbreaks with antiviral use in long-term care facilities in Taiwan, 2008-2014

Backgrounds

Influenza can spread rapidly in long‐term care facilities (LTCFs), and residents are usually at higher risk for influenza infections.

Objective

Our study aimed to evaluate the effectiveness of antiviral interventions on outbreak control.

Methods

Taiwan Centers for Disease Control used a syndromic surveillance system to monitor outbreaks in LTCFs. Local public health authorities verified those outbreaks and logged reports to the Epidemic Investigation Report Files Management System (EIRFMS). We conducted a retrospective cohort study by reviewing EIRFMS reports of influenza outbreaks in LTCFs during 2008‐2014. An influenza outbreak was defined as 3 or more cases of influenza‐like illness occurring within a 48‐hours period with ≥1 case of real‐time RT‐PCR‐confirmed influenza in the same LTCF. Antiviral interventions included providing antiviral treatment for patients and antiviral prophylaxis for contacts during outbreaks.

Results

Of 102 influenza outbreaks, median days from onset of the first patient to outbreak notification was 4 (range 0‐22). Median attack rate was 24% (range 2.2%‐100%). Median influenza vaccination coverage among residents was 81% (range 0%‐100%); 43% occurred during the summer months. Even though antiviral treatment was provided in 87% of the outbreaks, antiviral prophylaxis was implemented in only 40%. Starting antiviral treatment within 2 days of outbreak onset was associated with keeping attack rates at <25% (OR 0.29, 95% CI: 0.12‐0.71).

Conclusions

Early initiation of antiviral treatment may reduce the magnitude of influenza outbreaks. Clinicians should identify patients with influenza and start antiviral use early to prevent large outbreaks in LTCFs.

Clinical differences between H3N2 and H1N1 influenza 2012 and lower respiratory tract infection found using a statistical classification approach

Background

Influenza A H1N1 and H3N2 are two influenza waves that have been identified in past years.

Methods

Data from 77 inpatients from three tertiary hospitals were included and statistical analysis was performed in three different clusters.

Results

Thirty-four patients (44.2%) had respiratory distress upon admission, 31.2% had a smoking history or were active smokers, 37.7% manifested disease symptoms, and 7.8% were obese (body mass index >41). The mean age of patients was 51.1 years. Cough was the most common symptom observed in 77.9% of the patients, accompanied by sputum production (51.9%) and fatigue (42.9%). Hemoptysis and vomiting were rarely recorded in the patients (9.1% and 16.9%, respectively). Oseltamivir administration varied between 0 and 10 days, giving a mean value of 2.2 days. In particular, 19 patients received no drug, 31 patients received drug for only for 1 day, 19 patients for 5 days, and 8 patients from 2 to 10 days.

Conclusion

Clusters of symptoms can be used to identify different types of influenza and disease severity. Patients with vaccination had pneumonia, whereas patients without vaccination had influenza A. Patients more than 54.5 years old had H3N2 and patients less than 54.5 years had H1N1. White blood cell count values increased from normal to elevated in H3N2 patients but still remained abnormal in lower tract infection and H1N1 patients.

Non-influenza respiratory viruses may overlap and obscure influenza activity

OBJECTIVE

To report the number and timing of influenza A isolates, as well as overlapping respiratory viruses. Co-circulating respiratory viruses may obscure the determination of influenza activity.

DESIGN

Prospective clinical surveillance for the new onset of respiratory illness followed by viral cultures during seven separate influenza seasons.

SETTING

The Wisconsin Veterans Home, a skilled nursing facility for veterans and their spouses.

RESULTS

Influenza A isolates were encountered in greater numbers than non-influenza A isolates during three seasons. Seasonal variability is striking. In December 1992, we identified a large outbreak of respiratory illness. Influenza type B was cultured from 102 residents. In December 1995, influenza A was cultured from 285 people in Wisconsin. At that time, we identified outbreaks of respiratory illness in two of our four buildings. Based on statewide data, we suspected an influenza outbreak; however, 26 isolates of parainfluenza virus type 1 were cultured with no influenza. The potential importance of culturing at the end of the season was demonstrated in 1991-1992 when an outbreak of respiratory syncytial virus (RSV) overlapped and extended beyond influenza A activity.

CONCLUSIONS

When interpreting new clinical respiratory illnesses as a basis for declaring an outbreak of influenza A, clinicians should realize that co-circulating respiratory viruses can account for clinical illnesses. Clinicians might utilize healthcare dollars efficiently by performing cultures to focus the timing of influenza A chemoprophylaxis. Cultures could be performed when clinical outbreak criteria are approached to confirm an outbreak. Culturing of new respiratory illness could begin again before the anticipated discontinuation of prophylaxis (approximately 2 weeks).