Front-line Care Research Articles

(Re)arranging “systems of care” in the early Ebola response in Sierra Leone: An interdisciplinary analysis

Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response.This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse “systems of care” and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers – or arrangers – in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved.

Mandatory COVID-19 vaccination for frontline care home staff soon to become law

British Journal of Healthcare AssistantsVol. 15, No. 6 Health MattersMandatory COVID-19 vaccination for frontline care home staff soon to become lawAlan GlasperAlan GlasperEmeritus Professor of Nursing, University of SouthamptonSearch for more papers by this authorAlan GlasperPublished Online:11 Jul 2021https://doi.org/10.12968/bjha.2021.15.6.296AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Albert A. Care homes fear mandatory vaccination will lead to exodus of workers. 26 April 2021. https://www.carehome.co.uk/news/article.cfm/id/1647914/Fears-grow-mandatory-staff-vaccination-could-make-care-home-workers-unemployable (accessed 23 June 2021) Google ScholarAllegretti A. Ministers urged not to ‘threaten’ NHS staff over mandatory COVID jab. 30 May 2021. https://www.theguardian.com/politics/2021/may/30/ministers-urged-not-to-threaten-nhs-staff-over-mandatory-covid-jab (accessed 23 June 2021) Google ScholarAllegretti A. UK rights watchdog endorses compulsory COVID jabs for care home staff https://www.theguardian.com/society/2021/jun/02/uk-rights-watchdog-endorses-compulsory-covid-jabs-for-care-home-staff (accessed 23 June 2021) Google ScholarAragbonfoh Abumere F. Utilitarianism. 2019. https://press.rebus.community/intro-to-phil-ethics/chapter/utilitarianism/ (accessed 23 June 2021) Google ScholarBerger D. Up the line to death: COVID-19 has revealed a mortal betrayal of the world’s healthcare workers. 29 January 2021. https://blogs.bmj.com/bmj/2021/01/29/up-the-line-to-death-covid-19-has-revealed-a-mortal-betrayal-of-the-worlds-healthcare-workers/ (accessed 23 June 2021) Google ScholarBooth R, Rawlinson K. A third of care home staff in some London areas have not had COVID jab. 16 June 2021. https://www.theguardian.com/society/2021/jun/16/all-care-home-staff-in-england-should-have-covid-vaccine-says-minister (accessed 23 June 2021) Google ScholarBrowne Salas J, Comas-Herrera A, Drou Roget G et al. National discussions on mandatory vaccination for long-term care staff in 24 countries. LTCcovid international overviews of long-term care policies and practices in relation to Covid-19 (No. 1, May 2021). 2021. https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/() Google ScholarDepartment of Health and Social Care. Consultation launched on staff COVID-19 vaccines in care homes with older adult residents. 2021a. https://www.gov.uk/government/news/consultation-launched-on-staff-covid-19-vaccines-in-care-homes-with-older-adult-residents (accessed 23 June 2021) Google ScholarDepartment of Health and Social Care. Making vaccination a condition of deployment in older adult care homes. 2021b. https://www.gov.uk/government/consultations/making-vaccination-a-condition-of-deployment-in-older-adult-care-homes (accessed 23 June 2021) Google ScholarField RI. Mandatory vaccination of health care workers: whose rights should come first? PT. 2009;34(11):615–618 Google ScholarGoldstein A. Should health-care workers be required to get coronavirus shots? Companies grapple with mandates. 5 April 2021. https://www.washingtonpost.com/health/should-health-care-workers-be-required-to-get-coronavirus-shots-companies-grapple-with-mandates/2021/04/04/2369048e-92f2-11eb-a74e-1f4cf89fd948_story.html (accessed 23 June 2021) Google ScholarHassan C. Employees protest against Houston hospital’s policy that all staff must be vaccinated against COVID-1. 9 June 2021. https://edition.cnn.com/2021/06/08/us/houston-hospital-staff-protest-vaccine-mandate/index.html (accessed 23 June 2021) Google ScholarHoltug N. The harm principle. Ethical Theory Moral Pract. 2002;5(4):357–389 Crossref, Google ScholarKhinkulova K. Alarming COVID surge cools Russia’s football fever. 19 June 2021. https://www.bbc.co.uk/news/world-europe-5751135 (accessed 23 June 2021) Google ScholarLocke T. UK COVID-19 update: cases ‘rising exponentially’, mandatory NHS jabs divide opinion in Medscape UK poll. 2021. https://www.medscape.com/viewarticle/953270 (accessed 23 June 2021) Google ScholarNightingale F. Notes on nursing: what it is, and what it is not. London: Harrison; 1860 Google ScholarPaterlini M. COVID-19: Italy makes vaccination mandatory for healthcare workers. BMJ 2021; 373: n905 doi: https://doi.org/10.1136/bmj.n905 Google ScholarRoberts L. Nurse who spread Covid conspiracy theories that vaccines will ‘kill you’ struck off. 3 June 2021. https://www.telegraph.co.uk/news/2021/06/03/nurse-spread-covid-conspiracy-theories-vaccines-will-kill-struck/ (accessed 23 June 2021) Google ScholarRoyal College of Nursing. RCN position on mandating vaccination for health and social care staff. 2021. https://www.rcn.org.uk/about-us/our-influencing-work/position-statements/rcn-position-on-mandating-vaccination-for-health-and-social-care-staff() Google ScholarWalker P, Campbell D, Booth R. Plan to oblige care staff to have Covid jab and England easing delay confirmed. 16 Jun 2021. https://www.theguardian.com/politics/2021/jun/16/matt-hancock-confirms-plan-to-require-care-staff-to-have-covid-vaccine (accessed 23 June 2021) Google Scholar FiguresReferencesRelatedDetails 2 July 2021Volume 15Issue 6ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 11 July 2021 Published in print 2 July 2021 Information© MA Healthcare LimitedPDF download

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

ObjectivesThe psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital...

A Cross-Sectional Study of the Alarming Prevalence of Smoking Among Lebanese Physicians and Its Negative Impact on Promoting Cessation

Background: There is a paucity of data on the prevalence of smoking among physicians. As physicians are on the front line caring for patients’ health, a detailed analysis of their smoking habits and its impact on counseling their patients to quit is warranted. So far, no study in Lebanon has addressed the real prevalence of physicians smoking and its impact on promoting cessation. This study aims to fill this purpose. Methods: A cross-sectional study conducted using a web-based self-administered questionnaire was e-mailed to 4037 Lebanese physicians between November 2015 and February 2016. The questionnaire included 11 questions about basic sociodemographic information (age, gender, work province, specialty), smoking habits and attitude towards smoking cessation. SPSS was used for analysis. The main outcome was to calculate the percentage of physicians that smoke, its relationship to gender and age, and its impact on counseling their patients about smoking cessation. Results: 529 responders were analyzed (13.1% response rate). A high rate of physician ever-smokers was noted at 37% (n=195) whereas the prevalence of current smokers was 13% (n=70).. In addition, there was a difference in the gender of ever-smoking physicians where 47% of males were smokers compared to 20% of females only. Regarding the prevalence of smoking within different specialties, it was noted that 35% (n=74) of internal medicine physicians were ever-smokers compared to approximately 50% (n=51/102) of surgeons. There was a statistically significant difference between former-smokers and current-smokers in regards to how frequently they urge their patients to quit smoking. Conclusion: The high prevalence of smoking among Lebanese physicians is depicted and its negative impact on counseling patients to quit is a serious consequence. This is a major drawback in the fight against tobacco and further awareness may be needed among our future doctors to increase smoking cessation counseling and decrease the burden of smoking in Lebanon and worldwide.

\u2018Bare-bones\u2019 to \u2018silver linings\u2019: lessons on integrating a palliative approach to care in long-term care in Western Canada

Background‘Whole-person’ palliative approaches to care (PAC) are important for enhancing the quality of life of residents with life-limiting conditions in long-term care (LTC). This research is part of a larger, four province study, the ‘SALTY (Seniors Adding Life to Years)’ project to address quality of care in later life.A Quality Improvement (QI) project to integrate a PAC (PAC-QI) in LTC was implemented in Western Canada in four diverse facilities that varied in terms of ownership, leadership models, bed size and geography. Two palliative ‘link nurses’ were hired for 1 day a week at each site over a two-year time frame to facilitate a PAC and support education and training.This paper evaluates the challenges with embedding the PAC-QI into LTC, from the perspectives of the direct care, or front-line team members. Sixteen focus groups were undertaken with 80 front-line workers who were predominantly RNs/LPNs (n = 25), or Health Care Aides (HCAs; n = 32). A total of 23 other individuals from the ranks of dieticians, social workers, recreation and rehabilitation therapists and activity coordinators also participated. Each focus group was taped and transcribed and thematically analyzed by research team members to develop and consolidate the findings related to challenges with embedding the PAC.ResultsThematic analyses revealed that front-line workers are deeply committed to providing high quality PAC, but face challenges related to longstanding conditions in LTC notably, staff shortages, and perceived lack of time for providing compassionate care. The environment is also characterized by diverse views on what a PAC is, and when it should be applied. Our research suggests that integrated, holistic and sustainable PAC depends upon access to adequate resources for education, training for front-line care workers, and supportive leadership.ConclusionsThe urgent need for integrated PAC models in LTC has been accentuated by the current COVID-19 pandemic. Consequently, it is more imperative than ever before to move forwards with such models in order to promote quality of care and quality of life for residents and families, and to support job satisfaction for essential care workers.

The COVID-19 Pandemic in Spain: Experiences of Midwives on the Healthcare Frontline.

Background: Midwives look after women during pregnancy, childbirth and puerperium. In Spain, the first wave of COVID was particularly virulent. There are few studies about the experiences of midwives providing care during the COVID pandemic and very few have been undertaken in the countries of southern Europe such as Spain. This article sets out to take a more in-depth look at the experiences of midwives who were on the frontline of care during the early months of the COVID-19 pandemic as well as to identify new needs and resilience strategies that can help midwives. Methods: A qualitative methodology of phenomenological tradition was used, interviewing 10 midwives from primary care, hospital and independent care. Results: After content analysis, three central categories emerged: (a) cascade of emotions; (b) professional occupation and concern for the women; (c) resisting the day-to-day; resilience and resistance strategies. Conclusions: Despite the difficulties, midwives are concerned about the loss of rights and autonomy and about the increased vulnerability of women. Midwives have become aware of the power they have in their actions both in health management and administration, as well as in the care of women, creating strategies to provide dignified care to their users.

Designing hierarchical networks to improve patient access to care: a case study in veteran eye care

Across the United States, many patients, including veteran patients, face barriers in accessing appropriate, timely, and affordable healthcare. When developing or modifying healthcare systems to improve patient access, we can consider strategies (e.g., telehealth) in which lower-cost, more abundant resources are used for services often performed with more constrained and/or more expensive, specialized resources. We propose a framework in which hierarchical care networks allow patients to receive frontline care from lower cost, more accessible alternatives, while specialized resources are reserved for more complex care. We use operations research tools, including mixed-integer programming and facility location models, to design and analyze these networks. We present a case study applying these methods to improve veterans’ access to eye care screenings. The case study results demonstrate that using different providers in locations throughout the system can increase the number of patients screened by nearly four times the number currently screened while increasing the budget by only 2.5%. When designing healthcare networks to improve access, decision makers must consider several trade-offs, including how resources are distributed. Operations research tools are effective methods for understanding, designing, and evaluating these trade-offs to best understand the wide-ranging impacts of resource (re)distribution.

Medi-Caring on the Colonial Margins: The Position of African Medical Assistants in Rural Colonial Fort Victoria, Southern Rhodesia, 1930s–1960s

Focusing on the experiences of African medical auxiliaries belonging to rural colonial Fort Victoria province’s sprawling Ndanga Native Medical Unit, this article considers the ambiguous position occupied by this front-line group who pioneered black medical care work in the former British colony of Southern Rhodesia (Zimbabwe). Although a great deal of work has been done on the histories of medical auxiliaries across colonial Africa, how they managed their incorporation into a marginal but evolving colonial healthcare system requires a fresher look. The recent emphasis on auxiliaries’ cultural power and clinical acumen – two extremely important traits – has tended to overshadow the daily realities of their positioning on the margins of colonial health-care systems. Adopting a holistic approach, I reconsider the opportunities and constraints of their occupation. I argue that although African medical auxiliaries in remote rural places such as Ndanga were influential as culture brokers and providers of frontline care – a source of pride and inspiration for many – their haphazard recruitment, ad hoc training and casual conditions of service negatively exposed them to the vicissitudes of their colonial and professional subjugation. Moreover, as African medical training became more professionalised from the 1950s onwards, the once prestigious position of medical assistants was overtaken by newer categories of professionally trained African health-care personnel.

A national standard that will influence global efforts to protect antibiotics

Though the infectious diseases (ID) pharmacy specialty has been in existence for many years, recent issues have raised the profile of ID pharmacists within the healthcare system. First, antimicrobial resistance rates have reached a crisis point and gained the attention of international organisations.1 Second, and in large part due to antimicrobial resistance, recognition of the suboptimal use of antimicrobial agents has led to the rapid expansion of antimicrobial stewardship programs (ASPs) in many parts of the world.2-4 Finally, the COVID-19 pandemic has highlighted the importance of leadership that understands that practical aspects of antimicrobial pharmacotherapy can rapidly synthesise emerging literature and gain consensus through collaboration to produce local standards. All of these require expertise in antimicrobial therapies, and consequently the need for ID pharmacists has grown. The SHPA Standard of Practice (SOP) in Infectious Diseases for Pharmacy Services sets important national expectations and guidance for pharmacist practitioners wishing to practice ID. We believe that this document espouses the mission of the Society of Infectious Diseases Pharmacists (SIDP), which is to advance infectious diseases pharmacotherapy and lead antimicrobial stewardship to optimise the care of patients with infections. Both of us have served as President of SIDP and we see parallels between this SOP and the mission of SIDP. The SOP highlights the important contributions (in both depth and breadth) to direct patient care by ID pharmacists in varied practice settings including inpatient hospital care, people living with HIV, antimicrobial stewardship, rural and regional health services, community-based parenteral antibiotic therapy and emerging practices in primary care and aged care facilities. The standard also emphasises essential components of ID pharmacy practice beyond front-line patient care and operations: education quality and safety improvement, policy and protocol development, and research. This includes the importance of regional, national, and international collaborations to advance the science and to act as a mechanism that shares knowledge and best practices. The latter is especially pertinent for pharmacists practicing in settings without the benefit of colleagues in the specialty, including ID physicians. Perhaps more important is that this SOP also sets a standard for ID practice to include pharmacist practitioners in key clinical and administrative roles. The latter is not a standalone section but rather woven into all aspects of ID pharmacy practice. The standard also highlights the collaborative nature of infectious diseases practice and specifically mentions the important role of microbiology and infection prevention working together with the ID team to achieve optimal patient care. Highlighting the role of ID pharmacists in hospital leadership throughout the antimicrobial use process is key. Although written for Australia, this SOP has the potential for international impact. Pharmacy practice in other countries may come to mirror best practices described in documents such as this one. At the invitation of the authors, the two of us reviewed and provided input on a draft of this standard with this in mind. They are congruent with positions on pharmacist roles in the leadership of ASPs taken by the Board of Pharmacy Specialties and by SIDP.5-7 The SOP takes a big step forward and sets a standard that acts as a set of goals for pharmacists practicing in ID. These goals will likely change as practices evolve and ID pharmacists find new and innovative ways to improve the care of patients. With these standards as the starting point, ID pharmacists can further the vision of ensuring safe and effective antibiotics for now and the future. The authors have no conflicts of interests to declare.

What Prompts Doctors to Recommend COVID-19 Vaccines: Is It a Question of Positive Emotion?

Vaccines are among the most successful and cost-effective public health tools and have greatly contributed to eliminating or controlling several serious vaccine-treatable diseases over the past century. To curb the spread of COVID-19, efficacious vaccination is emerging as essential in mitigating the disease and preventing deaths. Health care workers (HCW) are one of the first groups to receive vaccinations, so it is important to consider their attitudes to COVID-19 vaccination to better address barriers to widespread vaccination acceptance. This study aimed to evaluate variables that are linked with the recommendation of vaccines and intention to take-up vaccination against COVID-19 among the HCWs, in the context of the current pandemic. The study was conducted during the first week of the vaccination campaign dedicated to Italian HCWs, beginning in December 2020, and it involved all doctors in a public hospital in Sicily. The following questionnaires were administered: (1) The perceived vaccine trust questionnaire, measuring the degree of trust in vaccines by healthcare professionals both in general and for the protection of healthcare professionals themselves and patients; (2) the positive and negative affect scale-state (PANAS), for assessing positive and negative emotions in relation to their work as “frontline care providers”; (3) The locus of control of behaviour (LCB) to measure the extent to which subjects perceive responsibility for their personal behaviour (internal vs. external); (4) recommendation vaccines item, referring to the intention to recommend vaccination. The findings suggest that socio-demographic control variables (age, gender, and seniority) showed little or no predictive power in vaccine recommendation, while vaccine confidence, positive emotions, and internal locus of control were excellent predictors of vaccine recommendations by doctors. Younger doctors, both in age and experience, are more confident in vaccines and recommend them more frequently. It is essential to improve institutional communication addressed to doctors to enhance their role as vaccination facilitators.

Reflections from the forgotten frontline: 'The reality for children and staff in residential care' during COVID-19.

Currently, 78,150 children are in care in England, with 11% of the most vulnerable living in 2,460 residential homes due to multitype traumas. These children require safe and secure trauma‐informed therapeutic care. However, the children's residential care workforce delivering this vital care is an unrepresented, under‐researched and largely unsupported professional group. The workforce undertakes physically and emotionally challenging work in difficult conditions, exacerbated by the COVID‐19 pandemic. Practitioner wellbeing is directly associated with outcomes for children. Therefore, we sought to understand how experiences within the workforce could improve overall working conditions, and thus outcomes for staff and children. Thirty participants took part in a survey, providing feedback on their experiences and the situations they faced during the English lockdown April‐June 2020. Two participants also opted to take part in a teleconference interview, rather than survey, although were asked the same questions. Data were analysed through thematic analysis. A stakeholder advisory board supported the project, including frontline staff, care leavers, service managers and policy researchers. The advisory board assisted in reflecting on the data from the survey and interviews to generate a complete analysis. Overall, staff require facilitated safe spaces for peer‐support, reflective and emotionally supportive supervision. An organisational awareness that staff wellbeing is intrinsically connected to the wellbeing and therapeutic outcomes of the children they care for is essential. Further, staff require a sense of belongingness to feel safe and competent in their role due to a lack of external recognition and professional representation or validation. Based on the findings of the study and an iterative process with the stakeholder advisory board, we created a Wellbeing Charter for adoption within organisations to promote and protect the wellbeing of this vital workforce. The COVID‐19 pandemic has exposed professional, financial and environmental inequalities that affect these frontline workers. Implementing organisational, statutory and policy‐driven initiatives to prioritise their wellbeing are essential for the vulnerable children they care for.

625 Health Economics and Safety of Frontline Carers in the COVID-19 Era: Time to Abolish Routine Group and Save For Emergency Appendicectomies?

IntroductionFace of healthcare, patient safety and protection of healthcare providers has been completely transformed with global health pandemic. However, emergency surgical procedures must still be performed, with the commonest being appendicectomy.It is common practice across National Health Service trusts to collect a group and save (G&S) sample pre-operatively which increases healthcare staff exposure to the patient and increased use of personal protective equipment in this pandemic.MethodProspective study of adult patients undergoing emergency appendicectomy since the transformation of emergency care with COVID-19 induced restrictions compared with patients undergoing the same operation before the pandemic.Results179 adult patients underwent emergency appendicectomy over 6-months in 2019–2020, 60 patients in the 12 weeks period from the start of the transformed emergency services due to the pandemic. Pre-operative G&S samples were taken for 60(33.5%) patients in the pre COVID-19 period, whereas 7(11.6%) were taken for patients undergoing appendicectomy during the pandemic. None of the patients in either group had intra-operative blood loss of more than 500 millilitres and none of them required peri-operative blood transfusionConclusionsOur study demonstrates that the routine pre-operative G&S can safely be abandoned as a routine practice for all patients undergoing emergency appendicectomy.

Experience of Orthopedic Surgeons Managing COVID Patients at the Peak of Second Wave in a COVID-dedicated Hospital

Introduction: The second wave of the severe acute respiratory syndrome coronavirus-2 pandemic in April 2021 had a sudden deluge of moderate to severe patients getting admitted to the orthopedics block, due to scarcity of beds in the medical wards, high dependency and intensive care areas of the hospital. This study is an analysis of these patients managed in the orthopedics block by orthopedic surgeons, which may be useful to formulate guidelines for the management of patients in future waves of the coronavirus disease 2019 (COVID-19) pandemic. Methods: The data of patients were collected by orthopedic residents from the Google sheet which was uploaded daily as part of the hospital data. The data from Google sheet were downloaded and compiled into an excel workbook and analyzed for patient progress, outcome, comorbidities, treatment given, oxygen management, and death analysis. Results: The data of 319 patients admitted from April 17, 2021 to May 20, 2021 in orthopedic block depicted successful recovery and discharge of 160 patients, worsening and transfer to higher wards for 126 patients and 33 deaths. The average age of these patients was 53.43 years with male preponderance (71% male). At the time of admission, 78.05% were reverse transcription polymerase chain reaction/rapid antigen test positive and 21.9% were COVID suspects. The patient's disease status on arrival was found to be mild in 21.3%, moderate in 43.8%, and severe in 34.7%. The most common comorbidity was hypertension in 39 patients followed by diabetes in 29 patients. The average number of days of hospital stay was 5.48 days. Conclusion: Medical professionals other than critical care medicine can be frontline care providers who can guide the ancillary departments at the peak of pandemic waves. Adherence to the standard operating protocols and interdepartmental coordination need to be effectively managed. This study can be used to formulate guidelines for further improvement in COVID patient care in case of future waves of this pandemic.

Frontline interdisciplinary clinician perspectives on caring for patients with COVID-19: a qualitative study

ObjectiveTo describe the drivers of distress and motivations faced by interdisciplinary clinicians who were on the frontline caring for patients with COVID-19.Design50 semistructured interviews. Transcripts were analysed using qualitative thematic...

Online survey on healthcare skin reactions for wearing medical-grade protective equipment against COVID-19 in Hubei Province, China.

With the spread of Coronavirus Disease 2019 globally, more than 40,000 healthcare staff rushed to Wuhan, Hubei Province to fight against this threatening disease. All staff had to wear personal protective equipment (PPE) for several hours when caring for patients, which resulted in adverse skin reactions and injuries. In this study, we used an online questionnaire to collect the self-reported skin damages among the first-line medical staff in the epidemic. The questionnaire was designed by four front-line wound care nurses and then revised through Delphi consultants. Items mainly focused on the adverse skin reactions and preventive strategies. The survey was distributed through phone application from March 15th to March 20th and received 275 responses in total. The prevalence of skin reactions (212, 77.09%) was high in both head and hands. The common clinical symptoms of skin reactions were redness, device-like mark, and burning pain in face; and dryness, dermatitis, and itch/irritation in hands. Three risk factors included gender, level of protection, and daily wearing time of PPE were identified that caused skin reactions among medical staff. 150 of 275 (54.55%) participants took preventive strategies like prophylactic dressings, however, more than 75% users had little knowledge about dressings. We suggest the frontline staff strengthened the protection of skin integrity and reduced the prevalence of adverse skin reactions after professional education.

Nursing in Albania: A Catalytic Force in Transforming Health Professionals and Health Care.

Transitions in nursing education and professionalism that align with global nursing standards are elucidated as critical success factors in transforming health professionals and health care in Albania. Progressive educational and regulatory pathways throughout the 2000s (1999-2020) are emphasized for their impact on the Albanian health system, including the achievement of universal healthcare coverage. Data collected by the Ministry of Health and Sport and the Regulatory Authority for nursing and other healthcare professions in Albania were analyzed and outcomes explicated with regard to Albania's major health challenges. Three milestones affirmed nursing as a driving force in the Albanian healthcare system: (a) nurses constitute the largest health professional workforce via a nurse-patient ratio of 1:400 in contrast to a physician-patient ratio of 1:2,500; (b) nurses are frontline care providers via clinical leadership in the management of primary healthcare centers, which ensure universal healthcare coverage; and (c) nurses are first responders via their presence and compassionate caring in the primary healthcare centers, including making critical shifts in converting primary healthcare centers to urgent care centers as needed. Nursing advancements have implicated quality care and professionalism in Albania across the health professions via three critical pathways: (a) health professional education at a university degree level for entry into practice (since 1999), which was prompted by and driven by nursing's quest to be a self-regulated profession (achieved in 2007); (b) healthcare global standards sparked by nursing's mandate toward professional autonomy, as achieved via regulatory procedures and policies; and (c) interprofessional healthcare initiatives that serve as collaborative platforms for innovative educational, clinical, and research projects.

Psychosocialization in Nepal: Notes on Translation from the Frontlines of Global Mental Health

As ‘psychosocial interventions’ continue to gain traction in the field of global mental health, a growing critical literature problematises their vague definition and attendant susceptibility to appropriation. In this article, I recast this ill-defined quality as interpretive flexibility and explore its role in processes of translation occurring at the frontlines of care in rural Nepal. Drawing from 14 months of ethnographic fieldwork among community-based psychosocial counsellors, I consider how the broad and flexible notion of the ‘psychosocial problem’ operates as a ‘boundary object’ in transnational mental health initiatives—that is, how it facilitates the collaboration of service users, clinicians, donors, and policymakers in shared therapeutic projects without necessarily producing agreement among these parties regarding the nature of the suffering they address. I suggest that psychosocial interventions may be gaining popularity not despite but precisely because of the lack of a unitary vision of the problems psychosocial care sets out to alleviate. In closing, I reflect on what distinguishes ‘psychosocialisation’ from medicalisation and highlight the limitations of the latter as a critical paradigm for the anthropology of global mental health.

Bayesian networks in healthcare: What is preventing their adoption?

There has been much research effort expended toward the use of Bayesian networks (BNs) in medical decision-making. However, because of the gap between developing an accurate BN and demonstrating its clinical usefulness, this has not resulted in any widespread BN adoption in clinical practice. This paper investigates this problem with the aim of finding an explanation and ways to address the problem through a comprehensive literature review of articles describing BNs in healthcare. Based on the literature collection that has been systematically narrowed down from 3810 to 116 most relevant articles, this paper analyses the benefits, barriers and facilitating factors (BBF) for implementing BN-based systems in healthcare using the ITPOSMO-BBF framework. A key finding is that works in the literature rarely consider barriers and even when these were identified they were not connected to facilitating factors. The main finding is that the barriers can be grouped into: (1) data inadequacies; (2) clinicians’ resistance to new technologies; (3) lack of clinical credibility; (4) failure to demonstrate clinical impact; (5) absence of an acceptable predictive performance; and (6) absence of evidence for model’s generalisability. The facilitating factors can be grouped into: (1) data collection improvements; (2) software and technological improvements; (3) having interpretable and easy to use BN-based systems; (4) clinical involvement in the development or review of the model; (5) investigation of model’s clinical impact; (6) internal validation of the model’s performance; and (7) external validation of the model. These groupings form a strong basis for a generic framework that could be used for formulating strategies for ensuring BN-based clinical decision-support system adoption in frontline care settings. The output of this review is expected to enhance the dialogue among researchers by providing a deeper understanding for the neglected issue of BN adoption in practice and promoting efforts for implementing BN-based systems.

Psychological Profiles of Successful Career Nurses: Implications for Managerial Psychology in an Era of Covid Challenge

We present findings from a 2020 follow-up study of 159 senior hospital nurses involved in the front-line care of COVID patients in urban centres in Northern England, prior to the “second wave” of COVID patients in November 2020. In 2020 further measures of adjustment stress (including PTSD), and self-actualization were added to earlier measures of personality adjustment, work-life stress, and career intention. Principal component and cluster analyses identified 3 main types in the 2020 follow-up cohort: A ‘Actualizing Professionals’; (N=59); B ‘Strong Professionals’ (N=55); C ‘Highly Stressed Nurses’ (N=30). The research model driving this research is that of Critical Realism which identifies the process of morphogenesis which creates a constructive dialogue for social change on behalf of nurses, who faced almost overwhelming stress in caring for COVID patients. We have identified two types of dedicated nurses with a hardy personality style which has helped them face severe stress in emerging as psychologically strong, self-actualizing individuals. These psychological profiles have implications for understanding and supporting women in a wider range of professional and managerial roles.

Variation in Initial U.S. Hospital Responses to the Coronavirus Disease 2019 Pandemic.

The coronavirus disease 2019 pandemic has strained many healthcare systems. In response, U.S. hospitals altered their care delivery systems, but there are few data regarding specific structural changes. Understanding these changes is important to guide interpretation of outcomes and inform pandemic preparedness. We sought to characterize emergency responses across hospitals in the United States over time and in the context of local case rates early in the coronavirus disease 2019 pandemic. We surveyed hospitals from a national acute care trials group regarding operational and structural changes made in response to the coronavirus disease 2019 pandemic from January to August 2020. We collected prepandemic characteristics and changes to hospital system, space, staffing, and equipment during the pandemic. We compared the timing of these changes with county-level coronavirus disease 2019 case rates. U.S. hospitals participating in the Prevention and Early Treatment of Acute Lung Injury Network Coronavirus Disease 2019 Observational study. Site investigators at each hospital collected local data. None. Forty-five sites participated (94% response rate). System-level changes (incident command activation and elective procedure cancellation) occurred at nearly all sites, preceding rises in local case rates. The peak inpatient census during the pandemic was greater than the prior hospital bed capacity in 57% of sites with notable regional variation. Nearly half (49%) expanded ward capacity, and 63% expanded ICU capacity, with nearly all bed expansion achieved through repurposing of clinical spaces. Two-thirds of sites adapted staffing to care for patients with coronavirus disease 2019, with 48% implementing tiered staffing models, 49% adding temporary physicians, nurses, or respiratory therapists, and 30% changing the ratios of physicians or nurses to patients. The coronavirus disease 2019 pandemic prompted widespread system-level changes, but front-line clinical care varied widely according to specific hospital needs and infrastructure. Linking operational changes to care delivery processes is a necessary step to understand the impact of the coronavirus disease 2019 pandemic on patient outcomes.