Front-line Care Research Articles

A Study to assess the impact of COVID 19 Pandemic on the academic performance among the Nursing students at selected nursing college, Salem

Background: Novel corona virus (covid-19) is an infectious disease spreading all around the world that has a globally significant morbidity at present. Nurses as frontline care providers in hospitals and community are exposed to a major risk. The major impacts of covid-19 on nursing education were unequal access to online distance learning, disruption of academic calendar, teaching and learning gap and so on. This study aims to assess the impact of COVID 19 pandemic on the academic performance among nursing students. Objectives: To assess the level of impact of COVID-19 on academic performance among the Nursing students. To associate the level of impact of COVID-19 on academic performance among the Nursing students with their selected demographic variables. Methodology: A Quantitative approach -Non experimental, descriptive research design was used in this study. The sample consists of 37 nursing students, selected by consecutive sampling technique. Result: The major findings of this study is majority 21 (57%) samples had more impact on academic performance due to COVID-19 pandemic and 16 (43%) samples has less impact on academic performance due to COVID-19. Conclusion: This study concludes that majority of the B. Sc (N) students were had more impact on academic performance due to COVID-19.

Health and social care frontline leaders' perceptions of competence management in telemedicine in Finland: An interview study.

This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders. The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices. The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis. The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals' competence in telemedicine. Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations. Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community.

An updated network meta-analysis of EGFR-TKIs and combination therapy in the first-line treatment of advanced EGFR mutation positive non-small cell lung cancer

ObjectivesTyrosine kinase inhibitors (TKIs) are a standard care option in patients with non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation. TKI-based combination treatment modes show encouraging outcomes. However, it remains unknown which is the optimal treatment as the first-line regimen for these patients on overall survival (OS).Materials and methodsRandomized controlled trials and meeting abstracts that investigated EGFR-TKIs alone or in combination as front-line care for patients with NSCLC were systematically searched in relevant databases and reviewed. Fixed and random effects network meta-analysis models were used to estimate progression-free survival (PFS), OS, overall response rate, and grade three and higher adverse events (AEs). Surface under the cumulative ranking curves (SUCRAs) were used to rank treatment effects.ResultsEighteen studies covering six treatments and involving a total of 4389 patients were included in this network meta-analysis. On OS, the top three treatment were first-generation EGFR-TKIs (1G EGFR-TKIs) plus chemotherapy (SUCRA, 88.1%), osimertinib (SUCRA, 65.8%) and second-generation EGFR-TKIs (2GEGFR-TKIs) (SUCRA, 63.3%). On PFS, the top three treatments were osimertinib (SUCRA, 96.0%), 1G EGFR-TKIs plus chemotherapy (SUCRA, 67.1%), and 1G EGFR-TKIs plus antiangiogenesis (SUCRA, 48.2%). Two types of TKI-based combination therapy have significantly higher risk of grade three and higher AEs than TKI alone.Conclusion1G EGFR-TKIs plus chemotherapy and osimertinib seem to be the two better options as first-line care in advanced NSCLC patients with EGFR-mutation. Osimertinib caused the lowest incidence of AEs. However, TKIs-based combination therapy significantly increased AEs.

Applying the Haddon Matrix to Frontline Care Preparedness and Response in Asymmetric Warfare.

Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs). An expert consensus methodology was used to achieve the research aim. A small subject matter experts' group was convened to create and validate the content of the Haddon Matrix. The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources. The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.

The psychological impact on frontline nurses in Spain of caring for people with COVID-19

AimTo understand the perceptions of National Health System nurses who have been working on the frontline of the psychological impact of caring for people with COVID-19 during the first and second waves. MethodsA qualitative study, the design and analysis of which was based on phenomenology. For data collection, a semi-structured interview was administered to a sample of nurses who worked on the frontline in public hospitals in Extremadura and Madrid, Spain. The interviews, which followed a script including various topics, were conducted between May and November 2020 so as to include the experiences of the first and second waves of the pandemic. Sample collection continued until data saturation. The data were analysed following the phenomenological method of Giorgi with the help of the Atlas-Ti software. ResultsTwo main themes emerged from the data analysis that explained the nurses' perceptions: (i) the main psychological repercussions of being frontline carers (anxiety, fear, stress, impotence, frustration, and an increase in obsessions and obsessive behaviours) and (ii) psychological coping strategies (collapse in the face of the situation, dissociative amnesia, leaning on colleagues and working as a team, resigning oneself, perceiving the situation as a war, and being aware of psychological repercussions). DiscussionCaring as the first line causes great psychological repercussions for nurses. It is necessary to implement psychological and emotional support programmes to address the post-traumatic stress that nurses can suffer.

‘When it comes to carers, you've got to be grateful that you've got a carer coming’: older people's narratives of self-funding social care in England

AbstractThe number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system ‘work’. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers.

Reflexiones sobre la salud mental en tiempos de pandemia: Una perspectiva centrada en la persona

The COVID-19 pandemic has placed an enormous burden on the world not only in terms of purely physical health but an enormous personal and social burden from a mental health point of view. A medical preparation, in recent years focused essentially on biological aspects, has faced an individual and collective terror in the face of death, which has been close to every person and especially to the doctor. Although the doctor is expected to provide emotional support to the patient, the fear of death is part of the doctor's day-to-day, particularly for those on the front line of care against COVID. Identifying and addressing the psychosocial aspects of COVID in the patient and the doctor himself remains a challenge in the ongoing COVID-19 pandemic.

What Pandemic Portraits Illuminate About Balancing Vulnerability and Inurement.

Portraits of clinicians quickly became emblematic of what the COVID-19 pandemic has demanded of everyone, especially caregivers who witnessed deaths likely unprecedented in number during their careers. This article describes an arts-based research protocol exploring portraiture as a medium for representing and understanding clinicians' experiences, mostly during the first year of the pandemic. This article presents Shadow of Corona, a large oil on canvas portrait commissioned by the AMA Journal of Ethics to commemorate the American Medical Association's 175th year. The article also includes Sarah, a charcoal study drawing for that portrait, and Front Lines of Care, a 3 by 3 collection of 9 smaller oil on canvas portraits.

Discussion Guide for the Brogan Article.

Discussion Guide for the Brogan Article.

COVID-19-Related Trajectories of Psychological Health of Acute Care Healthcare Professionals: A 12-Month Longitudinal Observational Study.

The COVID-19 pandemic hit healthcare professionals (HCPs) hard, potentially leading to mental health deterioration. This longitudinal study investigated the 1-year evolution of psychological health of acute care HCPs during the COVID-19 pandemic and explored possible differences between high and low resilient HCPs. From April 2020 to April 2021, a convenience sample of 520 multinational HCPs completed an online survey every 3 months, up to five times. We used mixed linear models to examine the association between resilience and the variation of COVID-19-related anxiety, depressiveness, perceived vulnerability, and psychological trauma symptomatology. We demonstrated “u-shaped” trajectories for all mental health symptoms. We also explored differences in the abovementioned variables between front-line and second-line acute care HCPs. In contrast to HCP.s with lower levels of resilience (-1SD), those with higher levels of resilience (+1SD) showed increased COVID-19 anxiety and perceived vulnerability over time. Front-line and second-line HCPs differed in their depressiveness and psychological trauma variation during the 1-year analysis. High and average resilient second-line HCPs showed steeper depressiveness increases with time than high and average resilient front-line HCPs. Acute care HCPs reported their most elevated clinical symptoms of depressiveness (5–7%) and psychological trauma symptomatology (26–46%) in April 2020. During the first year of the COVID-19 pandemic, second-line HCPs with more resilience showed a steeper worsening of their depressiveness than more resilient front-line HCPs. HCPs with low resilience may benefit from interventions at the beginning of a pandemic, whereas HCPs with high resilience might benefit from resilience-enhancing interventions at later phases.Trial RegistrationThe study protocol was pre-registered with the International Standard Randomised Controlled Trial Number (ISRCTN13694948) published (Fuchs et al., 2020).

Instrumental texture assessment of IDDSI texture levels for dysphagia management. Part 2: Texture modified foods.

Texture-modified foods and thickened fluids play a major role in clinical treatment for individuals who suffer from swallowing difficulties (known as dysphagia). International Dysphagia Diet Standardization Initiative (IDDSI) developed a standardized terminology and description for texture-modified foods and thickened fluids to allow dysphagia patients to receive the correct consistency of food/drink. While the IDDSI framework provides a consistent texture description (Levels 0-7) and is widely accepted as an international standard, testing and assessment of IDDSI texture level are qualitative in nature and subjective in manner. These methods were proposed primarily for use by frontline carers, but are not most ideal for industrial purposes of quality control of such products. Therefore, the main aim of this work was to develop a quantitative instrumental method that best describes IDDSI levels as an objective framework. A set of test samples, including commercially available instant mashed potato, baby rice cereal, and cooked potato cubes of varying texture, were prepared. Two IDDSI measuring techniques, fork pressure test and spoon tilt test, were used to evaluate texture grades of these samples. Puncture and compression tests based on texture analyzer were used to assess cohesiveness, adhesiveness, firmness, and hardness for each food category (Levels 4-7). Thresholds of cohesiveness and adhesiveness, as well as bands of acceptable firmness and hardness for each food category were clearly identified and are proposed as objective complements to the IDDSI framework.

P657: REAL-WORLD TREATMENT PATTERNS OF PATIENTS DIAGNOSED WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IN THE UNITED STATES (US)

Background: CLL represents the most common type of leukemia among adults in the US, but current data on the treatment patterns of patients in clinical practice is limited. Standard of care frontline therapy consists of various types of targeted therapy or chemoimmunotherapy (CIT), but it is reserved for patients with advanced-stage disease. Aims: This study aims to describe real-world treatment patterns among patients diagnosed with CLL in the US, with a focus on ibrutinib therapy. Methods: A retrospective database analysis was conducted using the Optum Clinformatics DataMartTM database (01/2007–07/2020). Patients with ≥2 medical encounters with a diagnosis code for CLL or small lymphocytic lymphoma (SLL) on different dates were selected (earliest date was defined as the index date). At least 12 months of continuous enrollment pre-index date (baseline period) and ≥18 years of age as of the index date were required. Patients with a diagnosis for mantle cell lymphoma or with evidence of anticancer therapy (antineoplastic, radiation, or cell therapy) during baseline were excluded. A subset of patients with ≥1 pharmacy claim for ibrutinib was identified. An adapted algorithm developed from previously published studies was used to identify lines of therapy (LOTs). Treatment patterns, including duration of therapy (DOT) and regimens were reported. DOT spanned from LOT initiation up to discontinuation of all agents in the LOT, a switch to another LOT, or the addition of a new agent. Median time to the first line (1L) and from 1L to second line (2L) were evaluated using a Kaplan-Meier analysis (KM) to account for censoring. Results: Among 23,087 patients with CLL, the median age was 74 years and 43% were female. Of these, 1,387 were treated with ibrutinib (median age: 75; female: 38%). Patients had a mean Charlson comorbidity index score of 1.9. Analysis of treatment patterns (Table 1) showed that 7,192 patients (31%) were treated with ≥1 LOT (mean ± standard deviation [SD] DOT of 1L: 1.6 ± 2.0 years), and 10% of patients were treated with ≥2 LOT (mean ± SD DOT of 2L: 1.2 ± 1.7 years). Ibrutinib was used by 907 patients in 1L (DOT in 1L: 1.0 ± 1.1 years) and 617 in subsequent LOTs (DOT in 2L+: 0.9 ± 1.1 years). Median time from index date to 1L initiation was 8.1 years. Of the patients who used antineoplastics therapies in 1L, a majority used CLL-related ones (79%). Most treated patients received targeted therapy (37%; rituximab: 19% and ibrutinib: 12%) and CIT (32%; bendamustine + rituximab: 13% and cyclophosphamide + fludarabine + rituximab: 5%). In 2L, 16% of patients used ibrutinib, 12% a bendamustine + rituximab regimen, and 4% chlorambucil. Median time from 1L initiation to 2L initiation was 4.4 years. Proportion of patients treated with CIT tended to diminish with subsequent LOT, whereas the proportion treated with ibrutinib tended to increase. Image:Summary/Conclusion: This real-world long-term data shows that patients receive their 1L many years after a first CLL diagnosis, with a median time to treatment of ~8 years. Among US patients with CLL, rituximab, bendamustine + rituximab, and ibrutinib were identified as the most used 1L regimens, and the latter two as the most used 2L regimens. As novel therapies are increasingly used, and genetic testing becomes more available, further research will be needed to evaluate the changes in the way CLL is treated and its effects on clinical outcomes.

Back to the Roots of Nursing: Qualitative Study on the Experience of Nurses in the Front Line During the COVID-19 Pandemic.

The COVID-19 emergency has led many health facilities to reorganize themselves in a very short time to meet the urgent needs for intensive, semi-intensive or ordinary care of SARS-CoV-2 patients. In this pandemic, characterized by speed of transmission and severity of respiratory symptoms, care has been affected by the increase in volume and clinical complexity of patients, the sudden and unpredictable staff decrease and the lack of support from family members / caregivers. At the same time, experience in the field has shown how “informal” resources have been activated, which enabled to treat the highest possible number of patients above the real availability of resources. The purpose of this study was to explore the experiences of nurses involved in frontline care (COVID Centers) during the pandemic with a particular focus on professional motivation and on the development of technical-professional and personal skills. A study with a qualitative research design using focus group technique was conducted. Two focus groups were held with nine nurses. Data were analyzed with inductive content analysis. The findings can be summarized in five main categories: professional identity; motivation and sense of mission; development of professional and personal skills; spirituality; person-centered care; uniqueness of the lived experience. These findings shed new light on the correlation between motivation, professional identity and value, sense of duty and sense of belonging to the professional group. Moreover, the experience in the COVID Centers represented a valuable opportunity for participants to rediscover some specific issues related to nursing professional identity and to develop new personal and technical-professional skills in a very short time. Finally, nurses experienced once again how the nurse-patient relationship and basic care are essential to provide effective and excellent care, even and especially for patients in critical conditions. Nurses re-discovered, in a careful body care and basic care, irreplaceable elements to give back to patients, often dying, their own dignity, and all the needed closeness and attention necessary also to compensate the absence of the loved ones. These elements represent a way to concretely and deeply express the ethics of a job well done in nursing.

The COVID-19 pandemic and sleep medicine: a look back and a look ahead.

Khosla S, Beam E, Berneking M, etal. The COVID-19 pandemic and sleep medicine: a look back and a look ahead. J Clin Sleep Med. 2022;18(8):2045-2050.

Nurses' caring experiences in COVID-19 pandemic: A systematic review of qualitative research.

Nurses, as front-line care providers, strive to offer adequate care to their clients. They have acquired valuable experiences during the COVID-19 pandemic that enhance the nursing profession. This study aimed to explore nurses' caring experiences in the COVID-19 pandemic. This is a qualitative meta-aggregative systematic review. Electronic databases (Google Scholar, PubMed, Web of Science, CINHAL) in English were searched to find out the meaningful subjective data on the COVID-19 pandemic. The inclusion criteria were studies published in English related to nurses' caring experiences in the COVID-19 pandemic. Seventeen qualitative studies with several approaches were included. Three key themes were identified from the studies: Weaknesses and strengths of nursing at the beginning of the pandemic, Nursing beyond challenges related to the pandemic, and Family and career challenges.Nurses face different challenges in caring for patients with COVID-19 that benefit the health and nursing professions. Governments, policymakers, and managers have to support nurses during and after the pandemic. Without enough support, nurses are likely to experience significant psychological issues that can lead to burnout and frustration.

Decent work in care homes: lessons and implications of the pandemic experience from Scotland

PurposeThe purpose of this paper is to identify lessons and implications on the theme of decent work in social care. This has long been highlighted as integral to improving social care for the elderly. The COVID-19 pandemic experience reveals lessons and implications about the systemic absence of decent work in one place, Scotland, in care homes. The main lesson and implication is a need for change beyond the focus on levels of pay and systemic advocacy of decent work as it is conventionally understood.Design/methodology/approachData was collected using qualitative, semi-structured interviews with 20 care workers in care homes.[AQ4] A range of care system institutional stakeholders was also interviewed. A range of care system institutional stakeholders was also interviewed.FindingsDecent work in social care may only be progressed to the extent that a culture change is achieved, transcending the institutional stasis about who owns and engages with progressing decent work.Research limitations/implicationsThis is a study in one place, Scotland, with a small sample of frontline care workers in care homes and representatives from a range of institutions.Practical implicationsEffective culture change for decent work in care homes needs to be a higher research priority. More explicit culture policies can be a mechanism by which overall decent work and system change may be catalysed and sustainably secured together. Explicit culture change is here set out with respect to operational, institutional and national domains.Social implicationsThere needs to be social policy and political support for situating decent work to be part of a broader culture change around care work with the elderly. A culture-oriented change plan as well as new resourcing and structures can together ensure that the nadir of the pandemic experience was a historical turning point towards transformation rather than being just another low point in a recurring cycle.Originality/valueThe situating of systemic decent work progress within a broader culture change, and modelling that culture change, are original contributions.

Walking a tightrope: A meta-synthesis from frontline nurses during the COVID-19 pandemic.

Nursing staff plays a key role in the public health response to the COVID‐19 pandemic, being in the front line of care. This study sought to synthesise the qualitative literature on care experiences of frontline nurses during the COVID‐19 pandemic. A search was conducted on five databases in January 2021. Fifteen qualitative studies met the inclusion criteria and were included in the research, being submitted to interpretive meta‐synthesis according to the eMERGe guide. The final synthesis included a line of argument that shows the experiences of frontline nurses during the COVID‐19 pandemic, divided into three major themes: ‘Instability on the edge of a cliff: unpredictable and unknown context,’ ‘The price of walking the tightrope: the uncertainty surrounding care,’ and ‘Finding the balance to reach the other side: dealing with the emotional demands of care.’ Although essential in the health response to the COVID‐19 pandemic, nurses experienced an emotional impact arising from the hampered care provision. Our results point to need for strengthening the training of nurses and future nurses, creating and promoting measures that contribute to their psycho‐emotional well‐being, ensuring a safe environment for their clinical practice, and promoting their participation in decision‐making processes.

Time Window for Acute Stroke Management: A Cross-Sectional Study Among Community Healthcare Practitioners in Primary Care.

IntroductionTime-to-treatment window is critical for managing acute ischaemic stroke. The community healthcare practitioners (CHPs) who deliver frontline care in the health system play an important role in stroke prevention and treatment.MethodsA multi-stage sampling design was adopted in Guangdong province, China. A total of 997 CHPs who participated in the survey were divided into two groups (the awareness group vs the unawareness group) according to their knowledge on the time window for stroke management. Logistic regression analysis was performed to explore factors associated with the awareness of “time window”.ResultsOverall, less than half (49.1%) of CHPs were aware of the time window for stroke management. The proportion of CHPs who were able to recognise stroke symptoms were higher in the awareness group (42.7%) than that in the unawareness group (38.8%). Most CHPs (82.9%) in the awareness group had the knowledge about the effectiveness of intravenous thrombolysis in treating acute cerebral infarction, whereas this was perceived by only less than half (43.6%) of CHPs in the unawareness group. Factors associated with the knowledge of time window for stroke management included participation in cerebrovascular disease management training (adjusted odds ratio [aOR]=4.203, 95% CI: 1.707–10.348, p=0.002), awareness of the time frame for CT initiation (aOR=5.214, 95% CI: 1.803–15.078, p=0.002) and for urokinase thrombolysis administration (aOR=11.927, 95% CI: 4.393–32.382, p<0.001), accurate perceptions about the target for blood pressure lowering (aOR=4.181, 95% CI: 1.713–10.207, p=0.002) and blood glucose control (aOR=2.446, 95% CI: 1.019–5.869, p=0.045), and the familiarity with prehospital stroke management principles (aOR=3.593, 95% CI: 1.383–9.332, p=0.009).ConclusionThe CHPs need to enhance their ability to address the acute ischaemic stroke onset promptly to provide effective treatment within the beneficial “time window”. This may help improve the stroke chain of survival with better multidisciplinary decision support systems that enable optimal stroke care delivery.

Developing a Post-COVID Care Clinic at an Academic Medical Center

Throughout 2020, the SARS-CoV-2 virus became widespread, resulting in a pandemic. To date, the USA has experienced 28+ million cases and 500,000 deaths. Data shows that 80% of cases are mild or moderate COVID-19, while 20% experience severe COVID-19. The COVID Front Line Care Team (MD/PA/NP/RN) was developed to provide telemedicine care for patients, in order to rapidly notify, risk stratify, contact trace, isolate, and provide support for patients. Approximately 70% of individuals with severe COVID-19 along with 10% of mild-moderate COVID-19 cases go on to develop Post COVID Syndrome (PCS).

The impact of workplace safety and customer misbehavior on supermarket workers' stress and psychological distress during the COVID-19 pandemic

PurposeEssential frontline workers in the retail sector face increased exposure risks to coronavirus disease 2019 (COVID-19) due to frequent interactions with the general public. Often these interactions are fraught with controversies over public safety protocols. The purpose of this study is to examine the impacts of frontline workers' perceptions of workplace safety and customer misbehaviors on their stress and psychological distress to inform managing workplace health and safety during public health crises.Design/methodology/approachThe authors conducted an online survey of 3,344 supermarket workers in the state of Arizona (US) during the state's first COVID-19 pandemic wave in July 2020. Measures included mental health distress, and perceptions of workplace safety and customer behaviors. The authors utilized a mixed-methods approach combining multiple regression analyses with qualitative analyses of open-ended comments.FindingsWorkers reported high rates of stress and psychological distress. Increases in mental health morbidity were correlated with perceptions of being unsafe in the workplace and concerns about negative customer encounters. Qualitative analyses reveal frustration with management's efforts to reduce risks intertwined with feelings of being unsafe and vulnerable to threatening customer encounters.Practical implicationsThe findings highlight the need to provide and enforce clear safety guidelines, including how to manage potential hostile customer interactions, to promote positive health workplace management during a pandemic.Originality/valueThis study is among the first to assess the COVID-19 pandemic's impact on the mental health of non-health care frontline essential workers and presents novel insights regarding perceived customer misbehavior and need for management support and guidance in a public health crisis.