Inpatient Staff Research Articles

Training inpatient psychiatric nurses and staff to utilize CBTp informed skills in an acute inpatient psychiatric setting

ABSTRACT Background The aim of this study was to investigate the impact of a novel, brief CBTp-informed skills training, called Positive Practices for working with Psychosis (PPP), on recovery-orientation of frontline inpatient psychiatric staff, and on staff knowledge of and confidence using skills informed by Cognitive Behavior Therapy for psychosis. Methods Twenty five providers participated in 12 hours of PPP training. We examined changes in providers’ skills in delivering recovery-oriented care (focusing on skills advocacy, evidence based practice, stigma, optimism, and client preference), and providers’ knowledge of, and confidence in using CBTp informed skills, using the Competency Assessment Instrument (CAI) and the Knowledge and Confidence Using CBTp Skills Scale (KC-CBTp). Results were analyzed using paired-sample t-tests. Results: Significant gains (p < .001) in self-rated knowledge and confidence using CBTp skills were seen on 8 of 9 domains measured. On the CAI, significant gain in optimism was seen (p = .004). Discussion Brief CBTp informed PPP training is a potential intervention for frontline staff, associated with significant gains in knowledge of, and confidence in using, evidence based CBTp-informed skills, and increased optimism in attitudes towards recovery. Limited change on recovery based competencies of staff was seen in other domains and requires further investigation.

Identifying homeless population needs in the Emergency Department using Community-Based Participatory Research

BackgroundAnnually 1.5 million Americans face housing insecurity, and compared to their domiciled counterparts are three times more likely to utilize the Emergency Department (ED). Community Based Participatory Research (CBPR) methods have been employed in underserved populations, but use in the ED has been limited. We employed CBPR in an urban American hospital with a primary goal of improved linkage to care, reduced ED recidivism, and improved homeless health care.MethodsA needs analysis was performed using semi-structured individual interviews with participants experiencing homelessness as well as with stakeholders. Results were analyzed using principles of grounded theory. At the end of the interviews, respondents were invited to join the “CBPR team”. At CBPR team meetings, results from interviews were expounded upon and discussions on intervention development were conducted.ResultsTwenty-five stakeholders were interviewed including people experiencing housing insecurity, ED staff, inpatient staff, and community shelters and services. Three themes emerged from the interviews. First, the homeless population lack access to basic needs, thus management of medical needs must be managed alongside social ones. Second, specific challenges to address homeless needs in the ED include episodic care, inability to recognize housing insecurity, timely involvement of ancillary staff, and provider attitudes towards homeless patients affecting quality of care. Lastly, improved discharge planning and communication with outside resources is essential to improving homeless health and decreasing ED overutilization. A limitation of results is difficulty for participants experiencing homelessness to commit to regular CBPR meetings, as well as possible bias towards social networks influencing included stakeholders.ConclusionCBPR is a promising approach to address gaps in homeless health care as it provides a comprehensive view incorporating various critical perspectives. Key ED-based interventions addressing recidivism include improved identification of housing insecurity, reinforced relationships between ED and community resources, and better discharge planning.

804 A Multidisciplinary Approach to Investigating Sleep Practices and Sleep Disturbances on an Inpatient Neurology Unit

Abstract Introduction Minimizing nightly disruptions in the inpatient setting requires a multidisciplinary, collaborative approach. Our aim was to assess staff perceptions and practices of sleep during hospitalization to help identify and prioritize improvement initiatives. Methods An online survey was distributed to inpatient staff (nurses, residents, attendings, APPs) on a neurology unit at an academic medical center. The survey assessed sleep disturbances, sleep knowledge and sleep practices. Responses across groups were analyzed using Cochran Armitage tests. Cumulative logit model was also performed. Results Among the 49 respondents, 75% reported not having the training to diagnose and treat sleep disorders. 51.2% rarely or never asked about sleep quality or duration prior to admission. 29.6% rarely or never tracked the amount and quality of sleep during hospitalization. Reasons for not tracking or considering sleep included “not being a priority”, “no place to document” and “not being there at night.” Overall, staff ranked noise, testing and vital sign checks as most disruptive to sleep quality and temperature as least disruptive. However, nurses perceived medication administration (p=0.0001) and testing (p=0.0296) more disruptive than the ordering providers. Multivariable analysis showed nurses ranked medication administration higher than providers when shift differences were controlled (p&amp;lt; 0.01). Evening/night shift workers ranked pain (p=0.0324) and anxiety (p=0.0360) higher than day shift workers. Those comfortable with diagnosing and treating sleep disorders were more likely to track sleep during admission (p=0.009), allow patients to sleep during medication administration times (p=0.0189) and allow sleep during scheduled lab draws (p=0.0189). Conclusion Our findings indicate that differences in sleep knowledge and sleep perspectives exist across the healthcare team. Possible explanations include training differences, ordering providers not knowing what time medications are administered or when tests are done, teams not clarifying whether nighttime orders are critical and nurses lacking empowerment to notify providers that sleep is being disrupted. Hand offs may need optimization with regards to pain and anxiety. A multidisciplinary approach, particularly between providers/nurses and night/day teams is critical to improve sleep on inpatient units. Our next steps include surveying patients, tracking nightly disruptions using EMR and decreasing unnecessary overnight orders using a team based approach. Support (if any):

Tidier. e-sport; a recovery oriented intervention in forensic psychiatry

IntroductionRecently video gaming, have attracted considerable attention for its possible beneficial therapeutic effects, the possibility for testing behavior in safe artificial environments and as a tool for professionals and patients to build specific competencies for the everyday life. Also, a substantial amount of research suggests that videogaming might improve the participants social and cognitive skills and emotional regulation. There is little or no evidence that videogaming increases long term aggression or leads to physical aggression. At a medium secure forensic psychiatric in-patient ward, the patients and staff engage in weekly E – Sport sessions (primarily counterstrike) to further the recovery process.ObjectivesTo provide a standardized description of how E-sport is organized and used in the recovery process among forensic psychiatric patients.MethodsThe Template for Intervention Description and Replication (TIDieR) checklist and guide is widely used to in health research to describe interventions in clinical trials and other health research contexts. By use of TIDieR we describe a newly developed E-sport intervention, in which staff members and patients in a medium secure forensic psychiatric ward engage in weekly E-Sport sessions (primarily counterstrike) to improve patient–staff relationship.ResultsThe E-sport intervention is detailed by use of the 12 TIDieR items and practical experiences and insights will be described.ConclusionsThis standardized and detailed description of how is used in a recovery-oriented process in forensic psychiatry can be used for future studies that wishes to implement the intervention or for research studies replicating the treatment.Conflict of interestNo significant relationships.

Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care.

This study examined associations of patient, hospital, and service system factors with provision of discharge planning to individuals treated in hospital psychiatric units. This retrospective cohort analysis used 2012-2013 New York State Medicaid claims data of 18,185 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. The claims data were linked to data from managed behavioral health care organizations indicating whether inpatient staff scheduled a follow-up outpatient appointment with a mental health provider. Additional data regarding hospital and service system characteristics were obtained from the American Hospital Association Annual Survey, the Area Health Resource File, and other state administrative databases. Rates and adjusted odds ratios were assessed for the likelihood of inpatient staff scheduling a follow-up appointment. Inpatient staff scheduled outpatient appointments for 79.8% of discharges. The adjusted odds of not having an outpatient appointment scheduled as part of the patient's discharge plan were significantly associated with several factors, including being homeless on admission, having a diagnosis of a co-occurring substance use disorder, having high levels of medical comorbid conditions, and not being engaged in psychiatric outpatient services in the month prior to admission. Patient characteristics were more strongly associated with failure to receive discharge planning than were hospital and service system characteristics.

Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting.

Evidence-based practice (EBP) is essential for clinical decision-making, improving care, reducing costs and achieving optimal patient outcomes. The Evidence-based Practice Mentorship Program (EBPMP) is a flexible, self-directed programme whereby participants carry out EBP projects guided by expert mentors. To evaluate EBPMP effectiveness and participant experience. To evaluate effectiveness, as measured by changes in EBP value, knowledge and implementation, participants completed pre- and post-EBPMP Quick-EBP-Value, Implementation and Knowledge (VIK) surveys. To understand participants' experiences individual and group interviews were conducted at the end of the programme and analysed using qualitative content analysis. Most participants were over 50 years old, Caucasian, inpatient staff nurses, baccalaureate prepared, with over 11 years' experience. Statistically significant improvements were observed in the post Quick-EBP-VIK knowledge and implementation domains. Individual and group participant interviews revealed four categories of importance to the experience: 1. perceived benefits of EBP, 2. time as a barrier to EBP, 3. desire for more cohort interaction and 4. positive mentee-mentor experience. EBPMP can improve participants' knowledge and implementation of EBP in an environment that values EBP; however, opportunities exist to implement programme modifications that address barriers identified by participants including project time and increased participant interactions.

Psychometric properties of Copenhagen Burnout Inventory among nurses.

Worldwide, nurses have been reporting high levels of burnout. Given the high prevalence of nurse burnout, measurements of burnout need to be carefully considered for their validity and reliability. Our research team used a relatively new instrument to measure burnout among nurses: the Copenhagen Burnout Inventory (CBI). This 19-item instrument measures burnout in three dimensions: Personal, Work-related, and Client-related Burnout. However, the psychometric properties of the CBI have not been examined in nurses. Thus, the purpose of this study was to determine the psychometric properties of the CBI in a state-wide survey of inpatient staff nurses. A total of 928 registered nurses working in Alabama-area hospitals (N = 42 hospitals) participated in this study. Confirmatory factor analysis resulted in an adequate fit to the data and supported construct validity. As evidence of convergent validity, the CBI was moderately to highly correlated with measures of the overall work environment, job satisfaction, and intent to leave, in the anticipated directions. The Cronbach's alphas for Personal Burnout, Work-related Burnout, and Client-related Burnout were 0.91, 0.89, and 0.92, respectively, demonstrating excellent internal consistency reliability for the subscales. Based on our data, the CBI demonstrates adequate validity and reliability for measuring burnout among frontline nurses. As nurses provide care to the most vulnerable patients in healthcare systems, their psychological well-being is important due to the impact on quality of care on patient outcomes. The availability of the CBI on its website allows nurses, nurse managers, and researchers to evaluate burnout in a variety of nursing populations with no licensing costs.

Positive risk management: Staff perspectives in acute mental health inpatient settings.

To explore inpatient staff's understanding and implementation of positive risk management. Risk management is an essential skill for staff working in acute mental health inpatient settings. National policies advocate the use of positive risk management as a form of collaborative, recovery-focused risk management. However, little is known about how staff understand, operationalize, and use positive risk management in practice. Qualitative reflexive thematic analysis study. The authors recruited a purposive sample of healthcare professionals working in acute inpatient settings (N=16) in 2019 across three National Health Service Trusts in the North-West of England. Participants completed semi-structured interviews which were analysed using reflexive thematic analysis. The analysis generated three themes: (a) within staff barriers; (b) within service user barriers; and (c) delivery in practice. Understanding and implementation of positive risk management was dependant on multiple factors, including staffs' beliefs about mental health, levels of worry and anxiety, and amount of experience and seniority. Staff were more likely to use positive risk management with service users that they perceived as being trustworthy and less risky. Use of positive risk management was reliant on the support practitioners received, how able they were to view situations from multiple perspectives, and the degree to which they felt able to prioritize positive risk management. Although staff expressed the desire and intention to practice positive risk management, the current study highlights challenges around operationalization and implementation. The authors discuss the clinical implications of the findings.

Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec

BackgroundDue to regional, professional, and resource limitations, access to mental health care for Canada’s Indigenous peoples can be difficult. Telemental health (TMH) offers the opportunity to provide care across vast distances and has been proven to be as effective as face-to-face services. To our knowledge, there has been no qualitative study exploring the experiences of TMH staff serving the Indigenous peoples in Northern Quebec, Canada; which is the purpose of this study.MethodsUsing a qualitative descriptive design, the entire staff of a TMH clinic was recruited, comprising of four psychiatrists and four support staff. Individual semi-structured interviews were conducted through videoconferencing, and results were thematically analyzed.ResultsTo address the mental health gap in Northern communities, all psychiatrists believe in the necessity of in-person care and note the synergistic effect of combining in-person care and TMH services. This approach to care allows psychiatrists to maintain both an insider and outsider identity. However, if a patient’s condition requires hospitalization, then the TMH staff face a new set of information sharing and communication challenges with the inpatient staff. TMH staff believe that the provision of culturally sensitive care to Northern patients at the inpatient unit is progressing; however, more work needs to be done. Despite the strong collegial atmosphere within the clinic and collective efforts to provide quality TMH services, all participants express a sense of frustration with the paper-based and scattered documentation system.ConclusionThe TMH team works in cohesion to offer TMH services to Indigenous peoples; yet, automatization is needed to improve the workflow efficiency within the clinic and collaboration with the Northern clinics. More research is needed on the functioning of TMH teams and the separate but important roles of each team member.

Responsibilities of type a mental hospitals for escapedpsychiatric patients during the covid-19 pandemic

This study aims to determine the form of responsibility for a mental hospital type A if a patient with a mental disorder (psychiatric patient) escaped from the hospital during the COVID-19 pandemic. Outpatients and inpatients with a mental disorder can escape from the hospital because they have disturbed-awareness. The pandemic conditions of the COVID-19 pandemic are hazardous to contract both patients and doctors, and health workers. There are some problems related to the burden of responsibility to the hospital or inpatient staff to psychiatric patients who escape from the hospital. The study concludes that the responsibility for psychiatric patients who escaped from the hospital includes three parties: the head of the hospital, the attending physician, and the health workers such as nurses.

591. A Model for assessing staffing needs for an Outpatient Parenteral Antibiotic Therapy (OPAT) program

BackgroundManagement of patients needing OPAT is complex, and requires a multidisciplinary team for transitioning patients from inpatient to outpatient care, ongoing monitoring of labs, antibiotic levels, managing complications of the drugs and intravenous access, and communicating with patients, family, home infusion pharmacies, home care nursing agencies, and the patients’ physicians and other providers. In addition, documentation of each of these activities in the EMR is necessary. Guidance on how to determine number of staff needed for an OPAT program is lacking.MethodsWe created a detailed step by step list of the various activities done by our OPAT nurse (RN) and determined the time needed to perform each activity. We calculated how many hours of nursing time would be needed per week to perform all the activities for patient care based on our OPAT volume.ResultsIn 2019 we enrolled 767 patients in 835 episodes of OPAT. Our weekly census averages about 120–135 patients. Median duration on OPAT was 30 days. We calculated that our OPAT RN workload was an average of 47.5 hours/week (range of 40–55 hours/week), with time per activity ranging from 5 minutes to 3 hours (table). As this calculated to more than one full time RN position, additional staff were requested.Assessment of Staffing Requirements for an OPAT Program ConclusionWe have assessed the workload for OPAT RN(s) in our program based on our 2019 patient volume. We recommend that one RN can safely manage about 500–550 patients per year. Based on this analysis we were successfully able to justify the need for a second RN for our program.Any OPAT Program can do such analysis to determine their OPAT staffing needs, and also plan for the anticipated increases in OPAT volume because of increasing longevity of the population, increase in diabetes incidence, invasive procedures such as arthroplasties, cardiac devices, etc.LimitationsThis analysis does not include time spent by inpatient staff to arrange for home care and home infusion services. It also does not account for an ID pharmacist time, or the physicians and APP time for management of these patients outside of the billable visit.Disclosures All Authors: No reported disclosures

A Spanish adaptation of the Quality in Psychiatric Care - Inpatient Staff (QPC-IPS) instrument: Psychometric properties and factor structure.

Western countries share an interest in evaluating quality of care in the healthcare field. In spite of this, there is a lack of intercultural comparison of the perceptions of professionals. One reason for this may be the lack of standardized instruments. The objective of this study was to investigate the psychometric properties and dimensions of the Spanish version of the Quality in Psychiatric Care-Inpatients Staff (QPC-IPS) instrument. After translation and revision of the instrument by a panel of experts, a questionnaire was obtained in Spanish that was administered to a pilot sample. A total of 163 professionals participated in the study. After conducting pilot testing and a cognitive interview with 30 professionals, it was determined that the QPC-IPS was adequate and could be self-administered. Confirmatory factor analysis confirmed six factors that explained 60.9% of the variation. In terms of internal consistency, a Cronbach's alpha of 0.92 was obtained for the full instrument. For test re-test reliability, the intraclass correlation coefficient for the overall questionnaire was 0.91. Convergent validity was analyzed using the NTP394 satisfaction instrument, yielding a positive correlation (0.58). The results demonstrated that the psychometric properties in terms of internal consistency, temporal stability (test-retest), content validity, and construct validity (confirmatory factor analysis) were adequate. These results confirm that the structure of the Spanish version is similar to the original Swedish version of the QPC-IP.

Implementation of The Kangaroo mother care (KMC) program in Depok Regional General Hospital and two PONED Public Health Centers in Depok, Indonesia

Increasing numbers of Low Birth Weight (LBW) cases at Depok Regional Hospital demonstrate the need for more effective intervention. This study aimed to assess the knowledge of Kangaroo Mother Care (KMC) among health workers and its implementation. The study used a survey to measure the difference in the knowledge before and after KMC training. A qualitative research was also conducted to assess its implementation. Data were collected through in-depth interviews and Focus Group Discussions. The health workers’ knowledge scores increased between pretest and posttest. Although not formally trained in KMC the in-patient staff had a relatively good knowledge. However, the management and health workers in the outpatient unit did not. There are many challenges to improve the implementation of the KMC program.

Utilizing time-driven activity-based costing to determine open radical cystectomy and ileal conduit surgical episode cost drivers

ObjectivesPatients undergoing radical cystectomy represent a particularly resource-intensive patient population. Time-driven activity based costing (TDABC) assigns time to events and then costs are based on the people involved in providing care for specific events. To determine the major cost drivers of radical cystectomy care we used a TDABC analysis for the cystectomy care pathway. Subjects and methodsWe retrospectively reviewed a random sample of 100 patients out of 717 eligible patients undergoing open radical cystectomy and ileal conduit for bladder cancer at our institution between 2012 and 2015. We defined the cycle of care as beginning at the preoperative clinic visit and ending with the 90-day postoperative clinic visit. TDABC was carried out with construction of detailed process maps. Capacity cost rates were calculated and the care cycle was divided into 3 phases: surgical, inpatient, and readmissions. Costs were normalized to the lowest cost driver within the cohort. ResultsThe mean length of stay was 6.9 days. Total inpatient care was the main driver of cost for radical cystectomy making up 32% of the total costs. Inpatient costs were mainly driven by inpatient staff care (76%). Readmissions were responsible for 29% of costs. Surgery was 31% of the costs, with the majority derived from operating room staff costs (65%). ConclusionThe major driver of cost in a radical cystectomy pathway is the inpatient stay, closely followed by operating room costs. Surgical costs, inpatient care and readmissions all remain significant sources of expense for cystectomy and efforts to reduce cystectomy costs should be focused in these areas.

A systemic response to supporting frontline inpatient mental health staff in coping with the COVID-19 outbreak

Purpose This paper aims to outline the process of supporting frontline inpatient mental health staff in developing ways of coping with COVID-19. Design/methodology/approach A whole system approach was used in formulating and developing support structures with particular focus on relationship-focused coping. Findings Interventions were developed to support staff in coping with problem-focused (e.g. systemic changes) and emotion-focused challenges (e.g. deaths of colleagues). These included psychoeducation, mindfulness-based meditation and rituals to mark the deaths of colleagues. Staff SPACE (Stopping to Process and Consider Events) sessions were used to support staff in managing the many emotions they were experiencing. Positive psychology-based interventions were used to keep morale up and help people to stay motivated. The process of seeking feedback and making changes was introduced to support staff in feeling heard and having a voice. The maternal or master intervention within each of the above was the relational component. Practical implications This work aimed to boost the emotional and psychological literacy of the system. This will be important in the aftermath of the pandemic and could have many benefits thereafter. Social implications The post-COVID-19 health-care workforce will experience significant challenges in terms of readjustment and recovery. It is important that appropriate measures are put in place to ameliorate this. Originality/value An innovative systemic formulation of the impact of COVID-19 on frontline staff, and a coordinated way of dealing with this, is outlined.

Mixing qualitative methods versus methodologies: A critical reflection on communication and power in inpatient care.

This paper offers an illustrative example to demonstrate one way of combining qualitative methods. The context for the study was a UK inpatient psychiatric hospital. Data set one was collected from weekly ward rounds where inpatient staff met with autistic patients to review medication, listen to patient concerns and make plans or adjustments in light of this. Data set two was reflective discursive interviews with patients and staff. The research objective was to critically consider the potential reasons for discrepancies in dissatisfaction reports from patients in the interviews, compared to relative compliance exhibited by patients in the ward rounds. Utilising a video‐reflexive design and critical discursive psychology approach, both data sets were analysed together. It is possible to simultaneously analyse two different data sets, one naturally occurring and one researcher generated because of the epistemological congruence in the overall design. We have presented an argument for the benefits of mixing two qualitative methods, thereby extending the mixed‐methods evidence base beyond the traditional discussions of quantitative and qualitative paradigms.

Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study

People who present to hospital following self-harm are at high risk of suicide. Despite this, there are considerable variations in the management of this group across hospitals and the factors influencing such variations are not well understood. The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm. Data on presentations to hospitals by those aged 18 years and over were obtained from the National Self-Harm Registry Ireland for 2017 and 2018. Factors associated with four common outcomes following self-harm (self-discharge, medical and psychiatric admission and psychosocial assessment before discharge) were examined using multilevel Poisson regression models. Care pathways following self-harm varied across hospitals and were influenced by both hospital and individual factors. Individual factors were primarily associated with self-discharge (including male gender, younger age and alcohol involvement), medical admission (older age, drug overdose as a sole method and ambulance presentations) and psychiatric admission (male gender, methods associated with greater lethality and older age). The hospital admission rate for self-harm was the only factor associated with all outcomes examined. The availability of psychiatric in-patient facilities and specialist mental health staff contributed to variation in psychiatric admissions and psychosocial assessments prior to discharge. Hospital factors explained the majority of observed variation in the provision of psychosocial assessments. Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.

A framework for studying risk factors for lower extremity musculoskeletal discomfort in nurses

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index

Impact on mental health care and on mental health service users of the COVID-19 pandemic: a mixed methods survey of UK mental health care staff

PurposeThe COVID-19 pandemic has potential to disrupt and burden the mental health care system, and to magnify inequalities experienced by mental health service users.MethodsWe investigated staff reports regarding the impact of the COVID-19 pandemic in its early weeks on mental health care and mental health service users in the UK using a mixed methods online survey. Recruitment channels included professional associations and networks, charities, and social media. Quantitative findings were reported with descriptive statistics, and content analysis conducted for qualitative data.Results2,180 staff from a range of sectors, professions, and specialties participated. Immediate infection control concerns were highly salient for inpatient staff, new ways of working for community staff. Multiple rapid adaptations and innovations in response to the crisis were described, especially remote working. This was cautiously welcomed but found successful in only some clinical situations. Staff had specific concerns about many groups of service users, including people whose conditions are exacerbated by pandemic anxieties and social disruptions; people experiencing loneliness, domestic abuse and family conflict; those unable to understand and follow social distancing requirements; and those who cannot engage with remote care.ConclusionThis overview of staff concerns and experiences in the early COVID-19 pandemic suggests directions for further research and service development: we suggest that how to combine infection control and a therapeutic environment in hospital, and how to achieve effective and targeted tele-health implementation in the community, should be priorities. The limitations of our convenience sample must be noted.

How does workplace bullying influence nurses' abilities to provide patient care? A nurse perspective.

To explore how workplace bullying influences nurses' abilities to provide patient care. Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. Qualitative descriptive study. Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.