We still cannot breathe: Applying intersectional ecological model to COVID-19 survivorship.

PURPOSE/OBJECTIVE: Individuals with historically oppressed identities, such as disabled or racialized minorities, face inequities across all societal institutions, including education, criminal justice, and healthcare. Systems of oppression (e.g., ableism, racism) lead to inequities that have ultimately contributed to disproportionate rates of COVID-19 morbidity and mortality in the United States. In the midst of the COVID-19 pandemic, increased public attention regarding police brutality toward Black people and the reinvigoration of the national Black Lives Matter (BLM) movement further highlighted the detrimental effects of oppressive systems and the urgent need to promote equity in the United States. The disproportionate number of COVID-19-related deaths and police brutality are inextricably connected, as both are products of oppression toward minoritized communities. The co-occurrence of the pandemic and BLM movement protests also creates an opportunity for critical discourse on the intersection of ableism and anti-Black racism specifically within the field of rehabilitation psychology. RESEARCH METHOD/DESIGN: The overarching goals of this review are to apply the Intersectional Ecological Model with the addition of the chronosystem to illustrate how systems of oppression lead to health disparity in COVID-19 survivorship and to provide recommendations to promote health equity. Conclusions/Implication: As the COVID-19 pandemic shifts to an endemic and efforts to eliminate oppressive systems continue, rehabilitation psychologists have an ongoing, evolving, and shared responsibility to employ socially-responsive solutions to promote optimal functioning for patients, families, and communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Way Forward in the COVID-19 Pandemic: Making the Case for Narrative Competence in Pulmonary and Critical Care Medicine.

Each surge of the coronavirus disease (COVID-19) pandemic presented new challenges to pulmonary and critical care practitioners. Although some of the initial challenges were somewhat less acute, clinicians now are left to face the physical, emotional, and mental toll of the past 2 years. The pandemic revealed a need for a more varied skillset, including space for reflection, tolerance of uncertainty, and humanism. These skills can assist clinicians who are left to heal from the difficulty of caring for patients in the absence of families who were excluded from the intensive care unit, public distrust of vaccines, and morgues overtaken by our patients. As pulmonary and critical care medicine practitioners and educators, we believe that cultivating practices, pedagogies, and institutional structures that foster narrative competence, "the ability to acknowledge, absorb, interpret, and act on the stories and plights of others," in our ourselves, our trainees, and our colleagues, may provide a productive way forward. In addition to fostering needed skills, this practice can promote necessary healing as well. This perspective introduces the practice of narrative competence, provides evidence of support for its implementation, and suggests opportunities for curricular integration.

Understanding Patients' Perceived Health After Critical Illness: Analysis of Two Prospective, Longitudinal Studies of ARDS Survivors.

BACKGROUND: Perceived health is one of the strongest determinants of subjective well-being, but it has received little attention among survivors of ARDS. RESEARCH QUESTION: How well do self-reported measures of physical, emotional, and social functioning predict perceived overall health (measured using the EQ-5D visual analog scale [EQ-5D-VAS]) among adult survivors of ARDS? Are demographic features, comorbidity, or severity of illness correlated with perceived health after controlling for self-reported functioning? STUDY DESIGN AND METHODS: We analyzed the ARDSNet Long Term Outcomes Study (ALTOS) and Improving Care of Acute Lung Injury Patients (ICAP) Study, two longitudinal cohorts with a total of 823 survivors from 44 US hospitals, which prospectively assessed survivors at 6 and 12 months after ARDS. Perceived health, evaluated using the EQ-5D-VAS, was predicted using ridge regression and self-reported measures of physical, emotional, and social functioning. The difference between observed and predicted perceived health was termed perspective deviation (PD). Correlations between PD and demographics, comorbidities, and severity of illness were explored. RESULTS: The correlation between observed and predicted EQ-5D-VAS scores ranged from 0.68 to 0.73 across the two cohorts and time points. PD ranged from -80 to +34 and was more than the minimum clinically important difference for 52% to 55% of survivors. Neither demographic features, comorbidity, nor severity of illness were correlated strongly with PD, with |r| < 0.25 for all continuous variables in both cohorts and time points. The correlation between PD at 6- and 12-month assessments was weak (ALTOS: r = 0.22, P < .001; ICAP: r = 0.20, P = .02). INTERPRETATION: About half of survivors of ARDS showed clinically important differences in actual perceived health vs predicted perceived health based on self-reported measures of functioning. Survivors of ARDS demographic features, comorbidities, and severity of illness were correlated only weakly with perceived health after controlling for measures of perceived functioning, highlighting the challenge of predicting how individual patients will respond psychologically to new impairments after critical illness.

COVID-19: Understanding and mitigating trauma in ICU survivors.

The spread of coronavirus disease 2019 (COVID-19) has placed many individuals in need of critical care, with a high proportion of hospitalized patients being admitted to intensive care units (ICU) to treat acute outcomes of COVID-19 (e.g., respiratory failure via mechanical ventilation). The ICU is known to be a setting where individuals are at a high risk of experiencing significant psychological difficulties, and patients with COVID-19 are particularly susceptible to such experiences, which can impact their recovery process (e.g., postintensive care syndrome). This article seeks to highlight the intersection between critical care related to trauma and COVID-19 and point providers toward opportunities for anticipating and managing secondary effects in effort to promote psychological adaptation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).