COVID-19-related anxieties: Impact on duty to care among nurses.

BACKGROUND: Duty to care is integral to nursing practice. Personal obligations that normally conflict with professional obligations are likely amplified during a public health emergency such as COVID-19. Organizations can facilitate a nurse's ability to fulfill the duty to care without compromising on personal obligations. RESEARCH AIM: The study aimed to explore the relationships among duty to care, perception of supportive environment, perceived stress, and COVID-19-specific anxieties in nurses working directly with COVID-19 patients. RESEARCH DESIGN: The study design was a cross-sectional descriptive study using an online survey. It was conducted at an ANCC Magnet® designated 385-bed acute care teaching hospital located in a suburban area. PARTICIPANTS AND RESEARCH CONTEXT: Included in this study were 339 medical surgical nurses working directly with COVID-19 patients during the early phase of the pandemic. ETHICAL CONSIDERATIONS: The study was reviewed by the institution's clinical research committee and determined to be exempt. A survey invitation letter with a voluntary implied consent agreement was sent to participants with a description of the research study attached to the anonymous survey. RESULTS: Nurses with specific COVID-19-related anxieties were more likely to agree that it was ethical to abandon the workplace during a pandemic. CONCLUSIONS: Organizations can and ought to mitigate the negative effects of COVID-19 on duty to care in future pandemics and healthcare emergencies by incorporating several recommendations derived from this study.

COMPARATIVE OUTCOMES OF COVID-19 SURVIVORS VERSUS NONSURVIVORS IN AN ACADEMIC INTENSIVE CARE UNIT

We aimed to study the characteristics and differences between survivors and non-survivors among the patients admitted to our Intensive Care Unit (ICU) with severe infection. B Methods: b We included a cohort of survivors and non-survivors admitted with the diagnosis of COVID-19 to our ICU between March 2020 and June 2020. B Conclusions: b In this cohort of critically ill COVID-19 patients, non-survivors had higher severity of illness scores throughout their ICU stay, were male and older, and required more vasopressor and renal replacement therapy support. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COMPARATIVE OUTCOMES OF ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS WITH COVID-19 INFECTION

B Methods: b This is a retrospective cohort study of COVID-19 positive patients with AKI admitted to the ICU at Anne Arundel Medical Center (AAMC) between March 2020 and June 2020. Our aim was to describe the clinical characteristics and comparative outcomes between these two groups of COVID-19 patients admitted to the Intensive care Unit (ICU). B Introduction/Hypothesis: b Severe COVID-19 is associated with multiple organ dysfunction and commonly results in acute kidney injury (AKI). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Covid-19 Mortality in an Acute Care Hospital: Association of Patient Factors With Decision to Forego the Intensive Care Unit.

BACKGROUND: Public awareness of the large mortality toll of COVID-19 particularly among elderly and frail persons is high. This public awareness represents an enhanced opportunity for early and urgent goals-of-care discussions to reduce medically ineffective care. OBJECTIVE: To assess the end-of-life experiences of hospitalized patients dying of COVID-19 with respect to identifying the clinical factors associated with utilization or non-utilization of the ICU. METHODS: Retrospective cohort study of hospital outcomes using electronic medical records and individual chart review from March 15, 2020 to October 15, 2020 of every patient with a COVID-19 diagnosis who died or was admitted to hospice while hospitalized. Logistic regression multivariate analysis was used to identify the clinical and demographic factors associated with non-utilization of the ICU. RESULTS: 133/749 (18%) of hospitalized COVID-19 patients died or were admitted to hospice as a result of COVID-19. Of the 133, 66 (49.6%) had no ICU utilization. In multivariate analysis, the significant patient factors associated with non-ICU utilization were increasing age, normal body mass index, and the presence of an advanced directive calling for limited life sustaining therapies. Race and residence at time of admission (home vs. facility) were significant only in the unadjusted analyses but not in adjusted. Gender was not significant in either form of analyses. CONCLUSION: Goals of care discussions performed by an augmented palliative care team and other bedside clinicians had renewed urgency during COVID-19. Large percentages of patients and surrogates, perhaps motivated by public awareness of poor outcomes, opted not to utilize the ICU.