Living with pulmonary sequelae of COVID-19 and the implications for clinical nursing practice: A qualitative systematised review.

AIM: To synthesise qualitative research on pulmonary sequelae of COVID-19 and identify patient needs and experiences to develop nursing care strategies. BACKGROUND: Qualitative research on long COVID by subtype has not yet occurred. As pulmonary sequelae constitute a serious long COVID subtype, exploring patient experience and needs can generate knowledge to guide nursing practice. DESIGN: Systematised review methodology utilised on a purposive sample of published articles and reported using the PRISMA guidelines and checklists. Searched MEDLINE, Cumulative Index to Nursing and Allied Health, and Google Scholar, for English or French articles published from February 2020 to June 2022; qualitative research with adults recovering from COVID-19 with evidence of pulmonary sequelae. METHODS: Established principles for data extraction followed related to data reduction, data presentation, data comparison, and conclusion formulation and verification. Analysis was informed by Thorne's Interpretive Description and extended with Meleis' transitions theory, Mishel's uncertainty in illness theory and Moore et al.'s holistic theory of unpleasant symptoms. The quality of included studies was assessed Joanna Briggs Institute critical appraisal tool for qualitative research. RESULTS: Four articles with six pooled participants provided data to yield three main themes: (1) a novel health-illness transition, (2) lung injury and pulmonary fibrosis as antecedent to illness uncertainty, (3) and pulmonary symptoms that are compounded by fatigue and weakness. CONCLUSION: Pulmonary sequelae of COVID-19 confers a unique health-illness transition, uncertainties and symptoms that can be addressed by theory informed nursing practice. RELEVANCE TO CLINICAL PRACTICE: Advocacy, optimising the nurse-patient relationship, offering up-to-date information and addressing uncertainty may help patients cope with pulmonary sequelae, a complex subtype of long COVID with important considerations for clinical nursing care. Despite a lack of evidence-informed clinical pathways, nurses can support patients to understand novel treatments, support discharge planning and acknowledge the synergistic nature of pulmonary symptoms and fatigue to support health-illness transitions. NO PATIENT OR PUBLIC CONTRIBUTION: This article involved analysis of previously published works.

Effects of the COVID-19 Pandemic on Healthcare Providers: Policy Implications for Pandemic Recovery.

BACKGROUND: Notably higher rates of mental health issues have been reported among healthcare providers (HCPs) during the COVID-19 pandemic. Concerns over the impact of policy decisions on the well-being of HCPs is growing, yet it remains underexplored in the literature. METHOD: HCPs from a 301-bed mental health hospital and a 408-bed acute care community hospital, both located in central Ontario, participated in interviews (N = 30) and answered open-ended questionnaires (N = 88) to provide their experiences with the COVID-19 pandemic. RESULTS: Using interpretive description methods, we found that public health policies and other strategies intended to mitigate COVID-19 transmission variably impacted HCP well-being and professional practice. DISCUSSION: Pandemic-related policies contributed to HCP stress by changing the healthcare environment and clinical practice. Understanding HCP experiences is key for leaders, policy makers and health system planners to deal with the current state, recovery and preparation for future pandemics. Direct input into policy development, implementation and evaluation from HCPs may support their well-being.

Effects of the COVID-19 Pandemic on the Mental Health of Healthcare Providers: A Comparison of a Psychiatric Hospital and a General Hospital.

BACKGROUND: Before the COVID-19 pandemic, healthcare providers (HCPs) were already experiencing a higher prevalence of mental health disorders compared with non-healthcare professionals. Here, we report on the psychosocial functioning and stress resilience of HCPs who worked during the COVID-19 pandemic in a large-sized psychiatric facility and a large acute care hospital, both located in central Ontario, Canada. METHODS: Participants completed five validated psychometric instruments assessing depression, anxiety, and stress (The Depression, Anxiety, and Stress Scale-21, DASS-21); work-related quality of life (Work-Related Quality of Life Scale, WRQoL); resilience (Connor-Davidson Resilience Scale, CD-RISC); anxiety about the novel coronavirus (Coronavirus Anxiety Scale, CAS); and loneliness (UCLA Loneliness Scale, ULS). Participants from the psychiatric hospital (n = 94) were sampled during the easing of restrictions after the first wave in Ontario, and participants from the acute care hospital (n = 146) were sampled during the height of the second wave in Ontario. RESULTS: Data showed that HCPs from the acute care hospital and psychiatric hospital reported similar scores on the psychometric scales. There were also no significant differences in psychometric scale scores between medical disciplines at the acute care hospital. Among all HCPs, being a nurse predicted better quality of life (p = 0.01) and greater stress resilience (p = 0.031). CONCLUSION: These results suggest that HCPs' psychological symptoms are similar across the hospital settings sampled. Compared to other HCPs, nurses may show a unique resiliency to the pandemic. We suggest that emergencies such as the COVID-19 pandemic have a pervasive effect on HCPs. It is important to address HCPs' mental health needs in terms of crisis management and improve resilience among all HCPs during the inter-crisis period before a new challenge arrives.

Effects of COVID-19 on Healthcare Providers: Opportunities for Education and Support (ECHOES).

Healthcare providers (HCPs) working at point of care with patients have experienced health-, home- and work-related stressors from the COVID-19 pandemic. The magnitude and duration of the pandemic pose particular challenges for nursing leadership, and there is little research to guide them during this unprecedented time. This study was designed to explore how the pandemic influences HCP well-being, professional practice, inter-professional collaboration and the education and supports that would assist them during the pandemic recovery period. The article reports on the qualitative portion of a mixed-methods study, which included 56 HCPs who work in a large mental healthcare facility in Ontario. Witnessing the impact of the pandemic restrictions on patients was a significant source of stress for HCPs. HCPs recommended strategies, such as learning new therapeutic modalities and participating in the redesign of health services as key strategies to support them during the pandemic as these would promote patient well-being. Lastly, the pandemic provided opportunities for HCPs to deepen their understanding of other professions. This awareness was viewed as a strength that could support interprofessional collaboration and enhance health services redesign. The findings and recommendations can assist leaders to address the mental health challenges arising from the pandemic.