Healthcare Team Resilience During COVID-19: A Qualitative Study (preprint)

BACKGROUND Resilience has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the principles of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a singular cognizant entity defined by its collective identity, purpose, competence, and actions.METHODS We developed a descriptive model which considered the healthcare team as a unified cognizant entity. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. To ensure the rigor of our study, we utilized the input of an expert in qualitative researcher and maintained an audit trail throughout the analysis process. Additionally, we explored factors participants’ described that may have either hindered or enhanced the resilience potentials within the healthcare team.RESULTS Five themes were identified from the interviews with acute care professionals across the US (N = 22): working in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants’ described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.CONCLUSION Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. The adapted model was useful to describe the healthcare team as a singular cognizant entity. Our research contributes to a growing understanding of the importance of resilience in healthcare and provides a bridge between individual and organizational resilience.

Virtual Visits in Prenatal Care: An Integrative Review.

INTRODUCTION: Addressing gaps in access to prenatal care is an important step to reversing rising rates of maternal and neonatal morbidity and mortality and invites the exploration of innovative care models. This integrative review of published literature explores the patient, health care provider, and organizational experience of integrating virtual visits in prenatal care. METHODS: A literature search to identify original studies and quality improvement projects published between 2010 and 2020 was conducted in PubMed, Scopus, CINAHL, and Google Scholar using keywords associated with both telemedicine and prenatal care. Inclusion criteria specified articles pertaining to synchronous virtual visits between pregnant patients and health care providers, and articles were excluded if visits were not pregnancy-centric or pertaining to telemonitoring or mobile applications. Reference lists of identified reviews were screened, and a hand search of 4 applicable journals was also conducted. Findings were organized according to the factors of the social ecological model: individual, interpersonal, organizational, community, and public policy. RESULTS: The search identified 2666 articles after duplicates were removed, of which 13 met all criteria. Findings across these 13 articles indicated strong patient and health care provider satisfaction with virtual care related to cost savings and convenience, with clinic wait times and cancellation rates also improving. Health care provider input and thoughtful organizational planning were key to a smooth telemedicine implementation process. There were notably no significant differences in clinical outcomes for those who used virtual care. DISCUSSION: Although data are limited, offering an integrated model that uses both virtual visits and in-person visits has been well-received by patients and health care providers and could improve access to care well into the future. Virtual visits in prenatal care have been well-received by patients and health care providers, showing promise as an emerging model for improving access to care.

A systematic concept analysis of healthcare team resilience in times of pandemic disasters.

BACKGROUND: The concept of resilience has been used as a descriptor for individuals and organizations with the dominant themes of bouncing back and moving forward. AIMS: To examine the concept of resilience in providers and healthcare teams during pandemic disasters. RESEARCH DESIGN: Walker and Avant's eight-step concept analysis method. DATA SOURCE: CINAHL, EBSCO Host, PubMed, and SCOPUS were searched using the combined terms "resilience" or "resiliency" or "resilient" and "healthcare professionals," or "healthcare worker" or "healthcare team" or "physician" or "nurse" or "doctor" and "pandemic" or "disaster." METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used to review the literature and apply findings using the eight-step Walker and Avant method for concept analysis. RESULTS: Three clusters emerged as attributes of individual resilience that may be applied to healthcare teams in times of pandemic disasters: (1) resilience is a dynamic contextual process, (2) resilience stabilizes the team to maintain a routine level of function, and (3) resilience is a catalyst for the actualization of innate or acquired skills and ability within the healthcare team. CONCLUSION: This analysis suggests that resilience enhances the healthcare team's ability to maintain function during acute changes created by pandemic disasters. Resilience in healthcare teams during pandemics requires future research to explore the phenomenon.

A framework for the promotion of ethical benefit sharing in health research.

There is an increasing recognition of the importance of including benefit sharing in research programmes in order to ensure equitable and just distribution of the benefits arising from research. Whilst there are global efforts to promote benefit sharing when using non-human biological resources, benefit sharing plans and implementation do not yet feature prominently in research programmes, funding applications or requirements by ethics review boards. Whilst many research stakeholders may agree with the concept of benefit sharing, it can be difficult to operationalise benefit sharing within research programmes. We present a framework designed to assist with identifying benefit sharing opportunities in research programmes. The framework has two dimensions: the first represents microlevel, mesolevel and macrolevel stakeholders as defined using a socioecological model; and the second identifies nine different types of benefit sharing that might be achieved during a research programme. We provide an example matrix identifying different types of benefit sharing that might be undertaken during genomics research, and present a case study evaluating benefit sharing in Africa during the SARS-CoV-2 pandemic. This framework, with examples, is intended as a practical tool to assist research stakeholders with identifying opportunities for benefit sharing, and inculcating intentional benefit sharing in their research programmes from inception.

Crafting Community-Based Participatory Research Stroke Interventions.

Stroke exerts a tremendous burden on individuals, families, communities, and health systems globally. Even more troublesome are the striking disparities faced across diverse populations. These disparities are further exacerbated by the COVID-19 pandemic. Despite efforts to advance stroke research, substantial gaps remain in understanding factors that contribute to stroke disparities, including the Social Determinants of Health. Strategically designed studies and tailored interventions are needed to bridge the inequities high-risk populations face and to meet their specific needs. Community-based participatory research offers an approach to equitably partner with community members to understand and work collaboratively to address community-specific health priorities. In this focused update, we highlight the main processes of community-based participatory research studies and share exemplars from our team's work in stroke research and from the literature. As we continue to face an increasing prevalence of stroke, compounded by the COVID-19 pandemic and ongoing implications of the Social Determinants of Health, partnering with communities to address community-driven health priorities can inform interventions targeted to overcome the disparities faced by certain populations.

"We've Had to Build the Plane as We Flew It.": Impacts of the COVID-19 Pandemic on School-Based Weight Management Interventions.

Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, elementary and secondary schools in the United States transitioned to remote learning to slow viral spread and protect students and school officials. This move interrupted academic education and school-based health interventions focused on physical activity (PA) and healthy eating behaviors to help combat childhood obesity. Little is known on how these interventions were affected by COVID-19. Methods: This concurrent multimethodological study incorporated two independent components: qualitative descriptive semistructured interviews with public school administrators and quantitative descriptive cross-sectional needs assessment survey of public school personnel. Results: Three themes were identified from interviews with school administrators (N = 28): changes in school-based interventions addressing PA and healthy eating behaviors, changes in academic delivery affecting PA and healthy eating behaviors, and needs of school administrators. From the survey (N = 1311), 635 (48.4%) participants indicated that schools' abilities to address PA and healthy eating behaviors were negatively impacted by COVID-19. The majority (n = 876, 66.8%) of participants strongly agreed or agreed that the pandemic would affect future school-based interventions related to PA and healthy eating behaviors. Conclusions: While schools are prime locations for delivering school-based weight management interventions related to childhood obesity, participants reported the pandemic had overall negative impacts on interventions addressing PA and healthy eating behaviors. Understanding these impacts is essential to adapting school-based interventions to changes from COVID-19 so students may receive health information and access health promotion interventions in remote learning environments and during social distancing.

Covid-19 in Critically Ill Patients in the Seattle Region - Case Series.

BACKGROUND: Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020. METHODS: We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. RESULTS: We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. CONCLUSIONS: During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.).