Postnatal quietness - the dilemma of visiting hours. A qualitative interview study with maternity care staff.

BACKGROUND: As part of the Person and Family Centred Care, involvement of relatives is a key concept. This means that an unrestricted visiting policy in hospitals wards is widely accepted and implemented. In maternity care, benefits and drawbacks of unrestricted visiting is still discussed, while it is acknowledged that a quiet environment is important for both new parents and newborns to enhance breastfeeding. The COVID-19 lockdown provided an opportunity to study how the restrictions for visitors influenced the work of maternity care staff in Denmark. OBJECTIVE: This study aimed to explore the experience of maternity care staff on how visitation restrictions for visitors influenced the care of new families in a maternity ward. METHODS: Individual interviews (n = 10) were performed between 20 November 2020 and 25 February 2021. A qualitative descriptive study was performed using thematic analysis. RESULTS: One overarching theme was identified: "Framing time to the experience of becoming a parent". Further, five sub-themes were identified and illuminated in the analysis: "Increasing confidentiality and presence", "Changing availability and space for guidance", "Welcoming peacefulness", "Being gatekeepers", and "Structuring time is caring". CONCLUSION: Restrictions for visitors influenced the care of new families because it encourages the space and place of becoming a parent. The hospital environment was shaped in a calm way, which increased the staffs' bedside time. The experience of an increased confidentiality with new parents led to in-depth conversations, making it easier to identify new parents' needs, focus on the initiation of breastfeeding, and individual guidance.

An investigation of the level of burnout and resilience among hospital based nurse managers after COVID 19 - A cross-sectional questionnaire-based study.

AIM: We aim to investigate burnout and resilience among hospital based nurse managers post COVID-19 in order to suggest appropriate person-centred leadership support. BACKGROUND: Nurse leaders are central to establishing safe and caring environments for patients and staff. Therefore, their own wellbeing is crucial, particular in times of crisis where they must provide support and guidance. METHODS: Cross-sectional questionnaire included ward managers. Data collected were burnout inventory, brief resilience score and demographic data. To analyse data, we used descriptive statistics. RESULTS: 51.2% answered the questionnaire. Of those, 32.3% displayed symptoms of high personal burnout and 29% of work-related burnout. 6.5% showed signs of high employee-related burnout. As a group, ward managers showed moderate to high resilience. CONCLUSION: Personal and work-related burnout was highly prevalent among ward managers. Results suggest that the cause of their burnout symptoms cannot be attributed to low individual resilience. We thus suggest a shift in focus from strengthening individual leadership resilience to the establishment of healthful and resilient cultures in accordance with person-centred leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Person-centred leadership has the potential to shift the focus from the resilience of individual leaders to that of collective responsibility for creating a healthful and resilient culture.

Patients' experiences of the COVID-19 pandemic and the change to telephone consultations in cancer care.

PURPOSE: During the COVID-19 pandemic, teleconsultations have increasingly been used to reduce physical contact and thus risk of infection. This study investigated how patients with cancer experienced the COVID-19 pandemic and how they perceived the change from in-person consultations to telephone consultations in an oncology outpatient clinic. The aim was to provide insights that could optimize the future use of teleconsultations in cancer care. METHODS: This qualitative study included 15 patients with colorectal, breast, gynecological, lung, or prostate cancer treated at the outpatient clinic at the Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in June or July 2020. Data were collected through semi-structured individual interviews and analyzed by thematic analysis. RESULTS: Patients with cancer experienced social, psychological, and organizational consequences of the COVID-19 pandemic related to their cancer care. Not all patients were comfortable with telephone consultations. Six themes were identified: (1) double burden as a consequence of simultaneous cancer and the COVID-19 pandemic, (2) parameters for patient satisfaction with telephone consultations, (3) the importance of relatives attending consultations, (4) loss of information and nuances during telephone consultations, (5) the impact of physicians' language and communicative skills during telephone consultations, and (6) patients' suggestions for future telephone consultations. CONCLUSION: Beyond the COVID-19 pandemic, it is important that hospitals offering teleconsultations involve patients' preferences, consider for which patients and consultations the solution is suitable, which technology to use, how to prepare patients and relatives, and how to provide physicians with the necessary communicative skills.

Facilitating person-centred leadership support during the Covid-19 crisis

Background: The Covid-19 crisis has created new and difficult working conditions for all frontline healthcare staff and leaders. Ward managers in particular have faced significant challenges. The practice development initiative described in this article began at a hospital in Denmark immediately after the country's first Covid-19 wave. The hospital has person-centredness as its vision for care and research. Aim: The purpose of this article is to offer a reflection on the ways in which our research and its findings enabled us to learn from the experiences of ward managers so as to support them and strengthen their network during a difficult time, using principles of practice development. Conclusion and implications for practice: The evidence produced in the project was found to be relevant to leadership practice by the ward managers and led to a strengthened position at a time of crisis. This implies that: • It is possible to establish collaborative and useful evidence for clinical practice under difficult circumstances • • By using principles of practice development it is possible to facilitate constructive dialogues between ward managers and executive managers • At a time of a major crisis, the role of ward managers should not be underestimated. [ FROM AUTHOR] Copyright of International Practice Development Journal is the property of Foundation of Nursing Studies 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.)

The Differences in Experiences Among Multi-Level Healthcare Leaders, Between the First and the Second Wave of the COVID-19 Pandemic: Two Cross-Sectional Studies Compared.

PURPOSE: To identify the differences in experiences during wave I and II of the COVID-19 pandemic among healthcare leaders. BACKGROUND: It is expected, that working conditions for COVID-19-pandemic frontline staff will change, as health care organizations have gained experience with handling the consequences of the disease. METHODS: An online survey was sent out to Danish health care leaders during the first and the second pandemic wave. Comparative analyses were performed in relation to three key characteristics: management level, management education and experiences as a leader. RESULTS: Eighty-nine health care leaders completed both surveys. Significant differences were found within the entire group across the key characteristics as they felt more prepared for each stage of the situation, they had more influence on the decisions taken, and they felt more concerned about the quality of treatment and care and their own health. Further significant results related to the three key characteristics were found at 1) Management level: The heads of department experienced being better informed, having more overview of their tasks and that these were meaningful. The ward managers experienced being more able to work in consistency with own beliefs and values, though they felt more overloaded. 2) Level of management education: Leaders, without a formal management education, experienced being more supported by staff. 3) Years of experiences as leader: Leaders with more than five years of experience, experienced being more prepared and informed, had more influence on decision-making, and were more worried about their own health. CONCLUSION: The learning from experience that happens naturally in crisis situations is the reason why the leaders feel more prepared. However, there is a need for further leadership and practice development, to create contexts where leaders feel more ready for all aspects of their role.

A population-based survey of patients' experiences with teleconsultations in cancer care in Denmark during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, teleconsultations (TC) have been increasingly used in cancer care as an alternative to outpatient visits. We aimed to examine patient-related and cancer-specific characteristics associated with experiences with TC among patients with cancer during the COVID-19 pandemic. MATERIAL AND METHODS: This population-based survey included patients with breast, lung, gastrointestinal, urological, and gynaecological cancers with appointments in the outpatient clinics, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in March and April 2020. Age- and sex-adjusted logistic regression analyses were used to study associations of sociodemographics, cancer and general health, anxiety, and health literacy with patients' experiences of TC in regards to being comfortable with TC, confident that the doctor could provide information or assess symptoms/side effects and the perceived outcome of TC. RESULTS: Of the 2119 patients with cancer receiving the electronic survey, 1160 (55%) participated. Two thirds of patients (68%) had consultations with a doctor changed to TC. Being male, aged 65-79 years, and having TC for test results were statistically significantly associated with more comfort, confidence, and perceived better outcome of TC. Having breast cancer, anxiety, low health literacy, or TC for a follow-up consultation were statistically significantly associated with less positive experiences with TC. Living alone, short education, disability pension, and comorbidity were statistically significantly associated with anxiety and low health literacy. CONCLUSIONS: Most patients reported positive experiences with TC, but in particular patients with anxiety and low health literacy, who were also the patients with fewest socioeconomic and health resources, felt less comfortable and confident with and were more likely to perceive the outcome negatively from this form of consultation. TC may be suitable for increasing integration into standard cancer care but it should be carefully planned to meet patients' different information needs in order not to increase social inequality in cancer.

On the frontline treating COVID-19: A pendulum experience-from meaningful to overwhelming-for Danish healthcare professionals.

OBJECTIVES: In the current study, we aimed to explore the experiences and attitudes among healthcare professionals as they transitioned from their familiar disciplines to respiratory medicine, intensive care or other departments during the first wave of the COVID-19 pandemic. BACKGROUND: In preparation for the increasing number of patients suspected of having or who would be severely ill from COVID-19, a major reconstruction of the Danish Healthcare System was initiated. The capacity of the healthcare system to respond to the unprecedented situation was dependent on healthcare professionals' willingness and ability to engage in these new circumstances. For some, this may have resulted in uncertainty, anxiety and fear. DESIGN: The study was a descriptive study using semi-structured focus group interviews. Healthcare professionals (n = 62) from seven departments were included, and 11 focus group interviews were conducted. The focus group interviews took place during June 2020. Analyses was conducted using thematic analysis. The current study was reported using the consolidated criteria for reporting Qualitative research (COREQ). RESULTS: Healthcare professionals experiences was described by five themes: 1) Voluntary involvement, 2) Changes within the organisation, 3) Risks, 4) Professional identity and 5) Personal investment. Common to all five themes was the feeling of being on a pendulum from a meaningful experience to an experience of mental overload, when situations and decisions no longer seemed to be worthwhile. CONCLUSIONS: Healthcare professionals experienced a pendulum between a meaningful experience and one of mental overload during the COVID-19 pandemic. The swinging was conditioned by the prevailing context and was unavoidable. RELEVANCE TO CLINICAL PRACTICE: To balance the continuous pendulum swing, leaders must consider involvement, and to be supportive and appreciative in their leader style. This is consistent with a person-centred leadership that facilitates a well-adjusted work-life balance and may help prevent mental overload developing into burnout.

Improving Person-Centred Leadership: A Qualitative Study of Ward Managers' Experiences During the COVID-19 Crisis.

PURPOSE: In order to provide guidance and prepare ward managers for future crisis situations similar to the COVID-19 pandemic, the aim of this study was to reflect and learn how person-centred nursing leadership may be strengthened in such situations. BACKGROUND: The pandemic has forced nurse leaders to face new challenges. Knowledge about their experiences may contribute to advancing leadership practices in times of future crises. METHODS: A qualitative directed content analysis was chosen. The theoretical perspective was person-centred leadership. Thirteen ward managers from a Danish university hospital were included and interviewed using telephone interviews three months after the first national COVID-19 case was confirmed. FINDINGS: The main findings of the study revealed that the ward managers often experienced a lack of timely, relevant information, involvement in decision-making and acknowledgement from the head nurse of department and the executive management. This was caused by the existing organizational cultures and the traditional hierarchy of communication. This meant that the ward managers' sense of own competences and leadership values and beliefs came under high pressure when they had to balance different stakeholders' needs. CONCLUSION: When the experience of ward managers results in them being unable to lead authentically and competently in a crisis like the COVID-19 pandemic, lack of engagement can occur, with serious consequences for patients, staff and the ward managers themselves. Traditional organizational cultures that are hierarchical and controlling needs to be challenged and reoriented towards collaborative, inclusive and participative practices of engagement and involvement. Leadership development must be an established and integrated component of organizations, so that ward managers are able to sustain person-centred ways of being and doing in times of crisis.

Health Professional Frontline Leaders' Experiences During the COVID-19 Pandemic: A Cross-Sectional Study.

PURPOSE: The aim was to identify the differences in experiences of Danish healthcare leaders in the beginnning of the coronavirus (COVID-19) pandemic and to generate knowledge for future leadership during and post crises. BACKGROUND: The global spread of COVID-19 has affected healthcare systems worldwide and has forced healthcare leaders to face challenges few were prepared for. It is expected that the pandemic may hit in several waves within the next year and therefore healthcare leaders must be prepared for these waves. METHODS: An online survey was developed, and comparative analyses were performed. RESULTS: One hundred and sixty hospital leaders were invited, and 72% completed the questionnaire. Significant differences were found within three selected characteristics: 1) Management level: significantly more heads of departments experienced taking complex decisions (P=0.05), being able to work in a way consistent with their beliefs and values (P=0.05), and they were less likely to experience that collaboration with other leaders was adversely affected by the COVID-19 situation compared to ward managers (P=0.04). On the other hand, ward managers were significantly more often worried about both their own health (P=0.01) and their family's health (P=0.04). 2) Management education: those with a formal management education more often experienced having the managerial competences to effectively manage the COVID-19 situation (P=0.00), and performing meaningful tasks during the situation (P=0.04). 3) Years of experience: significantly more leaders with more than five years of experience identified having the managerial competences to effectively manage the situation (P=0.01). CONCLUSION: Leadership support during a healthcare crisis like the COVID-19 pandemic should strategically focus on ward managers, leaders with no formal management education and leaders with less than two years of experience. Hospital leaders may use this knowledge to re-contextualize what is already known about targeted leadership support during healthcare crises and to act accordingly.