ABSTRACT
Background: Nurses practising in older people's care homes are often the only trained nurse on shift, undertaking leadership roles while also supporting residents with complex clinical needs. The study aimed to explore Nursing and Midwifery Council (NMC)- registered nurses' experiences of working in older people's care homes during the COVID-19 pandemic. Method: Recruitment used direct contact with care homes, social media and links provided by national partners, then purposive sampling for age, gender, type of care home and location. Data collected through one-to-one on-line interviews using a topic guide developed collaboratively with care home nurses, focusing on how COVID-19 impacted on nurses' resilience and mental well-being. Data were analysed thematically. Results: 18 nurses interviewed between March-July 2021: female 16, majority aged between 46-55 years;mean time registered with NMC 19 years (range 18 months-45 years);one had not nursed residents with COVID-19. Preliminary findings indicate that nurses developed enhanced clinical skills, which increased their professional standing. Many nurses were in leadership roles responsible for processing and sharing rapidly-changing guidance, making judgements on how to manage infection risk within the home. Nurses reported balancing information-assimilation and reporting with providing direct care due to staff shortages. All nurses provided emotional support to other staff. They sought support from their peers, namely nurses inside and outside their workplace. As leaders, many of the nurses spoke about the emotional impact of having to manage relatives' expectations and make decisions on whether a relative could be with a dying resident. Conclusion: Understanding the types of support that might best increase resilience and well-being for nurses in care homes now and in the future is essential to maintain a healthy, stable workforce. Support for nurses will likely benefit other care workers either directly through wider roll-out, or indirectly through improved well-being of the nurse leaders.
ABSTRACT
Background: The unprecedented impact of SARS-CoV-2/COVID-19 worldwide pandemic on healthcare hasbeen profound. At our large quaternary care pediatric healthcare system, in response to change how wedeliver care, a telemedicine strategy was rapidly developed with a priority to address the needs of patientsrequiring specialty time sensitive ambulatory care. One obvious opportunity was to rapidly expandtelemedicine capabilities to address the impact quarantines and stay at home orders would have on thedelivery of care to children with chronic conditions. We had some telemedicine capabilities in certainpopulations, however when our community shut down we responded with an immediate plan to expandtelemedicine services in a large multi-specialty practice. During the first week of the stay at home order, ourambulatory volumes drop by 69% reinforcing concerns regarding delays care (Fig. 1). Methods: We establisheda leadership model, task forces, and communication plan. We rapidly adapted to ongoing changes andaddressed specific needs including clinic workflow, patient populations, patient capabilities to utilize telehealth, education of clinical teams, and daily visible tracking tools. We measured daily telemedicinevolumes by practice, total visits, and proportion of telemedicine visits. Results: The 69% decrease inambulatory volume was countered with a 42,300% increase in telemedicine visits. Prior to COVID-19, weaveraged 4 telemedicine visits weekly and currently complete over 2,000. Through telemedicine, we aremaintaining a clinic volume of 57% of expected with 68% of all those visits being provided throughtelemedicine (Figure 2). All specialty services provide telemedicine. Certain specialty clinics adapted totelemedicine easier than others;allergy/asthma (98%;n = 581), pulmonary (97%;n = 390), neurology (96%;n =1,004), dermatology (95%;1,175), and otolaryngology (91%;n = 1,314) clinics experienced the greatest degreesof success over the past month while ophthalmology (55%;n = 531), cardiology (35%;n = 576) and orthopedics(14%;n = 1,713) faced challenges. Additionally, 30% of all completed telemedicine visits were for new referralvisits. Conclusion: We rapidly expanded telemedicine to provide time sensitive care in a large ambulatoryspecialty practice. Certain specialties were more amenable to telehealth for various reasons--vital signsavailable from home monitoring, ability to assess neurologic function in natural settings, etc. We realized thatevery specialty could do some aspect of telemedicine yet for others it was more challenging due to the needfor ancillary tests (Echocardiogram, x-rays, ophthalmology adjuncts, etc.) or lack of a good substitute forphysical exam findings (murmurs, abdominal exams, etc.). We successfully completed new referral visits (aprevious concern in specialty practices). Future steps to sustain our telemedicine practice are to continue torefinine best telemedicine practices, identifying appropriate populations and visit types, track financial impact,and measure patient outcomes.