ABSTRACT
Development of the Student Wellbeing Connect (SWBC) service was a response to increased student support needs in the initial stages of the COVID-19 pandemic in 2020. Due to the government-imposed restrictions during the COVID-19 pandemic, students often faced complex psychosocial and wellbeing issues (Dodd et al., 2021). Two years on from its inception, the case management service has become a core component of La Trobe University's Student Health, Wellbeing and Inclusion services responding to the complex and compounding factors that can impact the wellbeing and success of university students. Varying psychosocial needs can underly a student's presentation to a counselling service;thus, the case management service complements the counsellor's role by providing practical-based interventions. The focus of the service on practical issues has provided an alternative support model for students who do not identify as primarily requiring mental health or counselling support. This has opened service provision to a broader cohort of students. Using a multi-disciplinary, strength-based, and person-centred case management approach, students work collaboratively with Wellbeing Coordinators to identify internal and external supports to address their needs through psychosocial assessments and implementation of goal-focused planning. SWBC acts as a safety net within the university setting if/when psychosocial difficulties are impacting the student's experience, academic performance, and wellbeing. This paper will outline the operational and service provision framework for providing case management to tertiary students. © 2023, Australian and New Zealand Student Services Association. All rights reserved.
ABSTRACT
Background/aims: Data from early in the COVID-19 pandemic indicated a major decline in palliative care volunteer numbers and their support to service provision. This may impact on the quality and safety of palliative care service provision. The aim is to identify and understand the roles and deployment of volunteers in hospice and specialist palliative care services in the ongoing response to COVID-19. Methods: Multi-national cross-sectional survey of hospices and providers of specialist palliative care services, using a convenience sample. A 68-item online questionnaire, aimed at people responsible for volunteer deployment, was disseminated via social media, palliative care networks and key collaborators from May to July 2021. Questions captured volunteer deployment pre-COVID-19, through the pandemic and future plans. Descriptive analysis and chi-square tests were conducted to compare results. Free text comments were analysed using content analysis techniques. Results: Valid responses were received from 304 organisations (35 countries, 80.3% Europe). Most cared for adults only (60.9%), provided inpatient care (62.2%) and were non-profit (62.5%). 47.0% had cared for people with COVID-19. Volunteers tended to be younger than pre-pandemic. 47.7% changed the way they deployed volunteers;the mean number of active volunteers dropped from 203 per organisation to 33, and 70.7% reported a decrease in volunteers in direct patient/family facing roles. 50.6% said this drop impacted their organisation and care provision, increasing staff workload and pressure, decreasing patient support, and increasing patient isolation and loneliness. Conclusions: The sustained reduction in volunteer deployment due to COVID-19 has impacted the provision of safe, effective palliative care. Urgent consideration must be given to the future of volunteering including virtual modes of delivery, micro-volunteering, and appealing to a younger demographic.
ABSTRACT
Background/aims: Previous research on hospice and palliative care volunteering early in the COVID-19 pandemic suggested a significant decline in volunteering activity, impacting on the range, safety and effectiveness of services offered. Aim: To explore future organisational plans for volunteer roles and deployment in hospice and specialist palliative care services in light of the ongoing response to COVID-19. Methods: Multi-national cross-sectional survey of hospices and providers of specialist palliative care services, using a convenience sample. A 68-item online questionnaire, aimed at people responsible for volunteer deployment, was disseminated via social media, palliative care networks and key collaborators from May to July 2021. Free text questions focussed on future plans for volunteering. Free text responses were analysed using content analysis techniques. Results: 64% (n=195) of organisations maintained contact with nonactive volunteers. Many services intended to return to pre-pandemic volunteering activities. 14% (n=43) of organisations reported planning a phased re-introduction of volunteers, additional training, use of risk assessments and safe working protocols related to infection control. Others intended to be more flexible, continuing face to face roles whilst increasing virtual volunteering activities. Some planned to use volunteers more effectively, ensuring that roles matched organisational needs. Increased community volunteering was also highlighted. Others were confident that volunteers would return and undertook no planning. Conclusions: The approach to planning for the future of volunteering is not consistent. It was assumed that volunteers will return to roles as before. Urgent consideration must be given to engaging with volunteers to ascertain how many will return, identifying gaps, developing safe protocols for return, assessing future support and training requirements for changed environments and new ways of working.
ABSTRACT
Background/aims: A specialist palliative care service evaluation in an acute hospital during the first wave of COVID-19 showed that those from ethnic minority backgrounds, especially women, were referred later. Improvements in treatments, and operational and system-level changes to the palliative care service which were introduced to address this disparity, may have improved access for those from ethnic minorities. Aim: To assess the effectiveness of operational and system-level changes to the hospital specialist palliative care service, by examining care patterns and trends for those with COVID-19. Methods: Retrospective service evaluation comparing patients referred to an acute hospital palliative care service with confirmed COVID-19 infection either at the peak of the first (Mar-Apr 2020, W1) or second (Dec 2020-Feb 2021, W2) wave of the pandemic. Demographic, clinical characteristics, and outcomes data were collected and compared using statistical tests;generalised linear mixed models for modelling of elapsed time from admission to referral;and survival analysis for each wave. Results: Data from 165 patients (W1 = 60, W2 =105) were included. Overall, patients in W1 were referred earlier to palliative care than in W2, particularly in the first 8 days from admission. Receiving dexamethasone, anticoagulants and absence of dementia, hypertension, and fever were associated with longer time to referral. The delay in referral from W1 of Black and Asian patients of 2-4 days, accounting for 22%-44% of the overall time from admission to death, was no longer observable in W2. The Australian-modified Karnofsky Performance Status (HR < 0.92, upper CI < 0.97) and phase of illness (HR > 3, lower CI >2) were good predictors of survival in both waves. Conclusions: The delayed referrals for ethnic minorities were not seen in W2. Actions to integrate palliative care within organisational COVID-19 planning, engaging with minority ethnic groups, and educating the workforce on culturally sensitive approaches to care may have had a positive impact on access to palliative care.
ABSTRACT
Background: Internationally, COVID-19 has placed additional strain on already stretched health care systems. This has influenced how specialist palliative care organisations and their staff have been able to respond to clinical need in accordance with their professional values. Aims: To explore how COVID-19 impacted specialist palliative care staff and how organisations responded to the impact of the pandemic on staff well-being. Methods: Qualitative multiple case study, part of the CovPall study. Cases were English hospices providing specialist palliative care services in any setting. Semi structured interviews were carried out with hospice staff between 11/20-04/21, purposefully sampled by role, care setting and COVID-19 experience. Interviews were analysed using framework analysis. Results: Five cases (n=24 participants). Infection control constraints (e.g., visiting restrictions, PPE) prohibited and diluted participants' ability to provide care that reflected their core values. This resulted in staff experiencing moral distress. Despite organisational, team, and individual support strategies to address staff well-being, continually managing these constraints led to a 'crescendo effect' in which the impacts of moral distress (e.g., sadness, guilt, frustration, and fatigue) accumulated over time, sometimes leading to burnout. Some gained 'moral comfort' from solidarity with colleagues and making a valued contribution. Conclusions: This study provides a useful insight into why and how specialist palliative care staff experienced moral distress during COVID-19, and how organisations have responded. Despite their expertise in caring for the dying, staff well-being and mental health was affected by the pandemic. Prolonged experiences of moral distress has a detrimental impact on staff and the quality of care. Organisational, structural, and policy changes are urgently required to mitigate and manage these impacts.
ABSTRACT
Objectives: To present an exploration of the experiences of using focus group methodology to discuss end of life family conversations in families of African and Caribbean heritage;And to explore the change of dynamics of these focus group discussions when COVID 19 required a change from in person discussion to synchronous online discussions. Background: Individual interviews are widely used in qualitative research when exploring sensitive topics such as discussions with people who are dying or around the dying of others. Previous studies have explored many issues that arise in carrying out palliative care research. They have focused on ethical appropriateness, benefits and burdens and consent. When exploring the use of focus group methodology in sensitive research, issues such as confidentiality, anonymity, power imbalances between participants and risk of harm have been concerns. With the rise of participatory forms of research entering the palliative care arena, interest has grown and confidence has been built in utilising group discussions to generate a greater flow of ideas. Method: Process and outcome analysis of five focus groups of people from African and Caribbean heritage discussing end of life family conversations. Two focus groups were undertaken in person and three were conducted online. Results: The process analysis revealed a dynamic of power rebalancing. The groups had more participants than facilitators and the impact of this was noticeable, particularly in the group of older people where participants supported each other to focus on themes that were significant to them. The presence of two group facilitators, a common feature of focus groups provided insightful opportunities for reflexivity. Moving from in person groups to online groups altered the ratio of comments between facilitators and individual participants than between participants. Outcome analysis revealed that fewer themes were generated in the online groups.
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Background: Infection control measures during infectious disease outbreaks can have significant impacts on seriously ill and dying patients, their family, the patient-family connection, coping, grief and bereavement. Aim: To explore how family members of patients who are seriously ill or who die during infectious disease outbreaks are supported and cared for during serious illness, before and after patient death, and the factors that influence family presence around the time of death. Methods: A systematic review and narrative synthesis was undertaken. CINAHL, Medline, APA PsycInfo and Embase databases were searched from inception to June 2020. A forward and backward search of included papers was also undertaken. Records were independently assessed against inclusion criteria. Included papers were assessed for quality, but none were excluded. Results: Key findings from the 14 included papers include the importance of communication and information sharing, including new ways of using virtual communication. Restrictive visiting practices were understood by family, but the impact of these restrictions on the family experience and patient-family connection cannot be underestimated, causing distress and suffering. Consistent communication and information were critical to supporting family members including explaining personal protective equipment, which family found constraining and staff believed affected interpersonal communication. Cultural expectations and obligations associated with family caregiving and death were challenged during infectious disease outbreaks. Conclusion: Learning from previous infectious disease outbreaks about how family are supported is important and can be translated to the current COVID-19 pandemic and future infectious disease outbreaks. Consistent, culturally sensitive and tailored plans should be clearly communicated to family members, including when any restrictions may be amended or additional supports provided when someone is dying.
ABSTRACT
Background: The disproportionately high death rate of those from ethnic minority groups from COVID-19 is well documented. Little is known about how palliative care services have responded. Aims: To map and develop insights into the response of palliative care services caring for patients and families from ethnic minority groups during the COVID-19 pandemic. Methods: (design, data collection, analysis): Cross-sectional on-line survey of UK palliative care services' response to COVID-19. Quantitative data were summarised descriptively and chi-square tests used to explore relationships between categorical variables. Open-ended responses were analysed using reflexive thematic analysis. Results: 93/277 (34%) responding palliative care services reported on care for COVID-19 patients from ethnic minority groups (60/123 (49%) hospital palliative care teams and 35/152 (23%) hospice inpatient teams). Nearly two-thirds (59%) of services offered care across multiple settings. Services who supported those from ethnic minority groups were more likely to have hospital palliative care teams (χ2 =15.21, p <0.001) and less likely to have inpatient hospice (χ2 = 30.11, p <0.001) or home palliative care teams (χ2 = 7.05, p= 0.008). 61/93 (66%) responding services stated there was no difference in how they supported or reached ethnic minority groups. Five main themes were identified from free-text comments: 1) disproportionate adverse impact of restricted visiting 2) compounded communication challenges 3) unmet religious and faith needs 4) mistrust of services and 5) equal but inequitable service response. Conclusion / Discussion: Policies introduced during the COVID-19 pandemic may have disproportionately adversely impacted those from ethnic minority groups. The palliative care response may have been both unequal and inequitable. The traditional focus of personalised care is not enough. We provide urgent recommendations for service providers and policymakers.