Danger on the frontlines: How a system of failures led to a catastrophe during the COVID-19 pandemic

The COVID-19 pandemic thrust nursing into the spotlight, not only for the heroism that was on display each day on the frontlines while providing care to an extraordinarily high volume of critically ill patients, but also for the chaos and danger that surrounded the profession by providing this care in unsafe working conditions due to a lack of personal protective equipment (PPE). During the COVID-19 pandemic, there was a litany of system failures on federal, state, local, and organizational levels that left nurses and other frontline healthcare workers frequently exposed to a poorly understood and deadly infectious disease. The scope of this project was to identify areas of system failures in the supply and delivery of PPE, to examine issues with guidance versus regulation in providing protection for healthcare workers, and to evaluate enforcement both before and during the pandemic. Extensive research was completed on the nation's PPE supply chain infrastructure, existing workplace safety standards, and the real-time growing body of evidence gleaned from the ongoing COVID-19 pandemic. Based on increased production and availability of necessary PPE early in this project, the scope was prioritized and narrowed to focus on both emergency and permanent Occupational Safety and Health Administration (OSHA) standards to reduce workplace morbidity and mortality of healthcare workers. This evidence collected was utilized to develop a policy paper, in partnership with an American Nurses Association (ANA) Senior Policy Advisor, that provided recommendations for enforceable emergency and permanent airborne infectious disease standards to were necessary to mitigate further risks from COVID-19 for all frontline healthcare providers, as well as to provide protections from future threats. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Danger on the frontlines: How a system of failures led to a catastrophe during the COVID-19 pandemic

The COVID-19 pandemic thrust nursing into the spotlight, not only for the heroism that was on display each day on the frontlines while providing care to an extraordinarily high volume of critically ill patients, but also for the chaos and danger that surrounded the profession by providing this care in unsafe working conditions due to a lack of personal protective equipment (PPE). During the COVID-19 pandemic, there was a litany of system failures on federal, state, local, and organizational levels that left nurses and other frontline healthcare workers frequently exposed to a poorly understood and deadly infectious disease. The scope of this project was to identify areas of system failures in the supply and delivery of PPE, to examine issues with guidance versus regulation in providing protection for healthcare workers, and to evaluate enforcement both before and during the pandemic. Extensive research was completed on the nation's PPE supply chain infrastructure, existing workplace safety standards, and the real-time growing body of evidence gleaned from the ongoing COVID-19 pandemic. Based on increased production and availability of necessary PPE early in this project, the scope was prioritized and narrowed to focus on both emergency and permanent Occupational Safety and Health Administration (OSHA) standards to reduce workplace morbidity and mortality of healthcare workers. This evidence collected was utilized to develop a policy paper, in partnership with an American Nurses Association (ANA) Senior Policy Advisor, that provided recommendations for enforceable emergency and permanent airborne infectious disease standards to were necessary to mitigate further risks from COVID-19 for all frontline healthcare providers, as well as to provide protections from future threats. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of the first wave of COVID-19 on the health and psychosocial well-being of Maori, Pacific Peoples and New Zealand Europeans living in aged residential care.

OBJECTIVE: To investigate the impact of New Zealand's (NZ) first wave of COVID-19, which included a nationwide lockdown, on the health and psychosocial well-being of Maori, Pacific Peoples and NZ Europeans in aged residential care (ARC). METHODS: interRAI assessments of Maori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses. RESULTS: A total of 538 Maori, 276 Pacific Peoples and 11,322 NZ Europeans had an interRAI assessment during the first wave of COVID-19, while there were 549 Maori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative period. Fewer Maori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) during COVID-19. Lower rates of hospitalisation were observed in Maori (7.4% vs. 10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p < 0.001) during COVID-19. CONCLUSIONS: We found a lower rate of loneliness in Maori but a higher rate of depression in NZ European ARC populations during the first wave of COVID-19. Further research, including qualitative studies with ARC staff, residents and families, and different ethnic communities, is needed to explain these ethnic group differences. Longer-term effects from the COVID-19 pandemic on ARC populations should also be investigated.

A pilot investigation of reliability and validity of balance and gait assessments using telehealth with healthy older adults.

BACKGROUND: The use of telehealth has increased since the COVID-19 pandemic; however, the lack of reliable and valid tools to measure balance and gait remotely makes assessing these outcomes difficult. Thus, we investigated whether balance and gait measures used in clinical practice are reliable and valid when assessed remotely through telehealth. METHOD: In this pilot study, we investigated 15 healthy older adults who performed validated tests: Timed Up and Go simple, dual cognitive and motor tasks; Berg Balance Scale; Functional Gait Assessment and Dynamic Gait Index. The tests were assessed on two dates: (i) face-to-face, (ii) and remotely, via videoconference between 7 and 14 days after the initial assessment. Participants also undertook the Physiological Profile Assessment (PPA) to assess their risk of falling. Reliability was measured using intraclass correlation (ICC) two-way mixed with absolute agreement to contrast the score of the assessments undertaken face-to-face and remotely in real-time and recorded. We also assessed inter-rater reliability. Criterion validity was measured using Pearson correlation between the tests that were undertaken remotely and PPA. RESULTS: All tests showed good reliability between face-to-face and real-time telehealth (ICC = 0.79-0.87) and face-to-face and recorded telehealth (ICC = 0.78-0.88) assessments and good to excellent inter-rater reliability (ICC = 0.80-1.00). Correlation between the tests and PPA were significantly (p < 0.05) moderate for real-time (r = -0.68-0.64) and recorded (r = -0.69-0.71) telehealth assessments. CONCLUSIONS: The good reliability between face-to-face and remote measurements together with moderate validity of these measures to assess fall risk suggest that health professionals could use these measures to evaluate the balance and gait of healthy older adults remotely.

Impact of the 2020 New Zealand COVID-19 lockdown on participants in a community-based, peer-led fall prevention program.

OBJECTIVES: To explore the impacts of the 2020 New Zealand COVID-19 lockdown on peer-led Steady as You Go (SAYGO) fall prevention exercise classes and members, and to develop recommendations for mitigating impacts during future lockdowns. METHODS: Semi-structured phone interviews were conducted with 20 SAYGO program participants and managers following the first COVID-19 lockdown in New Zealand. Interviews were audio-recorded, transcribed verbatim and analysed using the General Inductive Approach. RESULTS: Participants were between 67 and 88 years of age, predominantly female (90%) and NZ European (80%), with one participant identifying as NZ Maori. Three themes were constructed from the analysis: Personal Function and Well-Being, Class Functioning and Logistics, and Future Strategies for Classes During Prospective Lockdowns. Participants used a range of strategies to stay connected with each other and continue the SAYGO exercises at home. Most participants and peer-leaders reported that they maintained physical function during lockdown, although some had feelings of psychological distress and social isolation. Contact systems and resource distribution varied substantially between groups. Classes resumed post-lockdown with only minor modifications and slightly decreased attendance. CONCLUSIONS: Overall, members of this peer-led model of fall prevention classes demonstrated resilience during the COVID-19 lockdown, despite some challenges. We propose three recommendations to address the challenges of maintaining existing peer-led exercise classes in the context of prospective lockdowns: (1) develop a comprehensive contact detail register and plans for each group; (2) delivery of modified exercise classes remotely over lockdown; and (3) implementation of a nationwide IT education and resource program for older adults.