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This chapter grounds the need for care against systemic issues of inequity made hyper-visible during the COVID-19 pandemic. The author considers how mathematics teacher education can shift towards enacting caring practices that will foster the development of positive mathematics identities before addressing how mathematics educators can cultivate collaborative learning environments that center on building authentic, caring relationships. The chapter shares the author’s identities in relation to building caring communities before next considering what guides the author’s understanding of care and how her enacted care shifted during and after the first year of COVID-19. The chapter concludes with examples of classroom practices for creating and sustaining caring learning environments in mathematics teacher education. © 2023 selection and editorial matter, Melanie Shoffner and Angela W. Webb;individual chapters, the contributors.
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Background: Intensive childhood cancer treatment produces suffering. In addition to physical symptoms, children miss out on life events and experience social isolation. Professionals' attitudes and actions shape children's lives during cancer treatment. Primary palliative care consists of quality of life (QOL)-promoting care enacted by professionals who are not acting within the context of specialty palliative care teams. Despite the rapid growth of specialty pediatric palliative care teams, most children receiving cancer treatment do not receive specialty pediatric palliative care. Yet how professionals conceptualize and enact their primary palliative care roles in the current era remains poorly understood. Objectives: We sought to understand: (1) professionals' role expectations for themselves and others to relieve suffering and promote joy, meaning, and accomplishment for children in their care;(2) perceived barriers and facilitators to promoting QOL for children in their care;(3) how team dynamics promote or impede QOL for children in their care. Design/Method: We utilized theoretical sampling and conducted semi-structured interviews of professionals working in a pediatric oncology center. Professionals were invited to participate via email and interviews were conducted face-to-face, by telephone, or via secure video conference by non-clinical members of the research team. Through constant comparative analysis, early interviews informed subsequent data collection. Thematic analysis incorporated the following data sources: audio-recordings, interview transcripts, debriefing discussions with interviewers, and memos. Results: Fifteen interviews were conducted April-September 2021 with oncologists (MDs/NPs), nurses, social workers, child life specialists, chaplains, and psychologists. Communication to share information and build on each other's ideas emerged as a central theme. Issues of presence and parity emerged: physical distancing and restrictive visitation policies due to the COVID-19 pandemic were impediments to promoting QOL. Some respondents perceived less patient isolation and exclusion when normal life seemed universally out of reach in the early months of the pandemic. Changes in working patterns induced by COVID-19 were seen as threats to communication, and by extension, to patients' QOL. Within-professions team membership was strengthened by weathering changes wrought be COVID-19. By contrast, efforts to ensure communication across professions were perceived to be asymmetric, leaving some clinicians feeling devalued and at times heightening tensions between professions. Conclusion: Communication, presence, and parity emerged as preliminary facilitators and barriers to working interprofessionally to promote QOL, particularly in the context of the COVID-19 pandemic. Understanding professionals' attitudes and actions around QOL for children with cancer will inform future interventions to enhance interprofessional primary palliative care.
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Purpose of Study Parents of infants admitted to NICUs often experience significant psychosocial stress and have higher risks for depression, anxiety, and disturbed parent-child bonding. Analyses of parental stress often use either a predominantly biomedical or qualitative approach. The current study integrates these domains, using parental demographic and psychosocial assessments, stress-related salivary biomarkers, measures of illness severity, and open-ended question interviews for a more complete assessment of parental NICU experience and stressors. We detail a novel use of theme-coded qualitative analysis of open-ended interviews to explore parents' perceptions of the NICU experience, sources of stress and well-being, and associations with stress/depression measurements. Methods Used Inclusion criteria: parents of infants admitted to a Level IV NICU born £34 weeks gestation or having a predicted length of stay >2 weeks. At weeks 1 and 6 and before discharge, we collected parental salivary cortisol and α-amylase (AM, PM) and the Edinburgh Postpartum Depression Scale, Perceived Stress Scale, and Social Provisions Scale. Infant data and the Neonatal Acute Physiology Perinatal Extension-II and Neonatal therapeutic Intervention Scoring System were recorded. Parents individually participated in recorded openended question interviews. Interviews were transcribed and annotated using qualitative content analysis based on a grounded theory approach. Investigators affixed codes (with inter-rater checks) to transcripts using an iterative approach, highlighting common phrasing and themes. Transcripts were entered into NVivo qualitative data analysis software to sort and label categories and themes. Summary of Results Results are available for 15 interviews. We identified patterns, themes, subgroup differences, and common phrasing to develop an interactive model of the complex interplay among social supports, NICU environment, COVID- 19-related stressors, and parental experience [figure]. The model facilitates evaluating multiple components which influence parental experience and clarifies parental-perceived barriers and facilitators. Voiced resiliency was compared to subjects' stress and depression salivary biomarkers and the validated scales. Conclusions Parent interviews revealed feelings of isolation, fear, and resilience among NICU parents. Textual analysis of open-ended interviews informed construction of a conceptual model describing the NICU experience. Integration of biomedical and qualitative methods more comprehensively reveals experiences of parents and points to strategies for fostering support and resilience.
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Purpose : Routine use of face masks for both patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the COVID-19 pandemic. This study evaluates the impact of physician, ancillary staff, and patient face mask use on rates and outcomes of post-injection endophthalmitis. Methods : In this retrospective comparative cohort study, all eye receiving intravitreal antiVEGF factor injections from 10/1/2019 to 7/31/2020 were included from twelve centers. Cases were divided into a no face mask group if no face masks were worn by the physician or patient during intravitreal injections or a universal face mask group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. The main outcome measures were rate of endophthalmitis, visual acuity, and microbial spectrum. Results : Of 505,968 intravitreal injections administered, 85 of 294,514 (0.0289%;1 in 3,464 injections) cases of endophthalmitis occurred in the no face mask group, and 45 of 211,454 (0.0213%;1 in 4,699 injections) cases occurred in the universal face mask group (odds ratio, 0.74;95%CI, 0.51-1.18;p=0.097;Table 1). In the no face mask group, there were 27 cases (0.0092%;1 in 10,908 injections) of culture-positive endophthalmitis compared to 9 cases (0.004%;1 in 23,494 injections) in the universal face mask group (OR, 0.46;95%CI, 0.22-0.99;p=0.041). Three cases of oral flora-associated endophthalmitis occurred in the no face mask group (0.001%;1 in 98,171 injections) compared to one (0.0005%;1 in 211,454) in the universal face mask group (p=0.645). At endophthalmitis presentation, mean logMAR visual acuity was 2.04 for no face mask group compared to 1.65 for the universal face mask group (p=0.022), although no difference was observed three months after treatment (p=0.764;Table 2). Conclusions : Universal face mask use during intravitreal anti-VEGF injections did not show a statistically significant reduction in presumed endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly that due to oral flora.
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Background: Physical distancing required during the COVID-19 pandemic mandated a sudden need to adaptour usual practices for palliative care patient encounters. Adopting virtual visits (VV) may present challenges inmanaging new technology, establishing rapport, discussing difficult topics, and may diminish patient, familyand clinician satisfaction. Problem statement: Pediatric palliative care clinicians have never performed virtualvisits. We worry that this mode of health care delivery would negatively impact care quality and patient andfamily satisfaction. AIM: By June 1, 2020, we aim to have patient/family and clinician satisfaction score of > 4 ona 5-point Likert scale for >80% of completed VV encounters. Methodology: This project was granted IRB exemption. We used the model for improvement to ask thefollowing questions: What are we trying to accomplish? Shift of inpatient and outpatient workfiow to includeVV. How we will know a change is an improvement? Family and clinician satisfaction surveys. What change can we make that will result in improvement: Several changes were considered and summarized in our Key DriveDiagram (KDD) ( Fig 1 ). Measures: We measured family satisfaction score by asking “How well did this visitmeet your care needs compared to an in-person visit?” with responses on a 5-item Likert scale. We measuredclinician satisfaction with an identically modeled survey. In later PDSA cycles, we gathered qualitative datafrom families and clinicians. The response rates to family and provider satisfaction surveys were used as theprocess measure;balance measures were RVU collected for virtual visits and assessment of staff satisfactionwith VV workfiow. Discussion: We adopted weekly PDSA cycles. Given the need for a rapid shift in caredelivery, interventions to set up technology and train staff on use of technology were made prior to obtainingfamily feedback. Interventions are summarized in KDD ( Figure 1 ). At the end of three PDSA cycles, 33% offamilies and 63% of all providers responded to surveys. 100% of families and 57% of clinicians rated VV asequivalent in quality to in-person visits. Qualitative feedback from clinicians indicated greater emotional tolland increased fatigue with VV. We plan to report data over a six-month period as both inpatient andoutpatient palliative care VV continue. Conclusions/Next Steps: We have demonstrated the ability to rapidlyadapt palliative care visits to a virtual platform while maintaining patient and family satisfaction whencompared to in-person visits. As in-person visits again become possible, we will continue to survey cliniciansand families to better compare satisfaction between the two visit types and develop a sustainable workfiowintegrating effective VV. (Figure Presented).