An investigation of healthcare professionals' perspectives on the tasks of mental health counselors in hospital settings

With the global mental health implications reported by the spread of COVID 19 (Javed et al., 2020) and the amplified mental health illnesses reported by the State of Mental Health in America (Reinert et al., 2021), there is an increased need to address psychological and emotional health along with physical health. Mental Health Counselors (MHCs) can be the next professional body to support the multidisciplinary teams within hospital settings to complement holistic care focusing on physical and emotional well-being. Researchers have demonstrated addressing the psychological needs of patients from their first admissions to the hospital has significant positive implications on their recovery outcomes as well as psychological, social, and relational well-being post-discharge (Zhang et al., 2016;Ng et al., 2007;Schoultz et al., 2015;McCombie et al., 2016;Hatch et al., 2011). Research on the effects of therapeutic intervention has effectively prevented PTSD in the general population when provided in the first month after trauma exposure (Bryant et al., 2008). Therefore, early therapeutic interventions in hospital settings to identify emotional and psychological reactions (Weinert & Meller, 2007) before discharging patients can significantly impact patients' post-discharge mental health. However, since counseling is a new profession entering the medical field, role confusion within multidisciplinary teams appears to impact counselors' effective integration into healthcare as they provide counseling services to hospitalized patients. Therefore, in this study, I address the gap in the literature by exploring the perspectives and expectations of healthcare professionals on what MHCs do in hospital settings. This study was guided by a social constructivist paradigm utilizing an exploratory sequential mixed-methods design, concept mapping (Kane & Trochim, 2007). Healthcare professionals conceptualized MHCs' tasks in hospital settings to facilitate medical and mental health services and enhance patients' well-being in 104 statements grouped in 11 clusters forming three central regions. The three main regions include: "Overarching Roles and Responsibilities of MHCs in the Hospital Setting" (Region I) contained two clusters (i.e., 'Fundamental Roles and Responsibilities in the Hospital Setting', & 'Specific Roles and Responsibilities in Different Hospital Units') of MHCs' tasks, while "MHCs' Specific Roles in the Hospital Setting" (Region II) entailed four clusters (i.e., 'Building Relationship with Patients,' 'Assessing/Evaluating Patients' Mental Health Status', 'Assisting and Supporting patients with Physical, Psychological, and Social Challenges in Relations to their Medical Condition' & 'Educating Patients') and "MHC's Roles and Responsibilities as a Multidisciplinary Team Member" (Region III) hosted five clusters (i.e., 'Advocating for Patients in the Multidisciplinary Team', 'Mediating Communication Between Healthcare Professionals, Patients, and Families', 'Collaborating with Other Multidisciplinary Team Members on Patients' Care', 'Training Other Multidisciplinary Members on General Wellness and Mental Health' & 'Offering Trainings and Emotional Support to Other Multidisciplinary Team Members'). The top three higher-rated clusters as being most important for participants were cluster 7 'advocating for patients in the multidisciplinary team', cluster 5 'assisting and supporting patients with physical, psychological, and social challenges in relation to their medical condition,' and cluster 11 'offering training and emotional support to other multidisciplinary team members'. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Familial responses to death in veterans affairs medical centers: Losing control and holding on

Purpose: To explore how families respond to the death and dying of their loved ones in a hospital setting, archival research was conducted using eight qualitative articles describing next-of-kins' perceptions of end-of-life care in Veterans Affairs Medical Centers (VAMCs). The articles were based on the qualitative arm of the VA Health Services Research and Development (HSR&D) study entitled, "Best Practices for End-of-life Care and Comfort Care Order Sets for our Nation's Veterans" (BEACON). Design: The archival research consisted of an interactive methodological process of data immersion, analysis, and interpretation which resulted in the emergence of two overarching thematic frameworks called "losing control" and "holding on." Findings: "Losing control" is the process that occurs when the patient experiences a cascading sequence of deleterious biological events and situations rendering the caregiver no longer able to direct the timing or setting of the dying trajectory. The notion of "holding on" captures family member's responses to the need to maintain control after relinquishing the patient's care to the institutional setting. During the patient's hospitalization, the dual dynamics of "losing control" and "holding on" unfolded in the spatial, temporal, and life narrative domains. Originality: The findings not only contribute to better overall understanding of family members' responses to death in the pre-COVID-19 hospital setting but also heighten the awareness of the complex spatial, temporal, and narrative issues faced by family members who lost a hospitalized loved one during the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Identification of Drug-Related Problems and Investigation of Related Factors in Patients with COVID-19: An Observational Study

Objective: Clinical prognosis of coronavirus disease-19 (COVID-19) may be severe and unexpected. Patients may quickly progress to respiratory failure, infections, multiple organ dysfunction, and sepsis. The main objective of this study is to investigate the drug-related problems of patients with COVID-19 and related factors. Method: A prospective observational study was conducted on patients with COVID-19 between September 2020 and May 2021. Patients' demographics, comorbid diseases, prescribed medicines and laboratory findings were recorded. Drug-related problems (DRPs) were identified by a clinical pharmacist according to recent guidelines, UpToDate® clinical decision support system and evidence-based medicine. Results: The median age of 107 patients was 64 and 50.46% of them were male. The median number of comorbidities was 3 (2-4) per patient. The majority of the patients had at least one comorbidity (88.79%) other than COVID-19 and the most frequent comorbidities were hypertension, diabetes mellitus and coronary artery disease. The total number of DRPs was recorded as 201 and at least one DRP was seen in 75 out of 107 patients. The median number of DRPs was 2 (0-8). In multivariate model, number of comorbidities (odss ratio (OR)=1.952;95% confidence interval (CI)=1.07-3.54, p<0.05, number of medications (OR=1.344;95% CI=1.12-1.61, p<0.001), and serum potassium levels (OR=5.252;95% CI=1.57-17.56, p<0.001) were the factors related with DRP. Conclusion: This study highlights the DRPs and related factors in patients with COVID 19 in hospital settings. Considering unknown features of the infection and multiple medication use, DRPs are likely to occur. It would be beneficial to consider the related factors in order to reduce the number of the DRPs. (English) [ FROM AUTHOR]

Observing the Patient Experience: Inside the Doctor's Office in a Pandemic

Focusing on the clinical doctor-patient consultation setting, this paper outlines the methodology and presents the results from a series of observational studies between doctor and patients undertaken in September and October 2020 within a public hospital setting during the COVID-19 pandemic. Using a design thinking methodology, the authors gained empathy and insights into the challenges experienced from both doctor and patient perspectives, during this period. This paper also discusses emergent themes from this qualitative investigation and examines the role of empathy in helping define the extent of the challenges that arose. As the first phase in a planned set of research phases, this work is informing and helping to shape subsequent ideation and design of multimedia related interventions to see if these human-centred design interventions can assist in improving the complex doctor-patient communication process. © 2021 IEEE.

Automated risk assessment of covid-19 patients at diagnosis using electronic healthcare records

COVID-19 causes significant morbidity and mortality and early intervention is key to minimizing deadly complications. Available treatments, such as monoclonal antibody therapy, may limit complications, but only when given soon after symptom onset. Unfortunately, these treatments are often expensive, in limited supply, require administration within a hospital setting, and should be given before the onset of severe symptoms. These challenges have created the need for early triage of patients likely to develop life-threatening complications. To meet this need, we developed an automated patient risk assessment model using a real-world hospital system dataset with over 17,000 COVID-positive patients. Specifically, for each COVID-positive patient, we generate a separate risk score for each of four clinical outcomes including death within 30 days, mechanical ventilator use, ICU admission, and any catastrophic event (a superset of dangerous outcomes). We hypothesized that a deep learning binary classification approach can generate these four risk scores from electronic healthcare records data at the time of diagnosis. Our approach achieves significant performance on the four tasks with an area under receiver operating curve (AUROC) for any catastrophic outcome, death within 30 days, ventilator use, and ICU admission of 86.7%, 88.2%, 86.2%, and 87.8%, respectively. In addition, we visualize the sensitivity and specificity of these risk scores to allow clinicians to customize their usage within different clinical outcomes. We believe this work fulfills a clear clinical need for early detection of objective clinical outcomes and can be used for early screening for treatment intervention. © 2021 IEEE

Burden of COVID-19 on workers in hospital settings: The French situation during the first wave of the pandemic.

We launched a survey in April 2020 to assess the number and proportion of hospital workers infected during the first wave of the COVID-19 pandemic in France, and to assess the attributable mortality. All French hospital settings (HS) were invited to declare new cases and attributable deaths by occupation category each week. Between March 1 and June 28, 2020, participating HS accounted for 69.5% of the total number of HS workers in France, and declared 31,088 infected workers; 16 died from the infection. We estimated that 3.43% (95% CI: 3.42-3.45) of French workers in HS, and 3.97% (95% CI: 3.95-3.99) of healthcare workers were infected during the first wave. Workers in regions with a cumulative rate of hospitalized COVID-19 patients equal or above the national rate, HS other than tertiary hospitals, or occupations with frequent patient contacts were particularly impacted. Targeted prevention campaigns should be elaborated.