Improving Outcomes in Oesophagectomy Patients

Introduction: Aberdeen Royal Infirmary is a low volume centre carrying out approximately 13 oesophagectomies per annum. Due to minimal exposure to post-operative oesophagectomy patients, staff had low perceived confidence in their management within the Intensive Care Unit (ICU). After an initial pause due to the COVID-19 pandemic, oesophagectomy service provision restarted in June 2020. Prior to this project, no standardised care pathway existed for post-operative oesophagectomy patients. A protocol driven management pathway was implemented within the ICU setting in October 2020. Objective(s): 1. Standardise the first 5 days of post-operative care for oesophagectamies 2. Improve 30 day mortality rate 3. Reduce opiate use on step down to High Dependency Unit (HDU) 4. Improve ICU Medical and Nursing staff perceived confidence in the management of oesophagectomy patients. Method(s): A multi-disciplinary approach was taken, with input from ICU, Surgical, Anaesthetic, Physiotherapy, Nursing, Pain and HDU teams. Standards of care for post-operative oesophagectomy patients were identified and a protocol was subsequently produced for use within ICU with reference to current Enhanced Recovery After Surgery (ERAS) guidelines.1 The protocol covered the first 5 days of post-operative care. It identified tasks to be completed each day and highlighted which staff group was responsible for performing each task. Additionally, an information sheet was distributed to Medical and Nursing ICU staff to educate them on oesophagectomy patients and recognition of potential complications that arise when caring for this patient group. Data on 30 day mortality and opiate use at step down to HDU was collected from electronic notes. This was collected retrospectively prior to implementation of the protocol from January 2019 - July 2020 and prospectively following its implementation, from October 2020 - December 2021. ICU staff perceived confidence in managing post-operative oesophagectomy patients was measured using a combined quiz and survey. It was completed by staff prior to introduction of the protocol. Following implementation of the protocol and distribution of the information sheet, the quiz and survey was repeated to evaluate improvement in staff confidence. Result(s): A total of 38 oesophagectomy cases were identified. 21 cases were reviewed prior to implementation of the protocol, with 1 mortality at 30 days. 17 cases were reviewed following implementation of the protocol, with 0 mortalities at 30 days. Qualitative scoring showed a 20% increase in staff confidence to manage this patient group. Review of drug prescription charts revealed a reduction in dose of modified release opiates at step down to HDU. Conclusion(s): Oesophagectomy is major surgery and causes significant staff anxiety in low volume centres. This protocol has successfully standardised care for this patient group and allowed continuation of this essential service provision during the COVID-19 pandemic. This protocol improved 30 day mortality, reduced opiate use at step down to HDU and improved ICU staff perceived confidence in caring for post-operative oseophagectomy patients.

Mental distress among healthcare workers due to COVID-19 during second wave in a tertiary care center of South Karnataka: A cross-sectional study

Background: Healthcare workers (HCWs) in India are facing physical and psychological pressure. The pandemic has significant psychological impacts. Hence, we wanted to assess the mental stress and social stress among HCWs during the second wave of COVID-19. Aim and Objectives: Assessment of the mental distress among HCWs of tertiary care level institution during second wave of COVID-19 with the following objectives: (1) To know the sociodemographic characteristics of the HCWs of tertiary care center and (2) to assess the psychological stress among healthcare workers of a tertiary health center. Material(s) and Method(s): It is a cross-sectional and observational study conducted in hospital setting, in a tertiary care setting. Data were collected from 196 HCWs of the institute. Institutional ethical clearance was taken before the study. Structured questionnaire included sociodemographic variables, work-related variables, and variables to assess social stress. We used hospital anxiety and depression scoring questionnaire to assess anxiety and depression. Data were collected through personal interviews and online through Google forms after taking informed consent. Descriptive statistics and Chi-square tests are used analyzed using Statistical Package for the Social Sciences Version 21 for Statistical analysis. Result(s): A total of 196 HCWs, 121 doctors, 74 nursing staff, and one ward staff participated in the study. Nursing staff were at higher risk for anxiety and depression, that is, 29% and 25% than others. Females were slightly more anxious (29%) and depressed (17%) than males. HCWs who are Muslim by religion were at more mental distress. Media exposure of more than 3 h had increased risk of mental distress. HCWs with other frontline COVID warrior as a partner were both anxious (40%) and depressed (20%). Anxiety (35%) was more among those who's family members got COVID positive. About 25% of them faced social stigma, 55% of them faced issue of isolation with in the community, and 14% of them faced acts of violence which is unacceptable. Conclusion(s): Although its second wave HCWs are still having psychological distress which needs to be addressed. Social stress that they are facing is significant and is associated with higher anxiety and depression, which has to be taken seriously.Copyright © 2023, Mr Bhawani Singh. All rights reserved.

Upskilling haematological services for WGS and germline assessments through a regional skin biopsy training programme

NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.

Burnout and Wellbeing during the Second Covid-19 Wave: Are There Differences between Medical Specialties?

Introduction: Burnout is common amongst clinical staff. Critical Care is widely accepted to have amongst the highest rates, with an incidence of >38%.1 The Covid-19 pandemic placed unprecedented pressures on staff, making them vulnerable to burnout.2 Although stressors were similar across medical teams, we suspected there were differences in burnout between medical specialties. Objective(s): This study aimed to examine burnout amongst the hospital MDT, focussing on three higher care clinical areas: Coronary Care (CCU), Respiratory (RSU) and Critical Care (ICU) and identify recurring positive and negative experiences. Method(s): Between March and April 2021 staff were invited to complete a two-part survey. Part one investigated demographic data and free text answers on feelings towards Covid-19. Part two questioned recipients on the 22 questions of the MBI -HSS (Maslach Burnout Index- Human Services Survey).3 This survey assesses burn-out in three domains: Emotional Exhaustion (EE), Depersonalisation (DP), and lack of Personal Accomplishment (PA). MBI-HSS results were analysed and a previously used 'high-risk' cut-off was used to calculate percentages per domain and overall. Free text analysis was conducted by two researchers to identify common themes, protective factors and negative factors which may increase burnout. Result(s): 148 staff members responded to the survey: 53% of respondents met the criteria for burnout in at least one domain. 58% of ICU staff, 42% of RSU staff and 44% of CCU staff were burnt out in one domain or more. ICU had the highest percentage of staff at high risk of EE and lack of PA. RSU had the highest percentage of staff scoring highly for DP. Free text analysis demonstrated some positive experiences from the Covid-19 pandemic: teamwork, communication, resilience, and opportunities to learn new skills were highlighted by staff across all areas. All areas found staffing and workload a negative factor. In ICU, workspace organisation and long shifts in PPE were key stressors which made communication and taking breaks safely difficult. Managing stress and uncertainty were highlighted by the ICU teams. In RSU, a significant proportion of staff found the lack of established treatments and poor outcomes difficult to manage, potentially highlighting the differences in Covid-19 management compared with ICU. As nursing staff work with higher ratios in RSU, some found managing patients' needs difficult: "Not having enough time to care for patients' basic needs . . . patients in side-rooms were left feeling isolated and scared". In CCU, there was a shift towards fear of catching the virus, PPE provision and poor infection control guidance, possibly arising from lower exposure to Covid-19: "It felt like the trust didn't give a s**t about their staff with regard to PPE and vaccinations." Conclusion(s): All clinical areas highlighted increased teamwork as a positive outcome of the Covid-19 pandemic, and good relationships have been built, a known protective factor against burnout. Many negative factors have impacted the rate of burnout, including high workload, staffing issues, redeployment and managing death and uncertainty. We hope to resurvey the same areas to assess wellbeing one year on, and address key factors to improve wellbeing.

Helping Hands

Introduction: We work in a large, tertiary Teaching Hospital Critical Care unit. As such we have a sizeable and diverse workforce from multiple professional backgrounds. We noted both anecdotally, and from the formal process of Exit Interviews that the changes imposed by the Covid-19 pandemic were impacting on team relationships. Physical barriers enforced by social distancing, as well as the burden of increased patient numbers and changes to job roles had driven apart nursing and medical teams. Critical care appeals to many staff because of the MDT and the chance to work with highly qualified, ambitious colleagues with varying skill sets. Nurturing this positive working relationship between different teams requires a commitment from all to share the burden of increased pressures wherever possible. Objective(s): The aims for this project are to identify specific areas within the working relationship between the medical team and the nursing team that can be improved. More than this, we want to open wider conversation about how teams can work more collaboratively for the benefit of the working environment, staff mental health and ultimately the patient. Method(s): We created an e-survey with input from the critical care matrons and psychologists before distributing amongst nursing staff. Questions focused on communication, practical support and the general working relationship. Each section contained MCQ's and white space questions to allow us to collect both quantitative and qualitative data. Following collection of responses we identified common themes that could be addressed and created an eye-catching poster with specific suggestions for the medical team. Result(s): Communication: Common themes were more presence on the unit with more regular walk-rounds and that STAT medications are often prescribed but not communicated to the nurse at the bedside and are therefore delayed. Practical support: Common suggestions were helping with repositioning patients and relieving breaks. Others included, pulling blood gases, printing off blood request forms and working in pairs for lines so that the nurse doesn't have to be engaged. Working relationship: suggestions mainly focused around introducing ourselves and level of training as well as social integration of the two teams. A few said that improving the communication and assisting with tasks would feed into improving the relationship. A few also said that the survey itself was a good start. Discussion(s): The survey generated many useful suggestions as well as demonstrating an open and receptive attitude. Responses were used to create a poster that gives clear and practical advice to the medical team. This method is easily reproducible and we believe that we have already seen positive changes that have been widely well received. We plan also to send a follow up survey once changes have become ingrained into the culture of the workforce. Acknowledgements Matthew Powell Jane Atkins Nathan Shearman Helen Horton.

Findings from a regional survey of critical care nursing staff focusing on retention and factors that influence wellbeing

Introduction: The Covid-19 pandemic has put unprecedented pressures on the National Health Service (NHS) with adult critical care being one of the key specialties that has been affected. NHS staff have been working relentlessly throughout the pandemic and adult critical care teams were at the forefront of that. Thames Valley & Wessex and Kent, Surrey & Sussex Adult Critical Care Operational Delivery Networks had heard from our unit matrons and clinical leads around their concerns for the wellbeing of their staff. We had also heard of the number of critical care nurses who have either left their roles or are planning to leave. Objective(s): As Networks our main objective was to gain a better understanding on some of the factors that locally might be influencing the wellbeing of our staff and any intentions to leave, and to see if this aligns with the published research. The Networks also planned to develop a series of recommendations based on the results from the data. Method(s): A survey was developed as a method of gathering both qualitative and quantitative self-reported data from nurses currently working on adult critical care units. All survey data collected was anonymous. This was circulated, via the unit Matrons and Nurse Leads, to nursing staff within their critical care department. Result(s): The survey produced a large amount of data, with 427 responses (approximately 15% of nurses) from 33 units across 24 questions. The data found that 51% of nurses report that Covid-19 has made them less likely to stay in their current roles. 7 in 10 reported high levels of stress because of their work with the most common cause of stress being "staff shortages" and "being asked to work on other wards". The results also showed within the next 3 years, 50% of nurses are planning on leaving their current roles in their adult critical care unit with 47% of nurses feeling they do not get adequate salary. On a positive note, 87% of nurses feel they are having a positive impact on patient care with 74% reporting that they would recommend adult critical care nursing to other nurses. Following this analysis of the data, the networks developed six recommendations that looked at repeating and sharing the report, wellbeing, salary, contributing factors for stress and dedicated time for education and development. Alongside a formal report, individual units with more than five participants were provided with an infographic, personalised to them with their results. Conclusion(s): The data showed points of significant interest for the networks and units and has generated interest from the wider critical care community, with the desire to replicate this survey Nationally. It is clear that despite 87% of nurses feeling they have a positive impact on patient care and 74% recommending critical care nursing to others, 50% of nurses are looking to leave. We need to understand this aspect in more detail along with the two key reasons for stress, moving to the wards and staff shortages.

Judicious use of the Critical Care Outreach Team: A QIP to reduce the inappropriate use of Early Warning Scores through targeted communication

Introduction: Early Warning Scores (EWS) use physiological parameters to create an aggregate score alerting medical teams to patient deterioration. Although vital tools for triggering referrals to critical care services in appropriate patients, the score does not take account of patients with persistently altered physiology or patients who are not deemed suitable for escalation to critical care. In these instances, EWS can result in the over-monitoring of patients and inappropriate contact of already strained critical care outreach services.1-2 Guidelines state that in such circumstances routine recording of EWS may be stopped.1 The COVID-19 pandemic has placed unprecedented demands on already overstretched resources in the critical care services,3 in particular on the Critical Care Outreach Team (CCOT). This makes their judicious use, and this QIP, ever more pertinent. Objective(s): In our trust, it was found that despite documented decisions not to escalate patients to critical care, these patients were still being monitored according to EWS, resulting in the inappropriate call out of the CCOT. We introduced measures to improve the proportion of inpatients with treatment limitations in place that had these limitations documented on their EWS charts, with the overall aim of reducing the number of inappropriate call-out of the CCOT. Method(s): We performed two snapshot audits on acute medical (control) and general medical wards (intervention) in a large district general hospital between the years 2018-2019. We obtained the percentage of patients with treatment limitations in place who had this documented on their EWS charts before and after improvement measures. Firstly, a paper prompt on the EWS chart was used in both control and intervention wards. Secondly, targeted communication interventions to general medical wards only. Targeted communication was not repeated after the second audit. A third snapshot audit was completed a year after improvement measures (2020) to identify whether improvements were sustained. Result(s): There was no significant difference in EWS amendment in the acute medical ward, where only a paper prompt was used. However, where targeted communication was used (general medical ward), there was a statistically significant improvement in review and amendment of EWS scores between the first and second audit in the intervention ward (37.2% vs 59.1%, p=0.017). However, this improvement was not sustained when the audit was repeated a year later. Conclusion(s): The proportion of inpatients with treatment escalation limitation decisions in place that have EWS amended can be improved by targeted communication, but paper prompts alone are not sufficient. However, these improvements are not sustained without repeated communication. The importance of appropriate amendment of EWS has two key benefits. Firstly, it reduces inappropriate and futile monitoring of end-of-life patients, allowing them to have a more dignified death. Secondly, instead of performing repeated observations (nursing staff) or patient reviews (CCOT) that will not alter management, nursing staff can better utilise their time in providing palliative support where appropriate (particularly considering current visiting restrictions), and the ever- stretched CCOT can be used more judiciously.

Factors affecting the resilience of hospital medical staff during the COVID-19 pandemic

Background. During the coronavirus disease 2019 (COVID-19) pandemic, most hospitals have faced a heavy load of pa-tients. In this situation, it is very important to consider the resilience and endurance of medical staff, as well as to identify and investi-gate the relevant factors which can increase their resilience.Objectives. The aim of this study was to identify the factors affecting the resilience of hospital medical staff during the COVID-19 pan-demic.Material and methods. The present study is a qualitative study using a semi-structured interview. Participants included doctors, nurs-es, clinicians and managers working in tertiary referral hospitals during the COVID-19 pandemic. Interviews were conducted as needed until data saturation was reached using the purposive sampling method. A total number of 20 people, including 6 physicians, 2 hospital managers, 7 nurses, 1 radiologist, 3 laboratory technicians and 1 clinical psychologist, were interviewed in 7 educational hospitals of the Kerman Province.Results. After data analysis and coding, 127 initial codes were identified. By reviewing the codes, 127 initial codes were merged by the research team, and 23 codes in 6 main categories, including Personal Factors (7 codes), Family-Related Factors (2 codes), Community -Related Factors (2 codes), Virus-Related Factors (2 codes), Organisational Factors (7 codes) and Economical Factors (3 codes) were extracted.Conclusions. Paying attention to the identified factors on the maintenance of medical human resources in the form of the "Surge Capacity Programme" can increase the resilience of medical staff. Such measures pave the way for a better response to other threats similar to the COVID-19 pandemic.

Nursing staff and the development of nursing services during the COVID-19 pandemic

The availability of sufficient, efficient nursing staff and the development of nursing services are crucial in the provision of high-quality care to healthcare services users. Provision of adequate nursing staff is of vital importance as it affects patient outcomes and safety. Limited nursing staff and a low ratio of nurses per patient are associated with an increased risk of patient death. Understaffing affects the staff members themselves, the patients and the health-care organizations, and, internationally, measures focusing on setting a safe nurse-to-patient ratio have been developed. Factors that increase the need for nursing staff are the increasingly demanding nursing care of patients in hospitals following advances in technology, the ageing of the population, and the increasing numbers of patients and their comorbidities. The COVID-19 pandemic constitutes a new significant determinant of increase in the need for qualified nursing staff. The COVID-19 pandemic has caused major organizational issues in healthcare systems world-wide, even in the developed countries with their reasonably well-organized primary and secondary healthcare systems. Staffing plans during the COVID-19 pandemic should focus on the care needs of patients with COVID-19, and should include the deployment and allocation of skilled clinical staff. Healthcare systems internationally need to take immediate and effective action regarding the availability of qualified nursing staff, to be better prepared for future public health threats.

An assessment of organizational well-being, organizational health, and work-related stress: A cross-sectional study of nurses involved with COVID-19 interventions.

BACKGROUND: Nurses have been affected by stress, developing many related consequences during the health emergency caused by the SARS-CoV-2 (COVID-19) pandemic. It is essential for healthcare organizations to protect their human resources because there is a strong correlation between the health status of healthcare workers and the quality of care provided. OBJECTIVE: The aim of the study was to measure the perception of the organizational health level of the workplace among COVID-19 nurses (i.e. nurses who directly dealt with COVID-19 countermeasures) as an influence on work quality and work-related stress. METHODS: A cross-sectional study was carried out by administering the Nursing Questionnaire on Organizational Health (QISO) to nurses in contact with COVID-19 patients. The search period ranged between August and September 2021 with nurses who work and/or worked in Lazio. RESULTS: 123 questionnaires were collected. The scores with a value below the recommended level (2,6) are: "Comfort of the working environment" (mean = 2.57; SD = 0.66); "Valorization of skills" (mean = 2.40; SD = 0.62); "Openness to innovation" (mean = 2.46; SD = 0.77); "Satisfaction with top management" (mean = 2.48; SD = 0.81); and the inverse scale "Fatigue" (mean = 2.94; SD = 0.55). CONCLUSION: Management of healthcare organizations should define action strategies to promote and increase organizational well-being and reduce work-related stress risk factors. Some action strategies that could be used include improving the elements of the work environment to make it more comfortable for workers; strengthening and improving communication; improving the relationship between nurses and senior management; and establishing a team of experts for psychological assistance.

The Relationship of Nursing Teamwork and Job Satisfaction in Hospitals.

Introduction: Teamwork is identified as a key contributor to patient safety and good teamwork is recognized as one of the presumptions of healthy work environment in nursing. The importance of job satisfaction in nursing has repeatedly been confirmed, but only recently has the association of job satisfaction and nursing teamwork been identified. Objective: To identify the level of nursing teamwork in hospitals in Iceland and its relationship with job satisfaction. Methods: This was a quantitative descriptive cross-sectional study. Data were collected with the Nursing Teamwork Survey administered to nursing staff in medical, surgical, and intensive care units in hospitals in Iceland. This study is based on data from 567 participants. Results: A logistic regression analysis indicated that work experience on current unit and perceived staffing adequacy contributes to job satisfaction and when controlling for unit type, role, experience on current unit and staffing adequacy, those reporting better teamwork are significantly more likely to be satisfied with their current position. With an additional unit for overall nursing teamwork, participants are almost five times likelier to be satisfied with their current position. Conclusion: Study findings show that there is a significant relationship between nursing teamwork and job satisfaction. The findings of this study confirm the importance of adequate staffing and good teamwork for nurses' job satisfaction. Staffing however, will remain the most challenging part of the equation as lack of nursing staff is foreseen globally in the coming decades turning the spotlight to teamwork. All stakeholders, including clinical nurse leaders, administrators, and instructors, need to emphasize on strengthening nursing teamwork. Good teamwork with increased job satisfaction may prevent turnover and shortage of nurses, an issue expected to grow during and following the COVID-19 pandemic. Facilitating good teamwork should be one of the priorities of every nurse leader.

Lifelong learning in community healthcare: Testing competence after learning activities in a blended learning space.

AIMS AND OBJECTIVES: This study reports from a municipality in Norway that implemented a competence enhancement programme for all its institutional nursing staff during the COVID-19 pandemic to fill identified competence gaps. BACKGROUND: Many Norwegian municipalities are experiencing a demand for expanded community healthcare services due to an increase in elderly patients and patients with extensive and complex needs. At the same time, most municipalities are striving to recruit and keep competent health personnel. New ways of organising and increasing the competence of the workforce may help ensure that the healthcare delivered corresponds to patients' changing needs. DESIGN AND METHODS: Nursing staff were encouraged to complete targeted competence enhancing activities with the aim of enhancing their competence in identified areas. The learning activities were blended and consisted of e-learning courses, lectures, supervision, vocational training and meetings with a superior. Competence was measured before and after the competence enhancing activities (n = 96). The STROBE checklist was applied. RESULTS: The results provide insight into the competence development of registered nurses and assistant nurses in institutional community health services. They show that the implementation of a workplace-based blended learning programme improved competence significantly, especially for assistant nurses. CONCLUSIONS: Offering workplace-based competence enhancing activities seems to be a sustainable way of facilitating lifelong learning among nursing staff. Facilitation of learning activities in a blended learning space may enhance accessibility and increase the potential for participation. A combination of reorganisation of roles and simultaneous competence enhancing activities can ensure that both managers and nursing staff prioritise filling competence gaps.

Restore C19 national practice survey: The position of UK delayed breast reconstruction services

Introduction: The offer of immediate breast reconstruction (IBR) was temporarily withdrawn for women requiring mastectomy during the COVID-19 pandemic to allow prioritisation of emergency care. Many women are now awaiting delayed breast reconstruction (DBR) surgery. This survey aimed to explore the current provision of DBR in the UK and how this had been impacted by COVID-19. Method(s): An online survey was distributed to UK breast units via the ABS/Mammary Fold newsletters and social media feeds between 10/2021 and 04/2022. Simple descriptive statistics were used to summarise the results. Result(s): Of the 42 UK breast units that completed the survey, most units reported that COVID-19 had led to increased waits for DBR. Before the pandemic over three quarters of units reported waits of less than 1 year (29% <6 months, 45% 6-12 months) whereas currently waits of 12-24 months are common with a third of units reporting waits of 24-36 months. A small number of units reported waits of >3 years or that DBR had not yet restarted (14%). Key identified challenges for DBR services included limited availability of theatre time and consultant and/or theatre/nursing staff, and a lack of in-patient capacity for post-operative recovery. Conclusion(s): Waiting times for DBR have been negatively impacted by COVID-19. As reconstruction is an integral part of women's breast cancer treatment, there is an urgent need to develop a recovery plan to address this issue, support patients and allow women to access reconstructive surgery in a timely manner.Copyright © 2023

Implementation of Modified Shutdown Protocol during COVID 19 Pandemic for Risk Mitigation at Manufacturing Sites

A well-planned pandemic protocol and define emerging risk preparedness checklist during pandemic help to ensure the shutdown is conducted safely and well efficiently so that manufacturing sites can be returned to normal operation as per defined timeline. As such we have implemented shutdown protocol to mitigate Occupational Health Hazards risk. The major challenge to manage the large workforce and additionally prevention of COVID 19 spread among workforces. COVID 19 risk management is a proactive preparedness which was included in revised shutdown protocol and implanted across all sites. This strategy would be great help to mitigate the risk and successfully completion of shutdown at respective manufacturing location. Methods & Guidelines: Methods: To managed shutdown risk management during a pandemic, the following methodology was considered during planning. * The first step was virtual meeting with the plant team to understand the shutdown job, list of hazardous activities, the number of the workforce, days of shutdown, etc. * The second step was to plan a Sustainable COVID 19 management program including testing and create a Bio bubble for all the employees and business partners involved in the shutdown. * The third step was to determine potential exposure to chemical, physical and biological agents, including medical OH requirements, the review of existing control measures. * The fourth step was to verification, planning, and execution of all requirements in the prescribed checklist and plant round to identify any gaps followed by a plant shutdown meeting. Result(s): Pandemic Management protocol and defined OH-IH emerging risk preparedness checklist during the pandemic had helped to ensured that Shutdown activities were well managed with proactive control program and robust system. Emerging risk details of one of the manufacturing sites are mentioned below. * Total no of workforce health screening: 25000 Nos Approx. * 24x7 ACLS ambulance with medical officer and nursing staff a defined job location * RT PCR testing before entry and periodic testing * Availability of antidotes & Safety Data Sheet * Basic first-aider training and shift wise availability * Arrangement of accommodation (Bio Bubble) till completion of shutdown Conclusion(s): Modified shutdown protocol with inclusion of COVID 19 management is great tool/approach to mitigate OH hazard including COVID 19 in shutdown and comprehensive monitoring of hazardous activities. The recommended control measures would help to ensure the next turnaround project will be completed with a well-defined checklist having all controls in place.

A study of collective psychological ownership predicted by work environment and mediating role of employee self-efficacy among nursing staff in Oman

The coronavirus pandemic has highlighted the importance of healthcare staff and as a result, there is renewed interest in the management of healthcare staff. One concept which can perform a central role in managing healthcare staff is psychological ownership which is investigated in the current study. The study is based on three literature gaps including foci of psychological ownership, its measurement level, and the process approach of understanding antecedents of psychological ownership. Based on these literature gaps, the objectives of the study were to measure the effects of the work environment on nursing staff collective-psychological ownership and test the mediating role of self-efficacy. Data was collected through a survey from nursing teams from selected private hospitals in the Sultanate of Oman. The result indicates that work environment dimensions have a significant influence on nursing staff collective-psychological ownership. Additionally, we found support for self-efficacy as a mediator in this relationship.

The Image of Healthcare and Healthcare Professionals in the Russian Television Media Agenda in 2019-2021

In this article, we analyze the image of healthcare and health professionals in the Russian television media agenda before and during the COVID-19 pan-demic and determine the frequency and content of health-related news reports on federal and regional evening newscasts for 2019-2021 (by the example of two news programs-Vremya, Channel One, and Vesti. Don, channel Russia-1). Content analysis of news reports was conducted by the Southern Federal University research team (Rostov-on-Don, Russia) in the course of the RFBR-supported research project on social well-being of the medical community in a complex epidemiological situation. Altogether, we have analyzed 1096 evening Vremya newscasts and 784 Vesti. Don newscasts. The sample set included 244 Vremya news items (about 19% of the total number), and 152 Vesti. Don news items (about 17%, respectively). The sampling was random mechanical (with a certain preset interval). The coded categories and units of analysis were registered as cards, one card per each news item. As the categories for analysis, we have selected topic, genre, nature, locality, length, central figure in a news piece, and presence of a challenge or a problem situation. Unit of count-news piece. On both federal and regional television in general, there was a significant increase in the number of news stories on healthcare from 2019 to 2021. In 2020 and 2021, the thematic angle has changed radically towards the news on the pandemic of a 2019 coronavirus disease and vaccination against it. It should be noted that the main heroes of health-related news reports were and still are neither doctors, nor patients, but representatives of the authorities and Rospotrebnadzor;the share of reports about ordinary doctors was decreasing;with the launch of COVID-19 vaccination, the number of news items featuring mid-level health professionals went up;on the other hand, as COVID-19 was spreading, scientists and inventors appeared in health-related news less frequently, especially in regional news;the pandemic has significantly shifted the focus from child patients to adults, and especially to the elderly. Keywords: medicine, healthcare, healthcare worker, doctor, nursing staff, media agenda, media, COVID-19 pandemic, coronavirus, content analysis, television, news story, in-depth interview

"People Need to Know They Matter to Somebody": Interdisciplinary Staff Perceptions of Compassionate Care Visits for Seriously Ill Residents in Nursing Homes During the COVID-19 Pandemic (Sci206)

Outcomes: 1. Articulate the risk, benefits, and outcomes of compassionate care visits during restricted visitation in nursing homes as they pertain to psychological, social, and spiritual domains of care. 2. Explore potential approaches to improve care for people living with serious illness in nursing homes while balancing risk/benefit and equitable access to resources for safety precautions during restricted visitation. During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services announced strict guidance for compassionate care visitation (CCV) in nursing homes (NHs) to protect residents and facilities from outbreak yet permit residents' visitors at the end of life. As a result, seriously ill NH residents, not imminently dying, experienced enormously high rates of social and physical isolation, and staff were left to interpret guidance and manage who could and could not have CCV. This qualitative descriptive study intended to illustrate NH staffs' understanding, use, and perception of risk around CCVs for residents experiencing serious illness during the COVID-19 pandemic. We conducted semi-structured interviews and analyzed data using directed content analysis to assess staffs' definition of CCVs, their facilities' use of CCVs, and staffs' perceptions of the risks and benefits of CCVs. Participants (N=24) included licensed and unlicensed nursing staff (eg, RN, LPN, CNA), social workers, and activities directors;were mostly female (88%) and White (79%);and had more than 3 years of experience working in NHs (79%). Results indicate the definition and use of CCVs simultaneously expanded over time supported by three themes: visits for those imminently dying, visits to support psychosocial needs, and visits to alleviate family concern. Throughout the themes, we found: 1) the benefits of CCVs-improved physical and emotional well-being-outweighed the risk of COVID-19 transmission and 2) the risks of CCVs were perceived as minimal when adequate safety precautions (e.g., screening, personal protective equipment, and vaccination) were available and used as risk mitigation strategies. The findings highlight the need to consider the physical and psychosocial consequences of social isolation of NH residents while expediently assessing the risk/benefit profile of CCVs and viral transmission and ensuring equitable access to safety precautions in NHs during public health crises.Copyright © 2023

Italian Society for Digestive Endoscopy (Sied), Italian Association of Healthcare Technical Operators (Anote) and Accreditation Assessment: Evaluation of Management and Organizational Efficacy with a Novel Remote Accreditation Method in 15 Centres

Background and aim: During the pandemic phase, many of the Italian centers of endoscopy reduced their activities due to the limitation of the procedures and redistribution of the personnel. Despite these upheavals, the SIED-ANOTE accreditation program continued its activity thanks to the use of Information and Communication Technologies with a remote accreditation program. The present work evaluated whether during the pandemic phase the Endoscopy Units already accredited, maintained the SIED quality standards in terms of organization and management. Material(s) and Method(s): SIED-ANOTE accreditation lasts two years, at the end of which an on site reaccreditation assessment is needed. During Covid-19 pandemic reaccreditation visits, before conducted in person, were held remotely. The fields evaluated in the present work were those areas included in section 7 of SIED-ANOTE accreditation manual and specifically: the centers documentation system, the coherence of the mission and the vision, the methods used to achieve the goals, the methods for assessing the competence of the doctors, leadership, and management of human resources. Result(s): From March 2020 up to now, we remotely reaccredited 15 centers (8 at second reaccreditation visit;7 at first reaccreditation visit). Eight of these centers are in North, six in the Center, and one in the South of Italy. During remote reaccreditation visit a total of 52 quality indicator (median value: 3.0;95% CI: 1.74-5.19) were not satisfied at evaluation versus 89 (median value: 6.0;95% CI: 3.69-10.0) during on site visit (p=0.49). The main unsatisfied issues concerned the section of reprocessing (20 time), in particular the performance of microbiological tests and endoscopic unit staff number (7 times), especially shortage of nursing staff. During pandemic period, we measured a tripling of dissatisfaction with that requirement. Other chapters with not satisfied quality indicators were: compilation of the nursing charts (7 times), periodic assessments of medical and nursing skills (7 times), and compilation of the endoscopy report (3 times), assessment of expected targets (2 times). Conclusion(s): Thanks to the use of Information and Communication Technologies, the SIED-ANOTE accreditation program continues via remote route. The periodic re-accreditation system shows a constant performance's improvement of the Endoscopic Unit, even in such an overwhelming period. Redistribution of the personnel seems not yet been resolved after acute Covid-19 pandemic phases.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.