Remote care for chronic pain: A qualitative evaluation with managers, practitioners, and patients

The Covid-19 pandemic obliged many healthcare providers to transition rapidly to a remote-only model of care. Concerns have been expressed about patient access to remote services, their appropriateness for sensitive consultations and physical examinations. Pre-pandemic research into telemedicine showed evidence of its effectiveness, but patient, staff and service user perspectives on remote care approaches remain unclear. This study explored the experiences and perceptions of care among patients, practitioners and managers in a single United Kingdom chronic pain organisation whose services were delivered remotely (telephone and online) during the pandemic. Nineteen participants (seven patients, seven practitioners, five managers) took part in in-depth qualitative interviews, conducted via telephone or online. Transcripts were analysed thematically. Five service provider and four service user themes were generated. Service provider themes comprised "The change process," "Accessibility and efficiency," "Effective when remote: Contact, support and education," "Concerns about communication, connection and disembodied work," and "Supporting and sustaining the team." Patients' themes comprised "Preferences, expectations and acceptance of remote care," "Convenience and accessibility," "Sense of support" and "Delivery modality matters." The study provides evidence from the qualitative evaluation of a single remote only service of its benefits and limitations as perceived by stakeholders. Findings suggest that service providers could address limitations, and progress to a blended care package, based on for patient need and choice. Further attention could be paid to services delivered by telephone, and to staff communication skills, resources, time management and wellbeing needs.Copyright © Nova Science Publishers, Inc.

It turned into something else: patients' long-term experiences of transitions to or from telepsychotherapy during the COVID-19 pandemic.

Introduction: The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients' long-term experiences of transitions to telepsychotherapy and back to the office. Methods: Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis. Results: (1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives. Discussion: The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.

The Virtual Doctor Is In: The Effect of Telehealth Visits on Patient Experience

COVID-19 has accelerated the adoption of telehealth. With this shift comes a need for empirically based research regarding the effect of telehealth on patient experience. The present study employed an online survey (N = 996) examining whether a patient's perceptions of a telehealth visit predicts (a) the likelihood that they will schedule a future telehealth visit, and (b) their recall of clinical information. Participants viewed a video of a real clinician delivering information on a COVID-19 antibody test, and responded to demographic, socioemotional, and cognitive items. We found that for every 1-point increase in an individual's satisfaction with their interaction with the doctor, they were.73 times more likely to revisit the doctor (p < .01). These results provide insight for researchers and medical professionals regarding patient perceptions of virtual encounters and suggest best practices to consider as we further integrate telehealth. © 2022 IEEE Computer Society. All rights reserved.

Efficacy of Alveolar Type II Epithelial Cell Transplantation for Pulmonary Fibrosis: A Meta-Analysis

It is difficult to maintain social distancing in highly populated areas where people live in proximity. This study aimed to qualitatively explore experiences of COVID-19 recovered patients residing in one such area. We employed semi-structured face-to-face interviews. An interview guide was developed, validated, piloted, and minor changes were made. People living in this area, above 18 years of age, and recovered from COVID-19 were approached for the interviews, 11 of them were recruited to be interviewed, and their verbal informed consent was audio recorded. The interviews were conducted in the Arabic language in a semi-private area of the community center, audio-recorded, transcribed verbatim, and thematically analyzed later. Thematic analysis generated 30 subthemes, which were categorized into seven overarching themes: information about COVID-19;life during COVID-19 illness;spreading of COVID-19;precautionary measures;interventions that helped in recovery;impact of COVID-19 on life;support received during COVID-19 illness. Experiences of people from the hotspot who had recovered from COVID-19 highlighted what life had been like in the hotspot under lockdown, especially with having been afflicted with the infection, factors that facilitated their recovery, and the way their lives were and have been affected due to COVID-19.

Pharmacist and patient experiences of primary care during the COVID-19 pandemic: An interview study.

Introduction: A number of significant changes designed to reduce the spread of COVID-19 were introduced in primary care during the COVID-19 pandemic. In Ireland, these included fundamental legislative and practice changes such as permitting electronic transfer of prescriptions, extending duration of prescription validity, and encouraging virtual consultations. Although such interventions served an important role in preventing the spread of infection, their impact on practice and patient care is not yet clear. The aim of this study was to investigate patient and healthcare professional (pharmacist and general practitioner) experiences to understand the impact of COVID-19 on primary care and medication safety during the first two years of the COVID-19 pandemic in Ireland. Methods: A qualitative study using semi-structured interviews was undertaken between October 2021 and January 2022. Participants included twelve patients, ten community pharmacists, and one general practitioner. Interviews were transcribed verbatim and analysed using thematic analysis. Only patient and pharmacist interviews were included. Findings: Themes from the interviews included: 1) Access to care, 2) Technological changes, 3) Experiences of care, and 4) Patient safety. Particular challenges identified included the difficulty faced by patients when accessing care, impacts on experiences of patient care, and extensive changes to pharmacy practice during the pandemic. Conclusions: This study found that COVID-19 countermeasures considerably impacted patient and pharmacist experiences of primary care in terms of care and medication safety. While many changes were welcomed, others such as virtual consultations were received more cautiously likely due to the rapid and unplanned nature of their introduction. Further research is needed to identify how to optimise these changes to improve pharmacist and patient experience, and to understand the impact on patient safety.

The patient perspective on the preoperative colorectal cancer care pathway and preparedness for surgery and postoperative recovery-a qualitative interview study.

BACKGROUND AND OBJECTIVES: This study aimed to explore colorectal cancer (CRC) patients' perspectives and experiences regarding the preoperative surgical care pathway and their subsequent preparedness for surgery and postoperative recovery. METHODS: CRC patients were recruited using purposive sampling and were interviewed three times (preoperatively, and 6 weeks and 3 months postoperatively) using semistructured telephone interviews. Interviews were audiotaped, transcribed verbatim and analysed independently by two researchers using thematic analysis with open coding. RESULTS: Data saturation was achieved after including 18 patients. Preoperative factors that contributed to a feeling of preparedness for surgery and recovery were patient-centred- and professional healthcare organization, sincere and personal guidance, and thorough information provision. Postoperatively, patients with complications or physical complaints experienced unmet information needs regarding the impact of complications and what to expect from postoperative recovery. CONCLUSIONS: The preoperative period is a vital period to prepare patients for surgery and recovery in which patients most value personalized information, personal guidance and professionalism. According to CRC patients, the feeling of preparedness for surgery and recovery can be improved by continually providing dosed information. This information should provide the patient with patient-tailored perspectives regarding the impact of (potential) complications and what to expect during recovery.

Optimization of Patient Flow and Process for a Primary Care Clinic during the COVID-19 Pandemic

Many patient throughput inefficiencies result from poor communication practices, inadequate understanding of optimizing healthcare systems to maximize efficiency, and longterm complications caused by the COVID-19 pandemic. The challenges precipitated by the pandemic, combined with the need to provide safe, high-quality care to patients, have further exacerbated existing patient flow and throughput issues. The overarching goal of this project is to improve the patient experience in primary care clinics and reduce the stress placed on providers, nurses, and staff. The authors implemented a two-phased approach that combined qualitative observations with quantitative data analysis, developed a robust methodology for understanding the University Physicians of Charlottesville (UPC) Clinic's processes, and produced structured insights for stakeholders. We established what components comprised a typical patient's journey through system intake through qualitative clinic observations: pre-registration, check-in, and rooming. In contrast to the qualitative observations, the quantitative analysis encompassed the complete patient experience, outs coping to include appointment durations and check-out. All quantitative analyses relied on data from the University of Virginia (UVA) Health's electronic medical record (EMR) system, Epic. In addition to the qualitative analyses, the authors utilized Cadence reports and appointment scheduling data to understand patient flow through the UPC Clinic. Primarily, the data are utilized to understand the distributions between the different patient flow milestones of registration, clinic check-in, rooming, and check-out and what factors, if any, were statistically significant. This approach enabled us to model the distribution of patient arrival times, wait times between arrival and rooming, and other relevant bottlenecks in the flow process. © 2022 IEEE.

Airway Management in Covid 19 Patients

BACKGROUND:- Those who work with COVID-19 patients airways are especially vulnerable. We present an empirical bit-by-bit strategy in order to guard in-hospital airway treatment of individual along COVID-19 disease, whether they are suspected or confirmed. The COVID-19 patient's airway care raises the danger of HCW exposure. Challenging extubation takes more time and might even entail many treatments with both the possibility for aerosolization, therefore rigorous attention to personal protective equipment (PPE) regulations is required to keep clinicians safe. Whenever an patient's airway risk evaluation indicates that awake tracheal intubation is the best option, therapies that produce greater secretion aerosolization should have been prevented. For decrease the chances of hypoxemia, optimal preoxygenation with a tight sealed facial mask might well be conducted beforehand to initiation. AMBU Bag during initiation should be avoided unless the patient experiences O2 depletion. Patients must be fully sedated with complete muscular relaxation for such best intubating circumstances. As a first-line technique for airway management, video laryngoscopy be suggested. If urgent invasive airway access is available, we advocate using a surgical approach like scalpelbougie-tube instead of an aerosolizing producing treatment like transtracheal jet ventilation. Invasive mechanical ventilation for individuals with COVID-19 necessitates tracheal intubation. The researchers wanted to characterise immediate intubation procedures, assess success rates & problems, and see if there was any difference in practise and results among high- and low-income nations. The researchers hypothesized that geographical & operational variables influence effective emergency airway care amongst COVID-19 patients. METHODS:- Among March 23, 2020, as well as October 24, 2020, the researchers conducted a prospective interpretive research project that would include 4,476 case of emergencies tracheal intubation done by 1,722 healthcare professionals from 607 institutions throughout 32 nation in patients of suspected or confirmed COVID-19 who required mechanical ventilation. The researchers looked into the links among intubation & operators factors, as well as the key result of first-trail success. CONCLUSIONS:- Incidence of unsuccessful tracheal intubation as well as emergency surgical airway among COVID-19 patients who required emergency airway care were reported, as well as characteristics linked to enhanced efficacy. While treating COVID-19, the chances for tracheal intubation failures must be evaluated. © The Electrochemical Society

The Ocular Surface

This is a study of patients who were diagnosed with COVID-19 between December 30 and February 7, 2020 with a clinical diagnosis of COVID-19, a total of 102 patients (48 males and 47 percent and 54 are female 53 percent) were diagnosed with clinical symptoms, Respiratory therapy and chest computer Tomography (CT) abnormalities. Patient's gestational age is 57.63 [14.90] year on average [SD].A total of 102 patients were recognize, with 72 of them being men (50%) and women (50%) respectively. Only two patients (2.78 percent) were found to have conjunctivitis out of 62 patients with laboratory confirmed COVID-19. SARS-COV2 RT-PCR detected ocular discharges in only one of two patients, SARS-COV-2 fragments. Covid-19 infected about 80,000 people in just three months, according to estimates with the help of 300 medical personal. It attacks the respiratory tract first and foremost, although it also affects extra-pulmonary locations, the gastrointestinal tract, as well as other organs. Fever, tiredness, and cough are the early symptoms of SARS-COV-2 infection,. Which rapidly develops into pneumonia. A large number of patients experience symptoms such as headaches, diarrhea, nausea, and vomiting at the start of their disease, and some patients also experience nausea and vomiting some patients occur with asymptomatic infection. Despite the fact that SARS-COV2 infection via the ocular surface is rare was shown to be astonishingly low in this investigation SARS-COV2 infection transmitted through the eyes as a nosocomial illness following occupation exposure is a viable route. the reduced positive rate of SARS-COV-2 conjunctival swab samples could be due to an ineffective diagnosis technique and a sampling time lag. © The Electrochemical Society

Patient experiences of an intensive care Liaison Nurse support service.

OBJECTIVES: To illuminate patients' experiences of being a part of an liaison nurse support service focused on supporting recently transferred intensive care unit patients. RESEARCH METHODOLOGY/DESIGN: A qualitative inductive descriptive design including in-depth interviews was chosen. SETTING: A project including an liaison nurse support service-intervention was undertaken during a 16-week period at a University hospital in Sweden. The liaison nurse support service was available Monday-Friday 10 am - 6 pm and nurses visited the patient 1-4 times after transfer to the ward. MAIN OUTCOME MEASURES: Of the 109 patients who were visited by the liaison nurse support service, 14 agreed to be interviewed about their experiences of the transfer. Data was analysed by inductive content analysis. FINDINGS: One overall theme, An advocate in a vulnerable situation emerged from the data. Four subthemes were identified: Ensures transfer of information between the intensive care unit and the general ward, Makes the circumstances understandable and coordinates between the care levels and Offers emotional support and stability in an uncertain situation. CONCLUSION: The liaison nurse support service contributed to ensuring accurate transfer of information, solved problems when the patient themselves did not have control or strength and provided emotional support.

Telehealth cancer care consultations during the COVID-19 pandemic: a qualitative study of the experiences of Australians affected by cancer.

BACKGROUND: In response to the onset of the COVID-19 pandemic, telehealth was rapidly rolled out in health services across Australia including those delivering cancer care. This study aimed to understand people with cancer and carers' experiences with telehealth for cancer care during the COVID-19 pandemic and associated restrictions. METHOD: Semi-structured interviews conducted with people with cancer and carers via telephone or online video link between December 2020 and May 2021. Participants were recruited through cancer networks and social media. Interviews were transcribed and thematic analysis undertaken. RESULTS: Twenty-three patients and 5 carers were interviewed. Telephone-based appointments were most common. Responses to telehealth were influenced by existing relationships with doctors, treatment/cancer stage and type of appointment. Four themes were derived: (i) benefits, (ii) quality of care concerns, (iii) involving carers, and (iv) optimising use of telehealth. Benefits included efficiency and reduced travel. Quality of care concerns identified subthemes: transactional feel to appointments; difficulties for rapport; suitability for appointment type and adequacy for monitoring. Both patients and carers noted a lack of opportunity for carers to participate in telephone-based appointments. Aligning appointment mode (i.e. telehealth or in person) with appointment purpose and ensuring telehealth was the patient's choice were seen as essential for its ongoing use. DISCUSSION AND CONCLUSIONS: While telehealth has benefits, its potential to reduce the quality of interactions with clinicians made it less attractive for cancer patients. Patient-centred guidelines that ensure patient choice, quality communication, and alignment with appointment purpose may help to increase telehealth's utility for people affected by cancer.

Loss of Rituals, Boundaries, and Relationship: Patient Experiences of Transition to Telepsychotherapy Following the Onset of COVID-19 Pandemic.

Telepsychotherapy is an increasingly common way of conducting psychotherapy. Previous research has shown that patients usually have positive experiences of online therapy, however, with large individual differences. The aim of this study was to explore patients' experiences of transition from in-person psychotherapy sessions to telepsychotherapy during the COVID-19 pandemic, as well as variation in the experiences with regard to the patients' personality orientation. Seven psychotherapy patients in Sweden were interviewed and the transcripts were analyzed using thematic analysis. Additionally, the participants were asked to rate their dissatisfaction/satisfaction with the transition, how hindering/helpful the transition was, and how unsafe/safe they felt after the transition in comparison to before. Personality orientation on relatedness or self-definition was assessed applying a self-assessment instrument (Prototype Matching of Anaclitic-Introjective Personality Configuration; PMAI). The participants experienced telepsychotherapy as qualitatively different from in-person psychotherapy. They reported several essential losses: the rituals surrounding therapy sessions were lost, including the transitional time and space between their every-day life and the therapy sessions, less therapeutic work was done, the therapists could lose their therapeutic stance, the sense of rapport was impaired, and the patients felt less open and emotionally available. On the other hand, some patients could feel freer online. As six of the participants had an anaclitic personality orientation, the present study could especially contribute to the understanding of how patients with strong affiliative needs and fear of abandonment experience the transition to meeting their therapists via communication technology. The participants' self-ratings showed that they were only marginally dissatisfied with the transition and experienced the transition as slightly hindering, whereas they felt rather safe after the transition, indicating low concordance between qualitative and quantitative evaluations. New studies are needed to explore the introjective patients' experiences of the transition. An essential topic is also to collect evidence and to test how the impaired sense of rapport when using communication technology can be remedied by adequate, patient-tailored interventions, a topic that has to be included in psychotherapy education and training.

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.

New life after near death: Surviving critical COVID-19 infection.

Background: Few studies have explored the illness perceptions, experiences or attitudes towards the future of survivors of critical coronavirus disease 2019 (COVID-19). Through in-depth qualitative interviews, we aimed to enrich our understanding of participants' perspectives, with the hope of offering more holistic and appropriate care to future patients. Methods: Participants who had survived critical COVID-19 illness (defined as a laboratory or clinical diagnosis of COVID-19, with hypoxia requiring high-flow nasal oxygen (HFNO) or mechanical ventilation) were invited to participate. After informed consent procedures, clinic-demographic details were documented and individual interviews conducted using a topic guide, and were audio-recorded, translated, transcribed and coded into NVivo software where themes were extracted. Results: Of 21 participants (13 female, 8 male), the mean age was 51.8 years (range 34 - 68), and mean duration of COVID symptoms was 21.7 days (range 17 - 37). Eighteen participants had been on HFNO, and 5 required mechanical ventilation. The major themes were: distressing experience; faith-based beliefs sustaining them; gratitude to healthcare workers (HCWs); better understanding of COVID and how dangerous it is; optimism for the future; and a resolve to implement lifestyle changes. Conclusion: Qualitative interviews revealed our participants' experience of severe COVID-19 as a difficult and terrifying ordeal, mitigated by faith-based beliefs, and the presence and care of HCWs. These experiences were reported by the participants as life changing, and all were inspired to focus on future self-care, and invest in fulfilling relationships. These insights call for future interventions to improve patient-centred care, including follow-up debriefing sessions, and support for lifestyle changes.

Remote-delivered cardiac rehabilitation during COVID-19: a prospective cohort comparison of health-related quality of life outcomes and patient experiences.

AIMS: Enforced suspension and reduction of in-person cardiac rehabilitation (CR) services during the coronavirus disease-19 (COVID-19) pandemic restrictions required rapid implementation of remote delivery methods, thus enabling a cohort comparison of in-person vs. remote-delivered CR participants. This study aimed to examine the health-related quality of life (HRQL) outcomes and patient experiences comparing these delivery modes. METHODS AND RESULTS: Participants across four metropolitan CR sites receiving in-person (December 2019 to March 2020) or remote-delivered (April to October 2020) programmes were assessed for HRQL (Short Form-12) at CR entry and completion. A General Linear Model was used to adjust for baseline group differences and qualitative interviews to explore patient experiences. Participants (n = 194) had a mean age of 65.94 (SD 10.45) years, 80.9% males. Diagnoses included elective percutaneous coronary intervention (40.2%), myocardial infarction (33.5%), and coronary artery bypass grafting (26.3%). Remote-delivered CR wait times were shorter than in-person [median 14 (interquartile range, IQR 10-21) vs. 25 (IQR 16-38) days, P < 0.001], but participation by ethnic minorities was lower (13.6% vs. 35.2%, P < 0.001). Remote-delivered CR participants had equivalent benefits to in-person in all HRQL domains but more improvements than in-person in Mental Health, both domain [mean difference (MD) 3.56, 95% confidence interval (CI) 1.28, 5.82] and composite (MD 2.37, 95% CI 0.15, 4.58). From qualitative interviews (n = 16), patients valued in-person CR for direct exercise supervision and group interactions, and remote-delivered for convenience and flexibility (negotiable contact times). CONCLUSION: Remote-delivered CR implemented during COVID-19 had equivalent, sometimes better, HRQL outcomes than in-person, and shorter wait times. Participation by minority groups in remote-delivered modes are lower. Further research is needed to evaluate other patient outcomes.

Toward digital transformation in healthcare: a framework for remote monitoring adoption

Purpose: Digital transformation (DT) is a priority for the healthcare sector. In many countries, it is still considered in the early stages with an underestimation of its benefits and potentiality. Especially in Italy, little is known about the impact of digitalization – particularly of the Internet of Things (IoT) – on the healthcare sector, for example, in terms of clinician's jobs and patient's experience. Drawing from such premises, the paper aims to focus on an overlooked healthcare area related to the chronic heart diseases field and its relationship with DT. The authors aim at exploring and framing the main variables of remote Monitoring (RM) adoption as a specific archetype of healthcare digitalization, both on patients and medical staff level, by shedding some lights on its overall implementation. Design/methodology/approach: The authors empirically inquiry the RM adoption within the context of the Cardiology Department of the Casilino General Hospital of Rome. To answer our research question, the authors reconstruct the salient information by using induction-type reasoning, direct observation and interviewees with 12 key informants, as well as secondary sources analysis related to the hospital (internal documentation, presentations and technical reports). Findings: According to a socio-technical framework, the authors build a model composed of five main variables related to medical staff and patients. The authors classify such variables into an input-process-output (I-P-O) model. RM adoption driver represents the input;cultural digital divide, structure flexibility and reaction to change serve the process and finally, RM outcome stands for the output. All these factors, interacting together, contribute to understanding the RM adoption process for chronic disease management. Research limitations/implications: The authors' research presents two main limitations. The first one is related to using a qualitative method, which is less reliable in terms of replication and the interpretive role of researchers. The second limitation, connected to the first one, is related to the study's scale level, which focuses on a mono-centric consistent level of analysis. Practical implications: The paper offers a clear understanding of the RM attributes and a comprehensive view for improving the overall quality management of chronic diseases by suggesting that clinicians carefully evaluate both hard and soft variables when undertaking RM adoption decisions. Social implications: RM technologies could impact on society both in ordinary situations, by preventing patient mobility issues and transport costs, and in extraordinary times (such as a pandemic), where telemedicine contributes to supporting hospitals in swapping in-person visits with remote controls, in order to minimize the risk of coronavirus disease (COVID-19) contagion or the spread of the virus. Originality/value: The study enriches the knowledge and understanding of RM adoption within the healthcare sector. From a theoretical perspective, the authors contribute to the healthcare DT adoption debate by focusing on the main variables contributing to the DT process by considering both medical staff and patient's role. From a managerial perspective, the authors highlight the main issues for RM of chronic disease management to enable the transition toward its adoption. Such issues range from the need for awareness of the medical staff about RM advantages to the need for adapting the organizational structure and the training and education process of the patients. © 2021, Emerald Publishing Limited.

Self-care of patients with multiple chronic conditions and their caregivers during the COVID-19 pandemic: A qualitative descriptive study.

AIMS: Explore the self-care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self-care during COVID-19 pandemic. DESIGN: A descriptive qualitative design was used. The COREQ checklist was used for study reporting. METHODS: Individual semi-structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle-range theory of self-care of chronic illness, which entails the three dimensions of self-care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis. RESULTS: A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25 years and caregivers of 45.76 years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self-care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID-19 and in ensuring patients' self-care of chronic diseases through direct and indirect interventions. CONCLUSIONS: Critical events can modify the self-care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self-care and contributions to self-care behaviours. IMPACT: Patients with MCCs and their caregivers can react in different ways in their performances of self-care and contribution to patients' self-care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self-care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions.

Group and individual telehealth for chronic musculoskeletal pain: A scoping review.

BACKGROUND CONTEXT: Musculoskeletal (MSK) pain presents a global challenge. Individual and group pain management programmes (PMPs) are recommended approaches for patients with chronic MSK disorders. With advances in remote healthcare capability, telehealth, and the recent COVID-19 pandemic, the importance of telehealth PMPs has become even more evident. Nevertheless, it is not known how patients perceive PMPs for their MSK complaint when delivered via telehealth. OBJECTIVE: To synthesise the evidence of patients' experiences of group and individual telehealth PMPs for chronic MSK pain. DESIGN: A scoping review informed by the PRISMA extension for scoping reviews. DATA SOURCES: Based on a planned search strategy, modified following initial searches, an electronic search was conducted of key databases: Cochrane Library, Medline, CINAHL, EMBASE, AMED, SportDiscus and APA PsychInfo from 2010 until 11 May 2021. STUDY SELECTION: Any qualitative or mixed methods study reporting patient experiences of telehealth PMPs for patients with MSK disorders. DATA EXTRACTION AND DATA SYNTHESIS: Data were extracted and synthesised using thematic analysis. RESULTS: From 446 identified studies, 10 were included. Just two studies investigated group telehealth PMPs for patients with MSK disorders, with eight delivered individually. Four main themes emerged: (1) Usability of the technology, (2) Tailored care, (3) Therapeutic alliance and (4) Managing behaviour. The findings highlight patient acceptability of telehealth to support self-management for chronic MSK disorders, with appropriate clinical and technical support. Group telehealth has the potential to empower patients with peer support. Remote delivery of PMPs also impacts on how patients and providers interact, communicate and develop a therapeutic relationship. CONCLUSIONS AND IMPLICATIONS: Barriers and enablers to engagement in telehealth PMPs for patients with chronic MSK disorders have been identified. Peer support and group cohesiveness can be achieved remotely to enhance the patient experience. There is a critical need for further research in this area.

Chronic and rare disease patients' access to healthcare services during a health crisis: The example of the COVID-19 pandemic in Turkey.

OBJECTIVE: The restructuring of healthcare provision for the coronavirus disease 2019 (COVID-19) pandemic caused disruptions in access for patients with chronic or rare diseases. This study explores the experiences of patients with chronic or rare diseases in access to healthcare services in Turkey during the COVID-19 pandemic. METHODS: Semi-structured interviews were conducted with representatives (n = 10) of patient organisations (n = 9) based in Istanbul. Thematic analysis with an inductive approach was conducted to analyse the responses obtained through the interviews. RESULTS: The lack of clinical information at the beginning of the pandemic caused fear among patients with chronic or rare diseases. Patients experienced obstacles in access to healthcare services because of the overcrowding of hospitals with COVID-19 patients. Some treatment procedures were cancelled or postponed by physicians. Of these procedures, some were medically vital for those patients, leading to or exacerbating further health problems. The most positive measures that patients identified were where the Social Security Institution introduced regulations to facilitate access to prescribed medicine for chronic patients. Information exchange between the doctors and their patients was important to alleviate the uncertainty and reduce the anxiety among patients. DISCUSSION: Access problems experienced by patients during the COVID-19 pandemic were a complex mix of factors including shortages and physical barriers, but also perceptions of barriers. The findings of this study show that patient organisations can provide insights on disease-specific experiences and problems that are very valuable to improve access to healthcare services to achieve the universal health coverage target. Hence, this study emphasises the inclusion of patient organisations in decision-making processes during times of health crises. PUBLIC CONTRIBUTION: Representatives of patient organisations participated in the interviews.

COVID-19 and the Dreads of Hospitalization: Connecting With a Recollection of Memories As a Patient of Dengue Fever.

I have spent a considerable time in visiting and even staying at various hospitals since my childhood. With many of the memories still intact, the one encounter whose mark is an enduring one in my mind is when I caught dengue fever and was admitted to a public hospital. During this stay, I remember largely being restless inside my room. However, visiting an outdoor ground near my ward was always a rejuvenating experience and made me feel stronger and better. It was during that time when I truly realized the significance of indoor as well as outdoor design quality of health care buildings and how they impact the well-being of their users. To say the least, that short stay at the hospital was one of the major reasons that why for my graduate and undergraduate theses, I chose to explore the role of well-designed and accessible outdoor spaces especially gardens in health care buildings for promoting mental as well as physical health and well-being among users. Presently, as we steer through a deadly pandemic, my own experiences from this hospital stay makes me want to reflect back and reemphasize on why there is a need for health care policy makers and relevant governmental bodies to strategize and prioritize long-term goals for implementing measures such as evidence-based design considerations of hospitals, especially in developing countries, and to promote accessible, inclusive, and safe healing spaces where patients may leave with positive experiences instead of negative reminiscences and where the staff can also use these spaces for respite.