Exploring the views of care home staff on the use of antipsychotics for people with dementia amid the COVID-19 pandemic: A qualitative study

Introduction: There was an increase in antipsychotic prescribing for people with dementia during the COVID-19 pandemic (1). To explain this increase, the current study was conducted to explore the views of staff working in care homes for the elderly during the pandemic on the use of antipsychotics for residents with Behavioural and Psychological Symptoms of Dementia (BPSD). Aim(s): The aim was to explore the use of antipsychotics for people with BPSD during the COVID-19 pandemic by interviewing staff in care homes about their experiences during that time. Method(s): Semi-structured interviews were conducted online with staff working in ten UK elderly care settings using convenience sampling. Participants mainly onsite care home staff were recruited through online networks, for example, Twitter, and support groups such as CHAIN and NIHR clinical research network. Interviews were conducted between May 2021-March 2022, were audio recorded, transcribed verbatim, and analysed inductively using thematic analysis in NVivo version 12. Result(s): Ten interviews were completed with managers (n=2), care staff (n=6) and nurses (n=2) in nursing homes (n=7) and residential homes (n=3) (all were female). The first theme 'Challenges experienced in care provision' entails challenges experienced in the care environment;residents were confined to their rooms, activities were suspended, staff were absent and stressed, and family visits were barred. The reduced human contact affected residents' sense of self, mental and physical wellbeing, and in turn, their behaviours. The second theme 'Prescribing process' refers to doctors prescribing medicines in response to staff raising concerns. The third theme 'Attitude toward antipsychotics' denotes participants' positive and negative beliefs about antipsychotics. The positive beliefs included antipsychotics being the right choice and beneficial, an increased need and continued use of antipsychotics, use of a combination of medications and weighing the risks and benefits of antipsychotics. The negative beliefs included reports of adverse effects and short-term benefits of antipsychotics, antipsychotics not always beneficial, benefits in deprescribing, dislike for antipsychotics and belief antipsychotics are the last resort. Some expressed the need for antipsychotics had not increased but been driven by health professionals involved. The fourth theme 'Other psychotropic medication' alluded to other commonly used psychotropic medications and associated risks and benefits. The fifth theme 'Measures implemented within care settings' represented strategies implemented to avert the initiation or bolster antipsychotic deprescribing such as non-pharmacological approaches, nurses' assessment of residents before requesting antipsychotics, multidisciplinary consultation, and medication review. Conclusion(s): This is the first study that reports care home staff views on antipsychotic use for residents with dementia during the pandemic. The limitations include that only views of female respondents were obtained and the limited sample size. Care homes faced enormous challenges in the provision of care services to residents with dementia during the pandemic. The multitude of difficulties experienced in care homes due to lack of preparedness may have influenced staff to have positive views of antipsychotics and their use as an option during the pandemic. It's important to acknowledge and address these difficulties for example through education and training interventions to help with future preparedness.

The impact of a 12 month Music Therapy pilot on patients and staff within a NHS, in-patient, neurorehabilitation unit during the Covid-19 pandemic

Introduction: The UK Stroke pathway has been well developed since the introduction of the National Stroke Strategy in 2007 (Department of Health, 2007). Music Therapy (MT) is an AHP that has less presence within the current stroke pathway. In line with the national guidelines for Stroke rehabilitation (NICE, 2013), music therapy targets specific patient rehabilitation goals integrating a multi-disciplinary approach to therapy. Chiltern Music Therapy funded a 12-month, 1 day a week pilot MT service at Buckinghamshire Neuro Rehab Unit between 2020-2021. Method(s): The MT service comprised of a mixture of individual and group sessions. 27 patients were seen. Demographics, techniques, outcomes and feedback data was collected by the therapist, aiming to identify the benefits of MT for patients during the pandemic and how the pilot service enhanced standard therapies. Result(s): Patients accessed 86.5 hours of face-to-face (FtF) MT during the Covid-19 pandemic. 72% of SMART goals were fully or partially achieved. Data suggests MT reduces stress and anxiety, improves mood, and helps patients feel hopeful about the future;MT enhances patient engagement with therapy interventions;MT input increases patient's positive development in the areas of communication, cognition, motor skills, emotional expression, sense of self and behaviour. Staff and patient feedback was overwhelmingly positive. Conclusion(s): Introducing a MT service into existing therapy provision for stroke patients provided opportunities for FtF interaction during the Covid-19 pandemic. MT meets multiple national standards and guidelines for stroke. MT enhances patient engagement with therapy interventions, assists achieving rehab goals whilst reducing stress and anxiety and improving mood.

Strengthening career adaptation among school teachers in Pakistan: Test of strengths-based career intervention imparted through emotionalized learning experiences.

This study demonstrated that the Exemplary Teaching intervention offered to Pakistan's school teachers through the emotionalized learning experiences (ELE) format fared better than that offered through the teacher-centered methodology as regards the development of career adaptability, teaching self-efficacy, and work engagement from Time 1 to Time 2. Analyses to explore the development of career variables from Time 2 to Time 4 revealed that only the teachers who were offered the ELE intervention effectively engaged in step-by-step career construction over the academic year. Theoretical contributions of the results and implications for offering future career interventions amid COVID-19 are also discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10775-021-09502-2.

Renforcer l'Adaptation de la Carrière des Enseignant·e·s au Pakistan: Test d'une Intervention de Carrière Basée sur les Forces à travers l' Emotionalized Learning Experiences Cette étude a démontré que l'intervention Exemplary Teaching proposée aux enseignantes pakistanaises par le biais de emotionalized learning experiences (ELE) a donné de meilleurs résultats que celle proposée par la méthodologie centrée sur l'enseignante en ce qui concerne le développement de l'adaptabilité de la carrière, l'auto-efficacité de l'enseignement et l'engagement professionnel du Temps 1 au Temps 2. Les analyses visant à explorer le développement des variables de carrière du Temps 2 au Temps 4 ont révélé que seuls les enseignantes à qui l'on a proposé l'intervention ELE se sont effectivement engagés dans une construction de carrière étape par étape au cours de l'année scolaire. Les contributions théoriques des résultats et les implications pour proposer de futures interventions sur la carrière au sein de COVID-19 sont également discutées.

Fortalecimiento de la adaptación profesional entre los maestros de escuela en Pakistán: Prueba de intervención profesional basada en el esfuerzo e impartida a través de experiencias de aprendizaje emocionalizadas Este estudio demostró que la intervención del Exemplary Teaching ofrecido a los maestros de escuela de Pakistán a través del formato de experiencias de aprendizaje emocionalizado (ELE) fue mejor que la ofrecida a través de la metodología centrada en el maestro en lo que respecta al desarrollo de la adaptabilidad de la carrera, la autoeficacia de la enseñanza y el compromiso laboral del Tiempo 1 al Tiempo 2. Los análisis para explorar el desarrollo de las variables de carrera del Tiempo 2 al Tiempo 4 revelaron que solo los profesores a los que se les ofreció la intervención del Exemplary Teaching (ELE) participaron efectivamente en la construcción de una carrera paso a paso durante el año académico. También se discuten las contribuciones teóricas de los resultados y las implicaciones para ofrecer futuras intervenciones profesionales en medio del COVID-19.

Becoming anonymous: how strict COVID-19 isolation protocols impacted ICU patients.

In this article, I provide phenomenological reflections on patients' experiences of undergoing extreme isolation protocols while admitted to Intensive Care Units [ICU] during the first wave of COVID-19. Based on observation studies from within the patient isolation rooms and retrospective, in-depth phenomenological interviews with patients, I characterize this exceptional experience as one of becoming anonymous. To illustrate this, I start by establishing a perspective on embodied existence as constituted on a scale between anonymous embodiment and being enrooted into a personal niche. Against the backdrop of this framework, I illustrate how being admitted to the ICU under strict isolation protocols produced extraordinary experiences of becoming anonymous. Sources of the anonymization were: (1) Mechanical expropriation, pacification and disownership of the visceral-kinaesthetic body; (2) Objectification; (3) Spatial and intercorporeal anonymity (4) Surrealism: the intermingling of objective impressions and dream-like interpretations. Finally, I illustrate how anonymization induced an experience of embodiment as raw materiality, confronting the patient with what Martin Heidegger called the facticity of naked existence. This experience is discussed against Levinas' critique of Heidegger, while I propose that insights from this exceptional case may substantiate Heidegger's account.

Sense of Self-Efficacy and Helplessness Among Students of Higher Grades of Primary School During the COVID-19 Pandemic

Learning in unknown circumstances is a great challenge for young people, particularly those who lack the ability to regulate their emotions. This text presents the results of research on the image of the life of students in higher grades of primary school, measured by the sense of self-efficacy and the sense of helplessness. The research was conducted during the COVID-19 pandemic among 303 students. It was found that (1) students rather express their belief in their own effectiveness (agency), and, at the same time, (2) half of the students indicated the feeling of helplessness;(3) helplessness is significantly higher among girls;(4) in the case of girls, there is a clear and strong negative relation between the sense of effectiveness and the helplessness. © 2022, Adam Marszalek Publishing House. All rights reserved.

Changes in Subjective Time and Self during Meditation.

This study examined the effects of meditative states in experienced meditators on present-moment awareness, subjective time, and self-awareness while assessing meditation-induced changes in heart-rate variability and breathing rate. A sample of 22 experienced meditators who practiced meditation techniques stressing awareness of the present moment (average 20 years of practice) filled out subjective scales pertaining to sense of time and the bodily self and accomplished a metronome task as an operationalization of present-moment awareness before and after a 20 min meditation session (experimental condition) and a 20 min reading session (control condition) according to a within-subject design. A mixed pattern of increased sympathetic and parasympathetic activity was found during meditation regarding heart-rate measures. Breathing intervals were prolonged during meditation. Participants perceived their body boundaries as less salient during meditation than while reading the story; they also felt time passed more quickly and they paid less attention to time during meditation. No significant differences between conditions became apparent for the metronome task. This is probably the first quantitative study to show how the experience of time during a meditation session is altered together with the sense of the bodily self.

Minimal Impact of COVID-19 Pandemic on the Mental Health and Wellbeing of People Living With Dementia: Analysis of Matched Longitudinal Data From the IDEAL Study.

Objective: Research suggests a decline in the mental health and wellbeing of people with dementia (PwD) during the COVID-19 pandemic; however few studies have compared data collected pre-pandemic and during the pandemic. Moreover, none have compared this change with what would be expected due to dementia progression. We explored whether PwD experienced changes in mental health and wellbeing by comparing pre-pandemic and pandemic data, and drew comparisons with another group of PwD questioned on two occasions prior to the pandemic. Methods: Community-dwelling PwD enrolled in the IDEAL programme were split into two groups matched for age group, sex, dementia diagnosis, and time since diagnosis. Although each group was assessed twice, one was assessed prior to and during the pandemic (pandemic group; n = 115) whereas the other was assessed prior to the pandemic (pre-pandemic group; n = 230). PwD completed measures of mood, sense of self, wellbeing, optimism, quality of life, and life satisfaction. Results: Compared to the pre-pandemic group, the pandemic group were less likely to report mood problems, or be pessimistic, but more likely to become dissatisfied with their lives. There were no changes in continuity in sense of self, wellbeing, and quality of life. Discussion: Results suggest the pandemic had little effect on the mental health and wellbeing of PwD, with any changes observed likely to be consistent with expected rates of decline due to dementia. Although personal accounts attest to the challenges experienced, PwD appear to have been resilient to the impact of lockdown and social restrictions during the pandemic.

'Tu historia cuenta' online version: Promotores' experience and perspectives on the virtual adaption of a hereditary breast cancer education and risk identification program

Background: Breast cancer is the most common cancer in women in the U.S. and the leading cause of cancer related death among U.S. Latinas. Despite having lower breast cancer incidence, U.S. Latinas are more likely to be diagnosed with advanced stage disease compared to non-Hispanic White (NHW) women. This can be attributed to lower rates of screening and longer time to follow up after an abnormal mammogram in the former group. We developed a comprehensive promotores-led education and risk stratification program for Spanish-speaking Latinas to increase mammography screening, genetic testing, and the understanding of the impact of family history on cancer risk. Due to COVID-19 we adapted the program to a virtual platform. This study aimed to record and share the experience from the promotores' perspective as they educated the Latino(x) community through virtual sessions. Methods: We used a stakeholder continuous engagement approach and the construct of relational culture to build the program materials. The promotores were part of two organizations in California: Vision y Compromiso (Sacramento region, and San Francisco) and Promoters for Better Health (Los Angeles). Their experience was captured using semi-structured interviews guided by a set of questions and a request for additional thoughts. Demographic information was captured using a questionnaire. The promotores' voices were incorporated into this program through multiple interactions including the revision of the interviews. Results: All promotores (N=14) in the program were fluent in Spanish and self-identified as Hispanics/Latinos(x). Ages ranged between 34 and 62, most being first generation immigrants. Educational achievement varied from high school to college degree. Through the interviews and informal interaction, promotores shared that virtual platforms helped alleviate numerous obstacles for attendance like transportation, scheduling conflicts, and childcare costs. However, the online approach removed the personal connection that promotores usually have with participants. The most important challenge described was the lack of privacy and a safe space for participants to share, since many took the class in the middle of their homes near family members. The promotores agreed delivering the program gave them a greater sense of self-worth and confidence. They never thought that they could learn, and teach, community members about genetics and cancer risk. Conclusions: Despite the challenges brought about by COVID-19, the experience of transforming the 'tu historia cuenta' program to a virtual platform provided unique opportunities for bi-directional collaboration between the academic and community partners and with the participants. Overall, we learned that the virtual program had both positive and negative aspects regarding community engagement. It also consistently empowered promotores as well as allowed them to continue their paid work during lock-down, which was equally appreciated during challenging economic times.

Can a 'second disaster' during and after the COVID-19 pandemic be mitigated?

In most disasters that have been studied, the underlying dangerous cause does not persist for very long. However, during the COVID-19 pandemic a progressively emerging life threat remains, exposing everyone to varying levels of risk of contracting the illness, dying, or infecting others. Distancing and avoiding company have a great impact on social life. Moreover, the COVID-19 pandemic has an enormous economic impact for many losing work and income, which is even affecting basic needs such as access to food and housing. In addition, loss of loved ones may compound the effects of fear and loss of resources. The aim of this paper is to distil, from a range of published literature, lessons from past disasters to assist in mitigating adverse psychosocial reactions to the COVID-19 pandemic. European, American, and Asian studies of disasters show that long-term social and psychological consequences of disasters may compromise initial solidarity. Psychosocial disruptions, practical and financial problems, and complex community and political issues may then result in a 'second disaster'. Lessons from past disasters suggest that communities and their leaders, as well as mental healthcare providers, need to pay attention to fear regarding the ongoing threat, as well as sadness and grief, and to provide hope to mitigate social disruption.

En la mayoría de los desastres que han sido estudiados, la causa subyacente que genera el peligro no persiste por mucho tiempo. Sin embargo, durante la pandemia COVID-19 una amenaza a la vida progresivamente emergente es mantenida, exponiendo a todos a variados niveles de riesgo de contraer la enfermedad, morir o infectar a otros. Distanciarse y evitar la compañía tiene un gran impacto en la vida social. Además, la pandemia COVID-19 tiene un impacto económico enorme para muchos por la pérdida de trabajos e ingreso, lo que está incluso afectando las necesidades básicas como la comida o la vivienda. En adición a esto, la pérdida de seres queridos puede agravar los efectos del miedo y la pérdida de recursos. El objetivo de este artículo es sintetizar a partir de una variedad de literatura publicada, lecciones de desastres pasados para ayudar a mitigar las reacciones psicosociales adversas a la pandemia COVID-19. Trabajos europeos, americanos y asiáticos sobre desastres muestran que las consecuencias a largo plazo tanto sociales como económicas de los desastres pueden poner en peligro la solidaridad inicial. Las disrupciones psicosociales, los problemas prácticos y financieros, y los complejos problemas comunitarios y políticos pueden resultar en un 'Segundo desastre'. Las lecciones de desastres pasados sugieren que las comunidades, sus líderes y también los proveedores de atención en salud mental necesitan prestar atención al miedo en relación a la amenaza en curso, así como a la tristeza y al duelo, y proveer esperanza para mitigar la disrupción social.