Rehabilitation needs after critical illness: Referral outcomes from a ICU follow up clinic in Northern Ireland

Introduction: In 2019/20 a total of 171,900 people were admitted to adult general intensive care units (ICU) across England, Wales and Northern Ireland, with a survival rate of 79.6% at hospital discharge.1 Patients who survive critical illness and admission to ICU often experience ICU-related long-term physical and non-physical impairments and disability following hospital discharge.2 National guidance advocates multidisciplinary team (MDT) follow up to identify and manage the unmet health needs of this patient population.3-4 The UK has seen an increase in the number of follow up services available in the last 7 years.2 The Covid-19 pandemic further highlighted the need to provide this service, locally resulting in the establishment of the Belfast Health and Social Care Trust (BHSCT) ICU follow up clinic in July 2020. The follow up clinic is offered to patients aged = 18 years, an ICU length of stay of = 4 days, who have been discharged from an inpatient setting within the last 12 weeks and do not receive follow up from any other established care pathway. The clinic consists of an ICU Nurse, Doctor, Clinical Psychologist and Physiotherapist. Patients are offered either a virtual, face-to-face or telephone appointment. Objective(s): To identify unmet rehabilitation needs and onward referral requirements of patients presenting at an ICU follow-up clinic in Northern Ireland. Method(s): Data was gathered retrospectively using an excel database detailing patient demographics, appointment details and onward referrals generated from the clinic. Data was analysed for a set time period between the 01/12/2021 - 09/02/2022. The type of referral and the profession responsible were captured. Result(s): During the time period eight post ICU follow up clinics were completed. A total of 36 patient's attended (14 male and 22 female). Six appointments were attended virtually via MS Teams, 12 via telephone and 18 face-to-face. Twenty-three (64%) of the patients required at least one onward health referral. A total of 61 onward health referrals were generated from this population. Table 1 details the number of onwards referrals by speciality. Conclusion(s): Approximately 64% of patients who attended the post ICU follow up clinic, during a 10 week period, demonstrated unmet rehabilitation needs resulting in onward health referrals. This data supports the need for a post ICU follow up clinic at BHSCT to identify ongoing need, ensure transition of care to relevant services and optimise patient's physical and psychological outcomes. One limitation of this study is that not all recommended allied health professionals are commissioned for the clinic which may impact on the health needs identified. Future work should consider the impact of this and discussions regarding the need for a commissioned post ICU follow up clinic which is truly MDT for this patient population should be considered.

Establishing an Intensive Care follow up clinic for patients in Belfast, Northern Ireland

Introduction: National guidance states that follow up should be offered to all patients who have spent more than four days in intensive care1 with specific guidance for the follow up of COVID patients released in May 2020.2 Prior to the pandemic, in the Belfast trust, there was no follow-up service provided for intensive care patients. The pandemic presented many new challenges to intensive care, with a high number of patients requiring follow up after discharge. It also presented a unique problem in that follow up clinics could not be delivered in the traditional face to face manner. Objective(s): To set up a follow up service that assessed patient recovery from COVID 19 and offered rehabilitation, in a manner that could be delivered safely during a national lockdown. Method(s): A database was collated of all the patients who had been treated in intensive care, during the first wave of the pandemic with a confirmed positive COVID-19 sample. A follow up pathway (Figure 1) was designed for the clinic based on the BTS and FICM guidelines.2-3 The multidisciplinary team used Microsoft Teams to complete clinic proformas for each patient, share files and perform virtual appointments. Patient questionnaires were collated using the forms app within MS Teams. Patients filled in various objective health questionnaires at both their 6 and 12 week appointments to allow the team to assess their rehabilitation. Once the appointments were completed the proformas were entered into their permanent medical record on the Northern Ireland Electronic Care Record (NIECR). Result(s): There were 42 patients treated in the pandemic's first wave, 40 were reviewed at 6 weeks and 39 at 12 weeks post hospital discharge. Anonymous feedback was gathered electronically from patients about their experience of the clinic. The feedback from the patients was overwhelmingly positive. To date the clinic has offered follow up to nearly 300 patients and is still in use. It has grown in size and has received input from the Belfast trust for further staffing and resources. The project recently received joint first prize in the innovation and transformation in care category for the Health and Social Care Quality Improvement (HSCQI) awards in the trust. Conclusion(s): This project highlights the essential requirement for follow-up after an intensive care admission with significant ongoing morbidity demonstrated in this patient cohort. It is currently still the only service with this breadth of MDT input in Northern Ireland. The initial use of MS Teams has allowed this service to run safely during a pandemic but it has since been adapted as the pandemic has evolved and is now offered to all Intensive care patients. Its collaborative platform allows for immediate communication throughout the whole team, and the ability for the team to be flexible. In essence, we have set up a unique and robust system that can be easily used to offer excellent follow up to Intensive care patients within the Belfast trust.

Social support services for dementia during the COVID-19 pandemic: A longitudinal survey exploring service adaptations in the United Kingdom.

OBJECTIVES: To understand how the delivery of dementia-related social support services across the UK adapted during the pandemic. METHODS: We devised a two-part online and telephone longitudinal survey. Providers participated between March and June 2021, and again 3 months later. Information relating to services delivered and delivery methods employed was collected before and during the pandemic at two timepoints (T1 and T2). RESULTS: A total of 75 participants completed the survey at T1, with 58 participants completing the survey at both timepoints. Thirty-six participants had complete data at T1. Day care centres and support groups were the most delivered primary services. During the pandemic, services shifted from in-person to remote or hybrid. While in-person services started to resume at T2, most services remained hybrid. At T2, the frequency of service delivery increased, however, a decreasing trend in usage was observed across survey timepoints. The telephone was the most employed format to deliver remote and hybrid services, however, reliance on videoconferencing software significantly increased at T1. Videoconferencing software was often used alongside the telephone and emails to remotely deliver services. CONCLUSIONS: Services were able to adapt and provide support to some service recipients. Complementing novel approaches to service delivery with more traditional formats may facilitate access to service recipients with limited digital literacy. Following the easing of public health measures, many service recipients may be reluctant to engage with in-person services. Thus, the provision of in-person and remote services needs to be carefully balanced amidst the current hybrid landscape. PATIENT OR PUBLIC CONTRIBUTION: Two public advisors (a former unpaid carer and a person living with dementia) were involved in designing and piloting the tool, interpreting the results and disseminating the findings. Both public advisors have experience in delivering dementia-related social support services before and or during the pandemic in the United Kingdom.

Contested social care- is there a ?right? way? How public investments diminish attitudinal differences towards social care in 34 European countries

The COVID-19 pandemic has uncovered the critical nature of social care for modern societies and the moral dilemmas related to the organisation of care, specifically in terms of frail adults. The scarcity of personnel in nursing homes challenged the possibility of adequate care, spurring debates on both the dignity of dependent people and end-of-life treatments. While 'classical' social care policies already stimulate conflicts about the 'right way' of caring, non-classical care policies, such as assisted dying, are particularly contested. We advance existing research by analysing public attitudes on both care policies jointly and, hence, integrate the literature on morality policy and social care. Based on multi-level analyses, combining individual-level with macro-level data from 34 countries, we uncover that gender and religious identity drive deviating attitudes in both fields, while long-term care expenditure mitigates scepticism among Catholics but less so among Muslims.

Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021.

Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.

Studying informal care during the pandemic: mental health, gender and job status.

Unexpected negative health shocks such as COVID-19 put pressure on households to provide more care to relatives and friends. This study uses data from the UK Household Longitudinal Study to investigate the impact of informal caregiving on mental health during the COVID-19 pandemic. Using a difference-in-differences analysis, we find that individuals who started providing care after the pandemic began reported more mental health issues than those who never provided care. Additionally, the gender gap in mental health widened during the pandemic, with women more likely to report mental health issues. We also find that those who began providing care during the pandemic reduced their work hours compared to those who never provided care. Our results suggest that the COVID-19 pandemic has had a negative impact on the mental health of informal caregivers, particularly for women.

Homelessness and mental health

The contemporary definition of homelessness has to be seen as a multifaceted societal issue with specific factors at play in different settings. Relative poverty, insecure housing, unemployment, and insecure unemployment can all contribute to homelessness and it is worth noting that these factors will vary across cultures. Homelessness is often expressed as a crisis -a break in the typical, cultured means of civilizations. In addition, severe mental disorders have been noted and reported in homeless populations for a considerable period of time. Individuals with severe mental illness often experience a range of housing settings depending on their personal and financial conditions or the available rehabilitation programmes, which will depend upon healthcare systems (2), in addition to societal conditions and local policies on social care, employment housing, and so on. Whilst the number of people currently experiencing homelessness cannot be precisely estimated due to varying definitions across countries and cultures, the link between homelessness and mental health disorders is undeniable. Both are strongly affected by social and economic determinants such as poverty, migration, unemployment, access to healthcare, and urbanization and, as a result, providing optimal care in the community requires understanding of the cultural context. This unique resource provides an overview of the connection between homelessness and mental health around the globe. Over 27 chapters it offers up-to-date research and policy evidence with an emphasis on developing models of social care and rehabilitation at a local level that enable easy access to mental health services. Written and edited by experts drawn from different cultural and geographical perspectives, this unique resource covers key topics such as COVID-19, dental issues, and chronic pain, the experiences of specific vulnerable groups, as well as case studies from specific countries. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

E-nursing homes: transforming access to nurses in nursing homes in response to the staffing crisis.

The UK is facing a nationwide staffing crisis within adult social care, due to difficulties in recruiting and retaining registered nurses. Current interpretation of legislation means nursing homes must always have the physical presence of a registered nurse on duty within the home. With the shortage of registered nurses increasing, reliance on agency workers is commonplace, a practice impacting service cost and continuity of care. Lack of innovation to tackle this issue means the question of how to transform service delivery to combat staffing shortages is open for debate. The potential for technology to augment the provision of care was highlighted during the COVID-19 pandemic. In this article the authors present one possible solution focused on the provision of digital nursing care within nursing homes. Anticipated benefits include enhanced accessibility of nursing roles, reduced risk of viral spread and opportunities for upskilling staff. However, challenges include the current interpretation of legislation.

Social work involvement in the COVID-19 response in China: Interdisciplinary remote networking

Summary: Social workers in China have been involved significantly in the response to the COVID-19 pandemic. This article introduces the innovative interdisciplinary remote networking framework which both provides a guide for medical and community social workers' involvement during the COVID-19 outbreaks, and also to support interdisciplinary collaboration with the aim of helping individuals and families in need during the pandemic. Findings: The implementation of interdisciplinary remote networking, developed by Chinese social workers, has effectively addressed the different domains of need experienced by the affected population and has established a new approach for social work in the field of health. The framework also provides an effective model for setting up a targeted and sustained service system that links social workers with psychological and medical resources, which capitalize on social resources to buffer the negative impacts of the disease. Social workers play an essential role during such a public health emergency, providing critical services for patients and families, medical workers, self-quarantined residents, and the general population. Applications: The service mode of interdisciplinary remote networking, based on the frontline experiences of social work interventions in China, may serve as a framework for combating COVID-19 in other countries. The framework is among the initiatives that provide transferrable skills to social work practitioners working in network-based social work services during public health emergencies. Thus, the framework presents implications for future practice development in both disaster social work and also public health social work. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Outreach to farmworkers before and during the COVID-19 pandemic

Outreach is an important element of social care. It is an informal but planned form of on-site service delivery to vulnerable populations. Outreach affects some target populations, such as migrant farmworkers, immensely. Outreach staff demonstrate a unique capacity to navigate remote and hard to -to-reach areas, making contact with farmworkers who would otherwise not receive essential services. This ethnographic study describes how organizations make first contact with farmworkers in normal times, and the changes to outreach observed during the COVID-19 pandemic.Outreach workers connect, interact, and provide services to farmworkers in unique settings and situations. The general components of farmworker outreach are planning, engaging, improvising, and initiating services. During the pandemic, the changes observed were a sense of urgency to serve farmworkers, and adaptations in the modality of outreach to include a focus on health, collaboration with health clinicians, and the use of social media to contact farmworkers.Outreach matters to farmworkers and other groups that are secluded, isolated, and vulnerable to abuse. In crisis times, such as the pandemic, outreach is even more vital. Hence, outreach, including the skills required t o conduct outreach, should form part of social work curriculum. Different models and outreach components should be evaluated to assess whether organizations providing outreach services to target populations deliver results beyond immediate benefits and contribute to structural change and advocacy on behalf of them. [ FROM AUTHOR] Copyright of Journal of Social Work is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Lessons from the stigma of COVID-19 survivors: A Marxist criticism appraisal.

Stigma refers to devalued stereotypes that create barriers for stigmatized individuals. During the COVID-19 pandemic, the stigmatization of survivors worsened existing inequalities and triggered mass hysteria. The paper delves into the stigmatization experienced by COVID-19 survivors and the role of Marxist criticism in analyzing this issue. The main findings from the empiricist tradition approach suggest that the perception of COVID-19 stigma is higher among those who are older, belong to ethnic minorities, lack social support, have manual occupations, and possess lower levels of education. The proposed destigmatization pathways include psychological counseling services, social support, and health education. Employing a Marxist perspective can aid in illuminating how economic practices and material conditions influence prevalent ideologies related to stigma. The stigmatization of COVID-19 survivors may be perceived as a consequence of social power inequality, although the current emphasis on individual characteristics as triggers for stigma may neglect the wider systemic forces in operation. Thus, it's crucial to establish improved social care policies to combat exploitation and oppression due to power imbalances. The ultimate objective of such an examination is to identify effective approaches to tackle and eradicate stigma regarding health-related concerns. An interdisciplinary approach integrating a pluralistic perspective would benefit investigating how social systems and individual attributes contribute to the exacerbation of social inequality and stigmatization.

An Exploration of Practitioners' Experiences of Delivering Digital Social Care Interventions to Children and Families During the COVID-19 Pandemic: Mixed Methods Study.

BACKGROUND: Digital technology is an increasing feature of social care practice, and its use has accelerated greatly in response to the COVID-19 pandemic. OBJECTIVE: This study aimed to assess social care practitioners' experiences of delivering digital interventions to vulnerable children and families during the pandemic. METHODS: A mixed methods study combining survey and qualitative research was conducted. In total, 102 social care practitioners working in the Republic of Ireland who delivered a range of digital social care support took part in a web-based survey. This survey captured practitioners' engagement and experiences of delivering digital social care interventions to children and families as well as training and capacity building needs. Subsequently, 19 focus groups with 106 social care practitioners working with children and families were also conducted. These focus groups were directed by a topic guide and explored in more depth practitioners' perceptions of digital social care practice, the perceived impact of digital technology on their work with children and families, and the future application of digital social care interventions. RESULTS: The survey findings revealed that 52.9% (54/102) and 45.1% (46/102) of practitioners, respectively, felt "confident" and "comfortable" engaging in digital service delivery. The vast majority of practitioners (93/102, 91.2%) identified maintaining connection during the pandemic as a benefit of digital social care practice; approximately three-quarters of practitioners (74/102, 72.5%) felt that digital social care practice offered service users "increased access and flexibility"; however, a similar proportion of practitioners (70/102, 68.6%) identified inadequate home environments (eg, lack of privacy) during service provision as a barrier to digital social care practice. More than half of the practitioners (54/102, 52.9%) identified poor Wi-Fi or device access as a challenge to child and family engagement with digital social care. In total, 68.6% (70/102) of practitioners felt that they needed further training on the use of digital platforms for service delivery. Thematic analysis of qualitative (focus group) data revealed 3 overarching themes: perceived advantages and disadvantages for service users, practitioners' challenges in working with children and families through digital technologies, and practitioners' personal challenges and training needs. CONCLUSIONS: These findings shed light on practitioners' experiences of delivering digital child and family social care services during the COVID-19 pandemic. Both benefits and challenges within the delivery of digital social care support as well as conflicting findings across the experiences of practitioners were identified. The implications of these findings for the development of therapeutic practitioner-service user relationships through digital practice as well as confidentiality and safeguarding are discussed. Training and support needs for the future implementation of digital social care interventions are also outlined.

Registered care home managers' experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study.

BACKGROUND: Visiting restrictions in care homes in England and many comparable countries during the Covid-19 pandemic were extensive and prolonged. We examined how care home managers experienced, understood and responded to the national care home visiting guidance in England in developing their visiting policies. METHODS: A diverse sample of 121 care home managers across England, recruited through varied sources including the NIHR ENRICH network of care homes, completed a 10-item qualitative survey. Follow-up, in-depth qualitative interviews were conducted with a purposive sub-sample of 40 managers. Data were analysed thematically using Framework, a theoretically and methodologically flexible tool for data analysis in multiple researcher teams. FINDINGS: Some viewed the national guidance positively; as supporting the restrictive measures they felt necessary to protect residents and staff from infection, or as setting a broad policy framework while allowing local discretion. More commonly, however, managers experienced challenges. These included the guidance being issued late; the initial document and frequent, media-led updates not being user-friendly; important gaps, particularly in relation to dementia and the risks and harms associated with restrictions; guidance being unhelpfully open to interpretation while restrictive interpretations by regulators limited apparent scope for discretion; fragmented systems of local governance and poor central-local coordination; inconsistent access and quality of support from local regulators wider sources of information, advice and support that, while often valued, were experienced as uncoordinated, duplicative and sometimes confusing; and insufficient account taken of workforce challenges. CONCLUSIONS: Underlying many of the challenges experienced were structural issues, for which there have been longstanding calls for investment and strategic reform. For increasing sector resilience, these should be are urgently addressed. Future guidance would also be significantly strengthened by gathering better data, supporting well-facilitated peer exchange, engaging the sector more fully and dynamically in policy-making and learning from care home managers' and staff's experiences, particularly of assessing, managing and mitigating the wider risks and harms associated with visiting restrictions.

Sixteen plus: Young people with declining capacity due to progressive illness: A critique based on governmentality

This study aims to add to the governmentality-based critique of health and social care and bring to bear such analysis to the specific context of those who are sixteen and above and have declining capacity due to progressive illness.The thesis is concerned with aspects of Foucault's work in regards to disciplinary and biopower. It adopts Michel Foucault's term 'governmentality' for analysis of the state's ability to manage its resources economically and efficiently, in a way that allows for regulation and the need to negotiate through a process of self-governing. Through problematising England's health and social care system, the thesis examines the governance of families via policy and legal framework centred on the Mental Capacity Act 2005, the Care Act 2014, and the Children and Families Act 2014. It suggests that the care and support assessment processes control individuals, the workforce, and the population.The study observed how ageing is a problem at a global, national, and local level and examined England's present economic, political, and legal responses. The programme of enquiry examined whether or not the rights and interests of people with advanced or progressive illness under these Acts are interpreted and followed as parliament intended. This study observed individuals, family and friend carers as they engaged and experienced the formal assessment processes - bringing to the forefront the ways of obtaining new knowledge into everyday contemporary life.The empirical study has made visible, comments within the carers' perspective and experiences. The impact of the conversational practices illustrate what Foucault termed the relationship of power and the possibility of resistance within the power/knowledge nexus. The carers' responses highlighted underlying tensions to the health and care system, and specifically the impact of being an unpaid carer. Furthermore, only one of the five had received their carers' assessments as part of the whole family approach. This suggests that the wellbeing of family and friend carers remains expendable in today's contemporary society.However, the 2020 coronavirus pandemic has impacted on this study. During the pandemic, we observe the rapid shift in legislation (whether temporary or permanent), which indicates how forms of institutional power are based on the ability to maintain and change over periods of time, and are not necessarily based on specific laws and legislation in a fixed time.This thesis, therefore, contributes to understanding the specific issue of health and social care governance of those 16 and over with declining capacity due to progressive illness, and the field of governance of health and social care. It combines these two aspects in the context of Foucault's work. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Stepping up for Operation Moonshot - Mass Spectrometry Testing for Covid 19

In September 2020 the UK government announced Operation Moonshot;the remit being to increase testing capacity for COVID 19. Amongst the diagnostic platforms to be considered was mass spectrometry. To facilitate this the Department of Health and Social Care (DHSC) brought together and funded academic mass spectrometry (P1) and specialist NHS laboratories (P2) across the UK With regards to the latter the GOSH Enzyme Lab and the Neurometabolic Unit (National Hospital) were identified as a P2 grouping that would collaborate with the mass spectrometry unit at the UCL Institute of Child Health (P1 - Head Prof K Mills). This P1 lab developed a unique proteomic approach to measure diagnostic proteins associated with the SARS-CoV-2 virus This method was transferred over to our NHS labs for full validation. Rapid progress was made and the DHSC identified us as a 'vanguard lab'. Within 6 months of commencement of the project a validated method was developed that had excellent agreement with PCR testing Our data was used in presentations throughout the DHSC and for briefing of government ministers. Despite the pressures of the pandemic our NHS staff went above and beyond to deliver on time Furthermore close working with an academic partner provided a proof of principle example whereby state of the art mass spectrometry-based methods can successfully be translated across into the NHS environment.

The Views and the Use of Information Communication Technologies to Access Dementia Post-Diagnostic Support: A Systematic Review

Introduction Post-diagnostic support is key to ensuring the well-being of people with dementia and unpaid carers. The COVID-19 pandemic has caused a shift from in-person to remote service delivery, often with the use of information communication technologies (ICT) formats. This systematic review examined how ICT has been used to access remote post-diagnostic support services that address the needs people with dementia, or those of dyad, and explored care recipients' views on accessing dementia-related support remotely. Method Concepts relating to dementia and ICT were searched across six databases (PsychInfo, PubMed, Cochrane Library, CINAHL, Social Care Online, and Web of Science) in March 2021 and updated in March 2022. Studies published from 1990 and written in English, German or French were considered for inclusion. Methodological quality was appraised using the Hawker quality assessment tool and reporting structured according to PRISMA guidelines. Results The search yielded 8,485 citations. Following the removal of duplicates and two screening processes, 18 papers were included. Papers described a range of post-diagnostic support, including exercise classes and therapeutic sessions, which were largely delivered remotely on a one-to-one basis. Videoconferencing software was the most employed ICT format, and people with dementia were directly engaging with ICT to access post-diagnostic support in 13 studies. Whilst studies demonstrated the feasibility of accessing post-diagnostic service remotely, overall, care recipients' views were mixed. Conclusions Following the increased reliance on ICT during the pandemic, it is likely that service delivery will continue with a hybrid approach. Accessing post-diagnostic support remotely is likely to benefit some care recipients. However, to prevent widening inequalities in access, service provision is required to accommodate to people with dementia and unpaid carers who are digitally excluded. Future research should capture the support provided by unpaid carers facilitating the engagement of the person with dementia when accessing remote post-diagnostic support.

From moral distress to mutual recognition: Diaries kept by French care professionals during the Covid crisis

This article focuses on the experiences of social care workers during the first wave of the Covid pandemic. The method involved analyzing diaries kept by 65 professionals in 8 French regions during the first lockdown in France in the spring of 2020. As a form of non-binding, narrative expression, keeping diaries breaks with traditional models of reporting common in social care structures and allowed professionals to reflect on the experience as it was lived. In the diaries, professionals explored how the crisis disrupted and challenged their personal and professional values but also allowed innovation in care practices for vulnerable populations that will continue beyond the pandemic period. Five care values were put to forefront by professionals: (1) spontaneity/flexibility;(2) respect for persons;(3) team reflexivity;(4) innovation;(5) solidarity. Mobilizing philosopher Paul Ricoeur's ideas on recognition, Payet and Laforgue's analysis of weak actors, as well as research on moral distress, we discuss how these values were tested during the crisis and what effect they had on professionals' and users' vulnerabilities. We will also elaborate the interest of keeping account of social care work through narrative methods. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Quality of life of a group of Ecuadorian health professionals in covid-19

Introduction: Covid-19 was the cause of a pandemic that claimed thousands of human lives. The pandemic has caused health professionals mental health problems that influence emotional, psychological and social well-being, which affects the way they think, feel and act in daily life. Objective(s): To de-termine the quality of life of health personnel during the Co-vid-19 pandemic in public institutions in the city of Cuenca. Material(s) and Method(s): Descriptive, cross-sectional and observational study. The study sample was 338 health professionals belonging to the Ministry of Public Health of the Canton Cuenca, province of Azuay-Ecuador, doctors, nurses, dentists, psychologists, assistants and biochemists who work at differ-ent levels of care were included. Two WHOQOL surveys and the Lazarus and Folkman scale of coping modes were used, for the tabulation of the data the RStudio statistical program was used. Result(s): In the psychological domain, no significant destructuring was found in the personnel studied. In the field of health, it should be noted that the personnel studied reported the inability to carry out the activities they need and the diffi-culty in moving from one place to another. Conclusion(s): When investigating the relationship of health personnel with the envi-ronment, no statistically significant alteration was found, but it was evidenced that social support is a protective factor for the mental health of personnel.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.