The 'hole' is greater than the sum of its parts: How conducting home visits during a pandemic revealed gaps in an educational system

Covid-19 turned the world upside down. What started as an impossible situation turned into a problem with new possibilities. Individuals, families, communities, and states worked tirelessly to restore balance to overworked systems. Using semi-structured interviews with teachers and administrators, this high school social worker set out to examine how COVID-19 challenged staff to rethink current educational practices like home visits. This qualitative ethno-infused phenomenological study examines the experiences of home visits by a school social worker during COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study.

INTRODUCTION: Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS: Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS: Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION: Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.

Website information on visiting policies at specialist in-patient palliative care settings during COVID-19 pandemic across Central and Eastern Europe: a quantitative and qualitative study

Introduction: Since the COVID-19 pandemic, visiting policies in various healthcare centres across the world have changed. Visiting patients by relatives and friends have been stopped or significantly limited. New conditions and legal constraints for family visits had to be implemented also at in-patient palliative care settings, even though accompanying a dying person is crucial for the quality of the end of life. The study aimed to identify and review the visiting policies at in-patient specialist palliative care settings across Central and Eastern Europe. Patients and Methods: The study was conducted one year after the COVID-19 pandemic outbreak from May to October 2021. Information about visiting policies, published on official websites of the in-patient specialised palliative care settings (stationary hospices and hospital-based palliative care units) from Central and Eastern European countries, were identified and categorised. The websites which lacked information about visiting policy during the COVID-19 pandemic were excluded. Qualitative and quantitative analysis of the obtained data was conducted by using content analysis techniques and descriptive analysis. The content from websites was translated into Polish with the usage of the Google Translate machine tool. Result(s): Data from 55 in-patient palliative care settings from 8 countries were collected and analysed (83.6% from Poland, and the other from Bulgaria, Czech Republic, Estonia, Lithuania, Romania, Slovakia and Ukraine). In 43.6% of the organisations, visits were stopped and 56.4% of settings published information about the special requirements for visiting arrangements. In 32.7% of all examined units upfront approval from a physician or the head of a department for visiting a patient was required, and 29.1% published information about personal protective equipment. 32.7% of organizations recommended telephone contact with the patient, and 12.7% provided video calls. Conclusion(s): Web information regarding visiting patients in in-patient palliative care settings is limited. There is a need to establish detailed requirements for the visits with better access to the website for the visitors, in case of a global disease outbreak.Copyright © Via Medica, ISSN 2545-0425, e-ISSN: 2545-1359.

Welcoming a new-born infant in times of coronavirus: Making the family fabric despite hospital visiting restrictions

The sanitary measures taken within hospitals during the COVID-19 pandemic, and in particular during the "first wave" challenged the author in the context of clinical practice in a neonatal intensive care unit. Closing hospitals to visitors for health safety reasons led to preventing new fathers from entering maternity wards and limiting or even prohibiting parental visits to their hospitalised new-borns. How can we devise ways of building the family when the family is emerging or extending under such extreme conditions? Through a few observations and the analysis of a clinical case, the author invites us to rethink practices limiting visits of parents but also of siblings to hospitalised babies. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Les mesures sanitaires prises dans les hopitaux durant l'epidemie mondiale de covid-19, notamment au cours de la << premiere vague , sont venues questionner l'auteure dans le cadre de sa pratique au sein d'un service de reanimation neonatale. La fermeture de l'institution hospitaliere aux visiteurs au nom de la securite sanitaire a ainsi conduit a fermer les services de suite de couches aux peres et a limiter, voire interdire, les visites des parents aupres de leur nouveau-ne hospitalise. Comment inventer des moyens de faire famille au moment ou la famille se constitue ou se reamenage dans des conditions aussi extremes ? Au travers de quelques observations et de l'analyse d'un cas clinique, l'auteure invite a repenser les pratiques limitant les visites des parents mais egalement des freres et soeurs aupres des bebes hospitalises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

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.

Towards family preservation: A systematic jurisdiction analysis of prison visitation policies during the COVID-19 pandemic

Since the onset of COVID-19, visitation to correctional facilities has been in flux, including periods of nationwide suspensions for all in-person visits. Frequent, high-quality parent-child interactions are critical in preventing recidivism and beneficial for the healthy development of children with incarcerated parents. As more variants arise, prisons must reevaluate their family visitation policies to ensure that families stay connected yet safe. As a follow-up to a previous study, we documented how different jurisdictions, including all 50 states, the District of Columbia (D.C.), and the Federal Bureau of Prisons (BOP), communicated, via their websites, their response to COVID-19 and the changes to prison visitation policies. Using each jurisdiction's website as our primary data source, we gathered publicly available information related to each state's COVID-19 safety protocols and prison visitation policies, with special attention to policies pertaining to minors. Findings suggest that as of November and December 2021, all jurisdictions, except D.C., had resumed in-person family visits (n = 34;65.4%) or had announced their commitment to a phased return (n = 17;32.7%). Additionally, most states and D.C. (n = 35;65.7%) offered video visits to all of their prison residents (incarcerated individuals) and six states (11.5%) offered video visits to some of their residents, whereas 11 states and the Federal BOP (21.2%) did not offer any video visits as an alternative. Despite the continued need for safe, accessible, and family-friendly alternatives to in-person visits, 11 jurisdictions did not offer video visitation to their residents further straining families' ability to stay connected through the ongoing COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The interplay of home visitors' personal and professional identities in effectively screening and supporting women around sensitive topics

Home visiting programs provide information, support, resources, and tools that empower new parents to promote positive maternal and child health outcomes. During home visits, there is a unique opportunity to screen for intimate partner violence (IPV), reproductive coercion, and unintended pregnancy with women in unguarded settings (i.e., the women's homes) while providing ongoing services via a therapeutic relationship. Using individual interviews and a deliberative discussion focus group, the current study examined the research question, to what degree do home visiting staff members' personal and professional identities impact their ability to effectively screen and support pregnant women and new mothers around the topics of unintended pregnancy and intimate partner violence including reproductive coercion? Interviews and a deliberative discussion focus group were conducted virtually with staff members from Healthy Families America (HFA) programs in Maryland. Six major themes emerged from the interviews and focus group: personal versus professional experience, therapeutic alliance building, keeping families engaged, use of supervision, addressing intimate partner violence/reproductive coercion in families, and home visiting in the time of a health pandemic. Participants shared how their personal and professional identities helped shape their perceptions of their roles within the home visiting field including the terms, its meaning, and the expectations of that role. The findings suggest that home visitors need additional training around reproductive health since they routinely interact with pregnant women and new mothers who are at-risk for poor pregnancy-related health outcomes that may be due to the lack of control or intention related to reproduction. Participants expressed general knowledge, comfort, safety plan creation, and resource linking around the issue of IPV. Participants had received extensive training on administering the Relationship Assessment Tool (RAT), which is the IPV screener for HFA. However, relatively few program recipients endorsed that their HFA program recipients are experiencing IPV using the RAT. Therefore, HFA staff would benefit from advanced level training utilizing more clinical skills around the topic of IPV including advanced screening skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Effect of coronavirus (Covid-19) pandemic on biological air pollutants: a case study of Valiasr hospital in Zanjan (2019-2020)

Background and Objective: Bioaerosols as small particles enter the body by inhalation and lead to respiratory diseases based on type, concentration, and exposure time. In sensitive workplaces such as medical centers, it is necessary to pay attention to the type and population of these pollutants and the possibility of nosocomial infections. In the present study, the population and type of bioaerosols (bacteria and fungi) in the air of different hospital wards under normal conditions, visiting hours, and Covid-19 pandemic was evaluated. Materials and Methods: Air sampling was carried out in different wards and ambient air of Valiasr Hospital of Zanjan during September 2019 (morning and visiting hours) and October 2020 (Corona pandemic) using an air sampling pump (Flite 3-SKC Ltd) with a flow of 14.1 L/min and then cultured in Sabaroud dextrose agar and nutrient agar. Results: The results showed that air pollution in wards such as infectious diseases and clinics in both periods was more than other wards. The microbial density during visiting hours (before the coronavirus outbreak) was almost 30% higher than normal conditions. In October 2020, due to the coronavirus outbreak and reduced traffic, microbial air pollution in the hospital decreased. In both periods of study, the frequency of gram-positive bacteria, especially Staphylococcus species (49%) was higher than other bacteria and among fungal species the frequency of Aspergillus (47%) was higher than others. Conclusion: This study showed that traffic restrictions caused by the coronavirus pandemic reduce microbial density in hospital space and this achievement can be used in the future with the aim of improving air quality and controlling nosocomial infections. © 2022 Iranian Association of Environmental Health, and Tehran University of Medical Sciences.

Variation in Communication and Family Visiting Policies in Italian Intensive Care Units during the COVID-19 Pandemic: A Secondary Analysis of the COVISIT International Survey.

BACKGROUND: During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies in Italian ICUs during the pandemic. METHODS: A secondary analysis from the COVISIT international survey was conducted, focusing on data from Italy. RESULTS: Italian ICUs provided 118 (18%) responses out of 667 responses collected worldwide. A total of 12 Italian ICUs were at the peak of COVID-19 admissions at the time of the survey and 42/118 had 90% or more of patients admitted to ICU affected by COVID-19. During the COVID-19 peak, 74% of Italian ICUs adopted a no-in-person-visiting policy. This remained the most common strategy (67%) at the time of the survey. Information to families was provided by regular phone calls (81% in Italy versus 47% for the rest of the world). Virtual visiting was available for 69% and most commonly performed using devices provided by the ICU (71% in Italy versus 36% outside Italy). CONCLUSION: Our study showed that restrictions to the ICU applied during the COVID-19 pandemic were still in use at the time of the survey. The main means of communication with caregivers were telephone and virtual meetings.

Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada.

INTRODUCTION: During the pandemic many Canadian hospitals made significant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. METHODS: A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. RESULTS: Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. CONCLUSIONS: The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-fits-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.

The lived experiences of health care professionals regarding visiting restrictions in the emergency department during the COVID-19 pandemic: A multi-perspective qualitative study.

AIMS: To explore the lived experiences of emergency department (ED) healthcare professionals regarding visiting restrictions during the COVID-19 pandemic. DESIGN: A qualitative phenomenology study. METHODS: Semi-structured interviews were undertaken. Participants consisted of 10 physicians, 20 clinical nurses, and three managers, who were purposefully selected from two EDs in China between April and July 2021. Colaizzi's approach guided data analysis. RESULTS: Four themes arose: (i) burden moral injury, (ii) higher workload to provide and support patient- and family-centered care, (iii) dissatisfied and unsafe healthcare service for patients and families, and (iv) tailoring strategies to provide family-centered care. PATIENT OR PUBLIC CONTRIBUTION: This study explored the lived experiences of ED health care professionals regarding visiting restrictions during the COVID-19 pandemic. Noted challenges included communicating with families and ethical decision making. Strategies that support ED clinician welfare, and communication with families are warranted if visiting policy restrictions are continued or re-introduced.

A Survey on forensic odontologists' activity in Italy during the COVID-19 pandemic.

Few information on virus contagion at the beginning of the covid-19 pandemic led to severe restrictions in the dental and forensic activity in Italy, the introduction of procedural guidelines and implementation of preventive measures. A specific survey on Italian forensic odontologists (FOds) activity was conducted to investigate the COVD-19 pandemic impact on daily practices, the preventive measures adopted to manage the risks of contagion procedures performed on living and dead people and the possible peculiar cases that required the intervention of a medical examiner. A total of 122 FOds answered, mostly males over 46 years coming from northern Italy. The results highlight the lack of specific guidelines for the procedures on living people compared to those on the dead but the regulations for the daily clinical practice resulted more than sufficient: in fact, more than 80% of FOds adopted the preventive and safety measures provided for dental practices. The forensic activity significantly decreased during the initial period (more than 75%) and gradually normalized to pre-pandemic numbers in approximately 50% of cases after the implementation of the vaccination campaign. 13 cases of occupational contagion have been reported, most of them (more than 85%) in northern and central Italy. In two cases members of the dental staff sued the employer for responsibility in the contagion. The decrease of the overall ID activity during the pandemic time can be more likely attributed to the of the dental data than the real impact of the pandemic regulations. The use of telematic tools, such as teleconferences, for many procedures proved to be an important resource useful for application even in post-pandemic times.

Sociobehavioural Factors Associated With Child Oral Health During COVID-19.

OBJECTIVES: The aim of this study was to identify the sociobehavioural factors that influenced children's oral health during the COVID-19 pandemic. METHODS: The online cross-sectional study was conducted in Al Jouf Province in the northern region of Saudi Arabia. A total of 960 parents of children aged 5 to 14 years were invited by multistage stratified random sampling. Descriptive, multinomial, and multiple logistic regression analyses were performed to estimate odds ratios and determine the relationship between independent and dependent variables. P < .05 was considered statistically significant. RESULTS: Of the 960 participants, 693 (72.1%) reported that their child had 1 or more untreated dental decay. The children of uneducated parents were 1.6-fold more likely to have 1 or more untreated dental decay (adjusted odds ratio [AOR], 1.66; 95% CI, 0.74-3.73; P < .001). The children of unemployed parents were 4.3-fold more likely to have a financial burden for a child dental visit (AOR, 4.34; 95% CI, 2.73-6.89; P < .001). Parents from a rural area were 26.3-fold more likely to have spent a lag period of over 2 years since their child's last dental visit (AOR, 26.34; 95% CI, 7.48-92.79; P < .001). Nursery-level children were 5.4-fold more likely to need immediate care (AOR, 5.38; 95% CI, 3.01-9.60; P < .001). CONCLUSIONS: The present study demonstrated a very high prevalence of 1 or more untreated dental decay in our cohort. Children of rural areas, uneducated, unemployed, widow/divorced, low- and middle-income parents and nursery school children were linked to poorly predictive outcomes of child oral health during the pandemic.

Patient safety and hospital visiting at the end of life during COVID-19 restrictions in Aotearoa New Zealand: a qualitative study.

BACKGROUND: Visiting restrictions were enacted in Aotearoa New Zealand to reduce transmission of COVID-19 and protect the healthcare system. This research aimed to investigate the experiences of families and clinicians of hospital visiting for people with palliative and end-of-life care needs during restrictions. METHODS: Semistructured interviews were completed between March and October 2021 with family members and clinicians who had personally experienced enactment of visiting restrictions during pandemic restrictions. A critical realist ontology was used to approach data analysis, sorting and coding to generate themes. RESULTS: Twenty-seven participants were interviewed, 13 being families who had experienced bereavement of a family member during the restrictions: seven nurses or physicians and seven being non-bereaved family members. Four themes were generated: patient safety-(re)defining the 'Visitor'; the primacy of SARS-CoV-2-patient safety and negotiating risk; dying alone: enduring harms; and agency, strategies and workarounds. CONCLUSION: Visitor rights and visitor policy at the end of life require greater protection during a pandemic. Transparent, coherent, publicly available evidence-based guidelines that key stakeholders, including patients, families and ethicists, are included in producing, are urgently required. We want to avert a legacy of disenfranchised grief in future pandemics.

Interpreter use in sustained nurse home visiting: interpreter experience and support.

BACKGROUND: The aim of this study was to explore the experiences of healthcare interpreters working with child and family health nurses (CFHNs) in providing child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs to culturally and linguistically diverse (CALD) families with limited English proficiency. METHODS: A mixed methods longitudinal research design was conducted to develop, implement and evaluate a training and practice support model for healthcare interpreters working with nurses and CALD families in providing CFHN services and SNHV programs in three major local health services in Sydney, Australia. One pre-training survey with 24 healthcare interpreters was conducted; field notes were recorded during training and implementation; and a post-implementation focus group with six healthcare interpreters was conducted. Quantitative survey data were analysed descriptively using Alchemer. The focus group was audio-recorded for transcription purposes, and this and the field notes were thematically analysed applying a socioecological framework. RESULTS: Three themes were identified from the initial, pre-training survey: facilitate communication and delivery accurately; a bridge linking the clients and the healthcare practitioners; and make everybody feel comfortable. Practice support implementation was negatively impact by system and COVID-19 related barriers. Four themes were developed from evaluative phase of the study including: system-related issues; interpreters' challenges; working with nurses; and client session related issues. CONCLUSION: Quality interpreting was favourably influenced by adequate time for interpreting the session including a pre- and post-briefing session with CFHNs, an appropriate mode of interpretation, allocation of female interpreters and the same interpreters with CALD mothers and clarity about interpreter role and cultural comfort. These strategies support the quality of communication and relationships in delivery of CFHN services and SNHV programs to CALD mothers with limited English proficiency.

Facilitating parent-child interaction in home visiting: Staff experiences and supervisory support

The infant and early childhood home visiting field intends to mitigate the detrimental effects of poverty on young children's development by using a two-generational approach that supports both children and their caregivers. One of the central goals of home visiting is promoting positive parent-child interaction. A best practice for home visitors in working to achieve this goal is the facilitation of parent-child interaction, or parent-child coaching, which provides parents an opportunity to learn through modeling, practice, feedback, and reflection. The limited research on parent-child coaching in the home visiting field has found that home visits often lose focus on this topic area. However, very little is known about staff experiences with coaching in the home and what supports they receive in this area (i.e., supervision and ongoing professional learning). This study used an explanatory, sequential mixed-methods approach to explore staff's beliefs, attitudes, and experiences with coaching and their existing and desired training and support in this area. Forty-one home visitors and supervisors from Early Head Start (EHS) and Healthy Families America (HFA) programs throughout Maryland completed online surveys, and 15 completed virtual interviews. Surveys revealed a high self-reported frequency of coaching in home visits, and interviews revealed beliefs and attitudes consistent with a family-centered, parent empowerment approach to supporting parent-child interaction. Interviews also revealed nuances in coaching frequency, with variation due primarily to family stressors, family attitudes and expectations, and most notably, disruptions to home visits during the COVID-19 pandemic. Home visiting staff generally reported feeling satisfied with the training they've received in parent-child coaching (or supervising this activity), and home visitors reported feeling well-supported by their supervisors, with some room for improvement in the quality of professional coaching. Limitations are discussed with regard to small sample size, lack of observational data, and complications in data collection and interpretation due to the ongoing pandemic. This study, however, makes an important contribution to the limited literature and can inform training developers and program administrators on how to best support their staff in achieving this key program goal and, ultimately, improving family outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Family support in intensive care units during COVID-19 visit ban: A multinational Delphi Study during first COVID-19 wave.

OBJECTIVES: This study assessed opinions and experiences of healthcare professionals, former patients and family members during the first wave of the COVID-19 pandemic and focuses on challenges in family-centred care for intensive care unit patients and affected families. RESEARCH METHODOLOGY/DESIGN: A two-round modified Delphi process assessed the opinions and experiences of experts such as healthcare professionals, former patients and their families (n = 151). SETTING: This study was conducted across four countries in Europe. RESULTS: In total, 121 participants (response rate 80.13%) answered the first Delphi round; the second was answered by 131 participants (response rate 86.75%). Participants perceived family support in the intensive care unit as highly important during the COVID-19 pandemic. Enabling contact amongst patients, families and clinicians is regarded as essential to build hope and confidence in the treatment and the recovery process. The extraordinary situation led to the implementation of new communication structures such as video calls and websites. CONCLUSION: A consensus was reached between healthcare professionals that virtual contact is essential for patients with COVID-19 and their families during visit restrictions. This should be done to establish confidence in the treatment.

General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: a retrospective survey among nursing home managers.

BACKGROUND: Though evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners' (GP) care during the pandemic in nursing homes is still scarce. METHODS: A retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses. RESULTS: The majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1-50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51-100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents. CONCLUSION: We found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes.

The impact of restrictions to visiting in paediatric intensive care during the COVID-19 pandemic.

BACKGROUND: Restrictions to hospital visiting were mandated during the COVID-19 pandemic, with variability in the degree of restriction imposed. At times, paediatric intensive care units (ICU) restricted visiting to one parent/carer. Views of parents/carers and ICU staff about changes in the visiting policy are not well understood. DESIGN: Service evaluation involving questionnaire survey incorporating rating scales and free-text comments. SETTING: Inner-city specialist children's hospital. PARTICIPANTS: Parents/carers of children on ICU between December 2020-March 2021 and staff who were working on ICU during May-June 2021. MEASUREMENTS AND RESULTS: Parents and staff on ICU were invited to complete a questionnaire focusing on their experience of being or working on ICU. Quantitative data were analysed descriptively and free-text comments were thematically analysed. Completed questionnaires were received from 81/103 (79%) parents/carers and 217/550 (39%) staff. The majority of parents (n = 60;77%) and staff (n = 191;89%) understood the need for the one-parent visiting policy but acknowledged it was a source of considerable stress. More staff than parents agreed it was appropriate other relatives/friends visiting was not permitted (Z = 3.715;p < .001). There was no association between parents' satisfaction with their child's care and views about the visiting policy. However, staff were more likely to report an impact on their ability to deliver family centred care if they disagreed with the policy. CONCLUSION: The COVID-19 visiting policy had a clear impact on parents and staff. In the event of any future threat to open-access visiting to children in hospital, the potentially damaging effect on children, parents, and staff must be considered. RELEVANCE TO CLINICAL PRACTICE: Visiting policies need to take account of parents being partners in their child's care, rather than purely visitors to the unit where their child is being cared for. Visiting for two carers should always be facilitated, including during a crisis such as a pandemic.

Health needs of vulnerable children and young people: the role of health in child protection conferences and representation in child protection plans

ObjectivesOver 50,000 children and young people in England are subject to a child protection plan.1 It is well established that abuse is detrimental to many aspects of child health in the short-, medium- and long-term.2 This project sought to build on existing knowledge to further understand the role health plays in child protection conferences. Specifically it sought to understand the health needs of vulnerable children and young people subject to child protection plans, how health needs are discussed at child protection conferences and which professionals are advocating for children and young people's health through the child protection process.MethodsRetrospective cohort study of case notes relating to 24 families (40 children) who underwent initial and review child protection conferences from January 2019-February 2021 in one local authority. This included accessible NHS notes and minutes from child protection meetings. Conference notes were reviewed to understand why conferences were taking place, which professionals were present, what health needs were discussed and what steps were taken in child protection plans to address health needs.ResultsHealth needs were almost universally addressed in child protection plans (23/24), with plans most commonly reporting on the need for school nurse assessment or health visitor monitoring. Health visitors and school nurses attended almost all conferences. Only seven children in this cohort were offered a Child Protection Medical Assessment with a paediatrician. High BMI and emotional distress were the most common health needs discussed. Emotional health was regularly commented on in conferences, particularly when domestic abuse was a factor. Plans commented on the need for CAMHS referral or to access emotional support in school. Access to emotional support in school was limited by school closures due to Covid-19 restrictions.Eighteen adolescents (10–17 years old) were involved in the analysis, many of whom had emotional health needs (14/18) or physical health needs (13/18);3 had contextual safeguarding needs. School nurses played an important role during and between conferences in identifying and managing the health needs of this vulnerable cohort of young people. Fourteen adolescents had school nurse assessments as part of their child protection plan, which provided an opportunity for health promotion and enabled identification of new health needs. School nurses were also able to offer psychosocial support, particularly to young people with contextual safeguarding concerns.ConclusionsHealth was well addressed in child protection conferences and plans. Health needs were almost exclusively represented by health visitors and school nurses. Emotional health needs were recognised and discussed in conferences, with limited avenues for children and young people to access support, particularly when support available through school was affected by Covid-19-related school closures. School nurses played a particularly important role for vulnerable adolescents subject to child protection plans as they were able to identify health needs, take appropriate steps to ensure management was in place and provide psychosocial support in the school setting.ReferencesChild protection plan statistics: England 2017–2021. NSPCC, 2021.State of Child Health. Royal College of Paediatrics and Child Health, 2020.