Impact of COVID-19 on nursing work in emergency units / Impacto da COVID-19 no trabalho de enfermagem em unidades de urgência/emergência / Impacto del COVID-19 en el trabajo de enfermería en unidades de urgencia/emergencia

Resumo Objetivo Analisar o impacto da pandemia da Coronavirus Disease 2019 (COVID-19) no trabalho de enfermagem em unidades de urgência e emergência. Métodos Pesquisa de abordagem qualitativa realizada entre profissionais de enfermagem atuantes em unidades de urgência e emergência no estado do Rio de Janeiro, Brasil. Dados coletados via online por meio de formulário semiestruturado e submetidos à análise lexicográfica no software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ). Resultados Participaram 31 profissionais de enfermagem. O aproveitamento do corpus textual foi de 94,9% mediante a geração de seis classes de segmentos de textos, que possibilitou identificar que os profissionais que atuam nessas unidades têm vivenciado sobrecarga no desenvolver laboral, dada a carga horária de trabalho exaustiva, bem como a falta de infraestrutura, de equipamentos de proteção e de recursos humanos. Ainda, evidenciaram-se desgastes físicos e mentais, com ênfase para o estresse e a exaustão, além do sentimento de medo pelo receio de contaminação. Conclusão A pandemia da COVID-19 promoveu impactos diretos no trabalho de enfermagem em unidades de urgência e emergência no que tange a aspectos relacionados a recursos humanos e materiais e infraestrutura, além da assistência prestada aos pacientes em condições graves.

Resumen Objetivo Analizar el impacto de la pandemia de Coronavirus Disease 2019 (COVID-19) en el trabajo de enfermería en unidades de urgencia y emergencia. Métodos Investigación de enfoque cualitativo realizada entre profesionales de enfermería que actúan en unidades de urgencia y emergencia en el estado de Rio de Janeiro, Brasil. Datos recopilados en línea a través de formulario semiestructurado y presentados para análisis lexicográfico en el software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ). Resultados Participaron 31 profesionales de enfermería. El aprovechamiento del corpus textual fue del 94,9 % mediante la producción de seis clases de segmentos de textos, lo que posibilitó identificar que los profesionales que actúan en esas unidades han vivido una sobrecarga en el quehacer laboral, considerando la duración de la jornada de trabajo agotadora, como también la ausencia de infraestructura, de equipos de protección y de recursos humanos. Además, se evidenciaron desgastes físicos y mentales, con énfasis en el estrés y el agotamiento, además del sentimiento de miedo por el temor a la contaminación. Conclusión La pandemia de COVID-19 ocasionó impactos directos en el trabajo de enfermería en unidades de urgencia y emergencia en lo que se refiere a aspectos relacionados con recursos humanos y materiales y con la infraestructura, además de la atención brindada a los pacientes en condiciones graves.

Abstract Objective To analyze the impact of the Coronavirus Disease 2019 pandemic (COVID-19) on nursing work in emergency units. Methods A qualitative research conducted among nursing professionals operating in emergency units in the state of Rio de Janeiro, Brazil. Data collected online through a semi-structured form and submitted to lexicographic analysis in the software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ). Results Thirty-one nursing professionals participated. The use of the text corpus accounted for 94.9%, through the generation of six classes of text segments, which made it possible to identify that professionals working in these units have experienced overload in developing work, given the exhausting workload, as well as the lack of infrastructure, protective equipment and human resources. Also, physical and mental exhaustion was evidenced, with emphasis on stress and exhaustion, in addition to the feeling of fear for fear of contamination. Conclusion The COVID-19 pandemic promoted direct impacts on nursing work in emergency units regarding aspects related to human and material resources and infrastructure, in addition to the care provided to patients in severe conditions.

Assessing the implementation of nurse practitioner-led huddles in long-term care using the Consolidated Framework for Implementation Research (CFIR).

BACKGROUND: The COVID-19 pandemic created major challenges in long-term care (LTC) homes across Canada and globally. A nurse practitioner-led interdisciplinary huddle intervention was developed to support staff wellbeing in two LTC homes in Ontario, Canada. The objective of this study was to identify the constructs strongly influencing the process of implementation of huddles across both sites, capturing the overall barriers and facilitators and the intervention's intrinsic properties. METHODS: Nineteen participants were interviewed about their experiences, pre-, post-, and during huddle implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. CFIR rating rules and a cross-comparison analysis was used to identify differentiating factors between sites. A novel extension to the CFIR analysis process was designed to assess commonly influential factors across both sites. RESULTS: Nineteen of twenty selected CFIR constructs were coded in interviews from both sites. Five constructs were determined to be strongly influential across both implementation sites and a detailed description is provided: evidence strength and quality; needs and resources of those served by the organization; leadership engagement; relative priority; and champions. A summary of ratings and an illustrative quote are provided for each construct. CONCLUSION: Successful huddles require long-term care leaders to consider their involvement, the inclusion all team members to help build relationships and foster cohesion, and the integration of nurse practitioners as full-time staff members within LTC homes to support staff and facilitate initiatives for wellbeing. This research provides an example of a novel approach using the CFIR methodology, extending its use to identify significant factors for implementation when it is not possible to compare differences in success.

Patient-Centered Care Through Nurse Practitioner-Led Integrated Behavioral Health: A Case Study.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.

An Examination of Self-Employed Nursing Regulation in Three Canadian Provinces.

The COVID-19 pandemic and its related stresses such as short-staffing, heavy workloads, and burnout are prompting nurses to re-consider institutional employment, bringing a renewed interest in self-employed nursing and its regulation. There is limited research on the regulation of self-employed nursing roles, and published work focuses on nurses' experiences rather than on regulatory practices themselves. This qualitative case study research aimed to examine the regulation of self-employed nurses by comparing the regulatory policies and processes of nursing regulatory bodies in Ontario, Alberta, and Saskatchewan. The findings demonstrated wide variation in the regulation of self-employed nurses across these jurisdictions. The article includes recommendations to clarify and harmonize the processes used to regulate self-employed nurses.

Association between the Nursing Practice Environment and Safety Perception with Patient Safety Culture during COVID-19.

AIMS: In this study, we aimed to identify the relationship between nursing practice environments (NPEs) and safety perceptions with patient safety culture (PSC) during COVID-19. DESIGN: We conducted a quantitative, non-experimental, correlational, and cross-sectional study. We interviewed 211 nurses from Peru using two scales: PES-NWI and HSOPSC. We used the Shapiro-Wilk test and Spearman's coefficient and estimated two regression models. RESULTS: NPE was reported as favorable by 45.5% of the participants, and PSC was reported as neutral by 61.1%. Safety perception, the workplace, and NPE predict PSC. All NPE factors were correlated with PSC. However, safety perception, support of nurses subscale, the nurse manager's ability, and leadership were predictors of PSC. CONCLUSION: To promote a safe work culture, health institutions should foster leadership that prioritizes safety, strengthens managers' abilities, encourages interprofessional collaboration, and considers nurses' feedback for constant improvement.

Factors Associated with Job Stress and Their Effects on Mental Health among Nurses in COVID-19 Wards in Four Hospitals in Korea.

Increased workload during the COVID-19 pandemic has threatened nurses' mental health. This study aimed to identify factors associated with job stress in COVID-19 nurses compared to other nurses. Nurses were recruited from four hospitals in Republic of Korea in November 2020. The general sociodemographic questionnaire, job stress, anxiety (GAD-7), and depression (PHQ-9) were used to conduct an online survey. Stepwise multiple regression analysis was used to identify the factors associated with job stress. A total of 290 participants were analyzed: 122 in the dedicated ward and 168 in the nondedicated ward nurse groups. Job stress, anxiety, and depression were higher in nurses dedicated to COVID-19 (4.19 ± 0.59, 5.98 ± 3.92, and 6.97 ± 4.47, respectively) than in the nondedicated group (3.92 ± 0.72 (p = 0.001), 4.98 ± 4.20 (p = 0.042), and 5.92 ± 4.36 (p = 0.047), respectively). Among COVID-19 nurses, job stress levels were higher in 30-39 year olds than in 20-29 year olds (3.71 ± 0.43 vs. 4.04 ± 0.54, p = 0.006) and in non-smokers compared with smokers (3.85 ± 0.49 vs. 3.38 ± 0.53, p = 0.24). Anxiety (ß = 0.34, standard error (SE) = 0.01, p < 0.001) and clinical experience of 5-10 years (ß = 0.23, SE = 0.10, p = 0.004) were associated with job stress. These findings can be applied when devising response strategies for infectious diseases and developing psychological and organizational intervention programs for alleviating job stress in nurses.

"I Don't Want to Go to Work": A Mixed-Methods Analysis of Healthcare Worker Experiences from the Front- and Side-Lines of COVID-19.

During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.

The Changing Landscape of Substitute School Nursing A School Nurse Administrator Roundtable.

School nurse administrators increasingly express concerns over the availability of substitute school nurses with return to in-person learning after the height of the COVID-19 pandemic. While healthcare staffing concerns and shortages are not unique to the school setting, the increasing health acuity of the student population, delegation principles, and staffing models complicate the issue. Traditional methods of covering absences may no longer suffice. In this article, five school nurse administrators share strategies, comparing pre-pandemic to current day facilitation of providing coverage for the absences of their healthcare staff.

Restorative clinical supervision: a chance for change but are we ready?

In the wake of the COVID-19 pandemic, nurses are experiencing increasing stress, burnout and mental health problems. The Advocating and Educating for Quality ImProvement (A-EQUIP) model of clinical supervision aims to support staff wellbeing, promote positive work cultures and improve patient care. Although a growing body of empirical evidence supports the positive impact of clinical supervision, several individual and organisational barriers may impede the implementation of A-EQUIP in practice. Organisational culture, staffing and workforce pressures all affect employees' ability to engage with supervision, and organisations and clinical leaders must consciously work to sustain lasting change.

Nursing and Maternity in the Pandemic: A Qualitative Study from Turkey.

OBJECTIVES: This study was conducted to examine the experiences and perceived challenges of nurses who are also mothers having a child during the coronavirus disease (COVID-19) pandemic. METHODS: A descriptive phenomenological design. The study was conducted with 18 nurse mothers working at COVID-19 clinics in Turkey. RESULTS: Nurse mothers missed their children and are worried about infecting their children. Based on content analysis, the themes of the study were determined as follows: (1) Nursing Care Process, (2) Disruption of Family Processes, (3) Nurse Mother's Perspective: Being a Child in a Pandemic, and (4) Coping with Challenges-"Searching for a solution." CONCLUSIONS: Necessary conditions should be provided for nurses with children or family members in need of care and protocols should be made with relevant institutions.

What is already known on the subject? Nurses working in COVID-19 units wear protective equipment and work for a long time under difficult conditions. In addition, nurses who have children are separated from their children because of the fear of transmitting COVID-19.What does this study add? Therefore, nurses caring for COVID-19 patients should alternately be replaced by nurses working in other services. They should be given the opportunity to rest and spend time with their loved ones if they are not carriers of COVID-19.

Exploring the core competencies of clinical nurses in chinese tertiary hospitals: a qualitative content analysis.

BACKGROUND: With the changes in social and medical environments and people's health needs, the nursing core competency should be updated and developed promptly. This study aimed to explore the core competencies of nurses in Chinese tertiary hospitals under the new health development strategy. METHODS: Descriptive qualitative research was conducted using qualitative content analysis. 20 clinical nurses and nursing managers from 11 different provinces and cities were interviewed via purposive sampling. RESULTS: Data analysis revealed 27 competencies, which were grouped into three major categories according to the onion model. These categories were motivation and traits (responsibility, enterprise, etc.), professional philosophy and values (professionalism, career perception, etc.), and knowledge and skills (clinical nursing competency, leadership and management competency, etc.). CONCLUSION: Based on the onion model, core competencies for nurses in Chinese tertiary hospitals were established, revealing three layers of core competencies and giving a theoretical reference for nursing managers to conduct competency training courses based on the competency levels.

The Effectiveness of Healthcare System Resilience during the COVID-19 Pandemic: A Case Study.

Introduction: The outbreak of the COVID-19 pandemic was a period of uncertainty and stress for healthcare managers due to the lack of knowledge (about the transmission of the virus, etc.) and also due to the lack of uniform organisational and treatment procedures. It was a period where the ability to prepare for a crisis, to adapt to the existing conditions, and to draw conclusions from the situation were of critical importance to keep ICUs (intensive care units) operating. The aim of this project is to compare the pandemic response to COVID-19 in Poland during the first and second waves of the pandemic. This comparison will be used to identify the strengths and weaknesses of the response, including challenges presented to health professionals and health systems and ICUs with COVID-19 patients according to the European Union Resilience Model (2014) and the WHO Resilience Model (2020). The WHO Resilience model was suitable to the COVID-19 situation because it was developed based on this experience. Methods: A matrix of 6 elements and 13 standards assigned to them was created using the EC and WHO resilience guidelines. Results: Good governance in resilient systems ensures access to all resources without constraints, free and transparent flow of information, and a sufficient number of well-motivated human resources. Conclusions: Appropriate preparation, adaptation to the existing situation, and effective management of crisis situations are important elements of ensuring the resilience of ICUs.

Role Modeling of Professional Behavior in Nursing Education During the COVID-19 Pandemic: A Mixed Method Study.

This study aimed to examine professional behavior as role models in nursing education during the COVID-19 pandemic perceived by nursing students. This study applied a mixed-method design using a sequential explanatory approach. A total of 120 nursing students participated in the self-reported questionnaire, and 10 were involved in semistructured individual interviews. The Professional Nurse Educator Role-Model questionnaire developed by the authors was used to collect quantitative data, and four open-ended questions modified from a previous study as the guideline in qualitative data collection. Quantitative data were analyzed using descriptive quantitative analysis. Open-ended questions were analyzed using thematic analysis. Quantitatively, students reported that excellent professional behaviors as role models were prevalent in nursing education (Mean 3.61 out of 4). Four themes from qualitative findings were revealed to complement the quantitative data, including teaching by example, altruism, efficiently performing, and effective communication. In conclusion, nurses as educators and clinicians could be students' professional role models, particularly in clinical settings during the COVID-19 pandemic. It is essential for nurse educators and clinicians to actively create a culture of professional nursing care for self and others during the pandemic to be present in wholeness and provide holistic care.

Psychological status and influencing factors of nurse in a Women and Children Hospital under normalized prevention and control of COVID-19 epidemic.

Objective To survey the psychological reaction status and influencing factors of the nurses in a class 3A hospital of Chengdu under the normalized prevention and control of COVID-19 epidemic to provide a theoretical basis for the related department of the hospital formulating the interventional strategy. Methods The cluster sampling methods was used to select 1 079 nurses in a class 3A Women and Children Specialized Hospital of Chengdu City as the study subjects under trending to normalized prevention and control after the outbreak of the novel coronavirus infection from May to June 2021.The self-made general data qestionnaire, Generalized Anxiety Disorder（GAD-7) scale and Maslach Burnout Inventory (MBI) were used to conduct the questionnaire survey, and the SPSS25.0 statistical soft was used for conducting the data analysis. Results Among 1 079 nurses, 304 nurses（28.2%） had the GAD-7 score ≥5 points, which was correlated with the education background, working years, professional and technical posts, working post during the epidemic, awareness of the impact of COVID-19 on work and social and family support, and the differences were statistically significant（P＜0.05）.In the work burnout scale, the subjects with meddle and high levels in the emotion burnout sense, work apathy sense and work non-achievement sense accounted for 40.7%（439/1 079）,33.3%（359/1 079） and 65.7%（709/1 079） respectively. Different professional and technical positions, work position and social and family support during the epidemic had the influence on the level of emotional burnout, different professional and technical posts, work positions during epidemic had the influence on the work apathy sense, different the educational backgrounds and profesional and technical posts and work posts during epidemic had the influence on the work non-achievement sense, and the differences were statistically significant（P＜0.05）.The nurses in the first line epidemic prevention posts had significant work burnout sense. Conclusion The nurses had a certain degree of anxiety and work burnout sense from COVID-19 epidemic outbreak to the normalized prevention and control, which needs to give the psychological support and better prevention and control strategies. (English) [ FROM AUTHOR] 目的 调查成都某三甲妇女儿童医院护士在新型冠状病毒感染(新冠)疫情常态化防控下心理反应状况及影响因素，为医院相关部门制定干预策略提供理论依据。方法 采用整群抽样方法选取2021年5-6月新冠疫情暴发流行后逐渐趋于常态化防控下成都市某三甲妇女儿童专科医院护士1 079名作为研究对象，使用自制一般资料问卷、广泛性焦虑量表、工作倦怠感量表对其进行问卷调查，采用 SPSS25.0 统计软件进行数据分析。结果 1 079名护士中广泛性焦虑量表评分大于或等于5分者304名(28.2%),与学历、工作年限、专业技术职务、疫情防控期间所在工作岗位、新冠疫情对工作影响的认知、社会家庭支持相关，差异均有统计学意义(P＜0.05);工作倦怠感量表的情感倦怠感、工作冷漠感、工作无成就感的中、高水平者分别占40.7%(439/1 079)、33.3%(359/1 079)、65.7%(709/1 079),不同专业技术职务、疫情防控期间所在工作岗位、社会家庭支持对情感倦怠感水平有影响，不同专业技术职务、疫情防控期间所在工作岗位对工作冷漠感有影响，不同学历、专业技术职务、疫情防控期间所在工作岗位对工作无成就感有影响，差异均有统计学意义(P＜0.05),一线防疫岗位护士有明显的工作倦怠感。结论 新冠疫情暴发至常态化防控下护士存在一定程度的焦虑症状和工作倦怠感，需要给予心理支持及更好的防控策略 (Chinese) [ FROM AUTHOR] Copyright of Journal of Modern Medicine & Health is the property of Journal of Modern Medicine & Health 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.)

Supporting practice nurses in diabetes, revalidation and appraisal programme: A practical course for new practice nurses (PN) undertaken diabetes care

Aims: To upskilling PN to undertake diabetes clinics and ensure high quality healthcare for our patients by maintain the nursing workforce in primary care. Method(s): The programme was delivered over two days, one month apart with follow up day's at six months and 1 year. During Covid-19 we had adapted the session to 4 half days over a 2 month period and are waiting to do our follow up day face to face. The programme included a broad range of topics and skills required to undertake diabetes clinics. Result(s): 13 PN attended from different geographical areas in our healthboard;having a various amount of experience as a PN from 16 yrs to 1 month but limited diabetes experience. Through anonymous questionnaire responses we showed an improvement in confidence across a broad range of core skills and management. Asked if they felt individually confident pre and post course -new diabetes diagnosis (38% to 92%), hypoglycaemia (53% to 92%), pens and meters (8% to 76%), sick day rules (30% to 84%), foot screening (61% to 92%) and advising on oral medication (30% no confidence improving to 84%). Increasing PN knowledge will ultimately improve patient's care thus reducing the risk of complications. preceptorship throught the course was offered by experience Diabetes Specialist Nurses. Conclusion(s): Even in these challenging times we have to maintain a skilled workforce by delivering education and preceptorship to PN. The Supporting prActice Nurses in Diabetes, Revalidation and Appraisal programme provides PN the tools to undertake diabetes clinics with confidence and ensure excellent patient care.

Restoring quality of an ECMO education programmme from the aftermath of COVID-19 pandemic: Preliminary results from a continuous quality improvement process

Objectives: Extracorporeal membrane oxygenation (ECMO) is a complex life support modality. To appropriately educate ECMO clinicians, a comprehensive program is required. However, there is no universal ECMO education (EE) program exclusively for intensive care unit Registered Nurses (RNs). Moreover, with the recent Coronavirus Disease 2019 (COVID-19) pandemic, the existing nursing shortage and the ability of ECMO programs to maintain an established EE program worsened. This continuous quality improvement (CQI) aims to reestablish the quality of an EE program at a large academic medical center at one of the past pandemic epicenters. Method(s): A CQI process with the Plan-Do-Study-Act (PDSA) cycle and Ishikawa diagram for root cause analysis (RCA), intervention implementation from July 2022 to June 2023 Results: The RCA revealed intrahospital pandemicrelated restrictions for employee gathering, EE instructor unavailability, increased nursing turnover, increased nursing shortage, and incomplete recordkeeping of ECMO educational activity (EEA) RN attendance as dominant factors disrupting the established EE processes. Six interventions were implemented, with one added in later: 1. Schedule 1 Certification Lecture Day/Quarter (Q), 1 Re-Certification Lecture/Q, and 1 Circuit Skills Class/ month, and 1 Simulation Lab/month 2. Reserve an education room for all EE activities, as COVID-19 policies allow 3. Increase the number of EE instructors 4. Increase Nursing Leadership-ECMO Manager collaboration for optimal RN signup 5. Optimize EEA schedule to help balance RN staffing needs 6. Develop a Master ECMO Folder in Google Drive and maintain updated attendance Five interventions showed positive preliminary results, whereas it was too soon for any conclusion for one (Table 1). Conclusion(s): While preliminary, the achieved results justify that restoring the quality of an ECMO education program after the negative impact of the recent pandemic is possible. However, final results are necessary to infer the effectiveness of each intervention. (Figure Presented).

How to find undetected cases of dementia in care homes: A new approach to dementia diagnosis using a diagnostic tool with five criteria to check and specialist nurses going into care homes and assessing residents could improve detection rates

The pandemic took its toll on memory clinics with many forced to close or scale back their services. This led to lengthening waits for dementia assessment and left many without a diagnosis.

The evolution of a charity support services team

Our charity's mission is dedicated to beating blood cancer by funding research and supporting those affected. Since 1960, we have invested over 500 million in blood cancer research, transforming treatments and saving lives. Since 2015 there has been a Support Services team within the charity. This service was established to provide information that the blood cancer community can trust, in a language they can understand. By connecting and listening to our community they deepen our understanding and help shape our work. Research suggests that blood cancer patients are more likely than any other patients to leave their diagnosis appointment feeling they do not fully understand their condition. Our service can often consolidate the information given by clinicians. Patients also need advice and support on how to adapt to day-to- day life after their diagnosis. There are challenges that are unique to blood cancer, such as living with cancer as a chronic condition, being on 'watch and wait' or fluctuating remissions and relapses. In 2023 the Support Services team have a 7 day presence on our phone line, email and social media platform where people can communicate with one of our trained blood cancer support officers, or one of three Registered Nurses, all who can provide information about blood cancer diagnosis and help with emotional and practical support. We also run an online community forum where people affected by blood cancer can connect, share experiences and provide peer support. The highly experienced haematology nurses provide a clinical aspect to the support of the Blood Cancer Community that enhances the established patient centred support given historically by the charity. The nurses advanced knowledge and experience of haematological cancers, treatments, side effects, holistic care and NHS process can further guide the community. This is in addition to the invaluable information from their treatment teams. In 2023 the Support Services team are now reaching thousands of the blood cancer community. We understand that in the past 3 years the COVID-19 pandemic and the work of our charity around this will have influenced the significant increase in contacts but equally the robust and trusted services provided through this charity has contributed too.

Developing an aid for virtual clinics for education and identification of lipohypertrophy during the Covid-19 pandemic: Diabetesclinic@ home

Aims/objectives: To develop an app to support virtual diabetes clinics to help people with diabetes to check themselves for lipos and to discuss what they found during the virtual consultation. Method(s): Collaborative project between clinical teams and medical illustrators in Swansea Bay University Health Board, academics in Swansea University and Eli Lilly under a Collaborative Working Agreement. The teams worked together to develop the content, animations, and a learning technologist developed progressive web app (PWA). The app was tested by diabetes patient groups in Wales, as well as HCP groups, Welsh Academy for Nurses in Diabetes (WAND) and Diabetes Specialist Nurses (DSN) forum prior to launch in June 2021. Result(s): Between 28th June 2021 and 11th November 2022 the app had 827 unique users and 124 returning users. Users came from 15 different countries including UK, Australia, USA, Germany, Brazil and Saudi Arabia. The proportion of UK users were 480 (60%) England, 265 (34%) Wales, and 19 (2%) Scotland. A total of 41 users completed the feedback form;of those 11 (27%) did not know about lipos prior to using the app, 11 (27%) found a lipo using the app, 14 (34%) said they made changes to injection technique after using the app and 37 (90%) said their knowledge of lipos increased following using the app. Conclusion(s): A PWA can help to aid virtual clinics an provide education for people with diabetes. The diabetesclinic@ home app improved knowledge and detection of lipos and improved injection technique.

Binge drinking alcohol and circadian misalignment in night shift nurses is associated with decreased resiliency to COVID-19 infection

Background: Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. Method(s): We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). Result(s): By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). Conclusion(s): Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.Copyright © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.