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J Healthc Manag ; 66(4): 258-270, 2021.
Article in English | MEDLINE | ID: covidwho-1475897


EXECUTIVE SUMMARY: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.

COVID-19 , Critical Care Nursing/economics , Critical Care Nursing/standards , Healthcare Disparities/standards , Home Care Services/economics , Home Care Services/standards , Quality of Health Care/standards , Adult , Aged , Aged, 80 and over , Female , Healthcare Disparities/economics , Healthcare Disparities/statistics & numerical data , Home Care Services/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Patient Satisfaction/statistics & numerical data , Practice Guidelines as Topic , Quality of Health Care/economics , Quality of Health Care/statistics & numerical data , SARS-CoV-2 , United States
Rev. baiana enferm ; 34: e36559, 2020.
Article in Portuguese | LILACS (Americas) | ID: covidwho-1328334


Objetivo: refletir sobre o elevado risco de complicações da COVID-19 em pessoas portadoras de doenças crônicas não transmissíveis, bem como os possíveis desdobramentos para aqueles acometidos pela doença. Método: Revisão narrativa, desenvolvida com base em artigos publicados em periódicos e documentos de órgãos oficiais nacionais. Resultados: O estudo permitiu a reflexão acerca da vulnerabilidade das pessoas com doenças crônicas no contexto de pandemia pelo novo coronavírus, bem como os impactos para esse público. Esse cenário impacta substancialmente nos serviços de saúde, e sinaliza para a necessidade de uma atenção diferenciada no que tange as medidas de prevenção. Conclusão: O atual cenário apresenta-se com muitos desafios para a população, o que requer ações de autocuidado e atendimento às medidas de prevenção que visem o resguardo individual e coletivo.

Objetivo: reflexionar sobre el alto riesgo de complicaciones de la COVID-19 en personas con enfermedades crónicas no transmisibles, así como las posibles consecuencias para los afectados por la enfermedad. Método: revisión narrativa, desarrollada sobre la base de artículos publicados en revistas y documentos oficiales de organismos nacionales. Resultados: el estudio permitió la reflexión acerca de la vulnerabilidad de las personas con enfermedades crónicas en el contexto de la pandemia del nuevo coronavirus, así como los impactos de esta población. Esta situación repercute considerablemente en los servicios de salud, y señala la necesidad de una atención diferenciada con respecto a las medidas de prevención. Conclusión: el escenario actual se presenta con muchos desafíos para la población, que requiere acciones de autocuidado y el atendimiento a las medidas preventivas encaminadas a la protección individual y colectiva.

Objective: to reflect on the high risk of complications of COVID-19 in people with chronic non-communicable diseases, as well as the possible consequences for those affected by the disease. Method: narrative review, developed based on articles published in journals and documents of official national agencies. Results: the study allowed the reflection about the vulnerability of people with chronic diseases in the context of the new coronavirus pandemic, as well as the impacts to this population. This scenario substantially impacts health services, and highlights the need for a differentiated attention regarding the prevention measures. Conclusion: the current scenario presents itself with many challenges for the population, which requires self-care actions and meetings preventive measures aimed at the individual and collective safety.

Humans , Chronic Disease , Coronavirus Infections , Pandemics , Critical Care Nursing , Disease Prevention
Am J Crit Care ; 30(4): 256-265, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1325840


Communication is the essence of the nurse-patient relationship. The critical care nurse's role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients' messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.

Communication , Critical Care Nursing , Intensive Care Units , Nurse-Patient Relations , COVID-19/epidemiology , Humans , Nurse's Role , Pandemics , Professional-Family Relations , SARS-CoV-2
J Nurs Adm ; 51(7-8): 374-378, 2021.
Article in English | MEDLINE | ID: covidwho-1309671


OBJECTIVE: The goal of this qualitative phenomenological study was to explore in-depth, critical care nurses' (CCNs) lived experience while caring for coronavirus disease 2019 (COVID-19) patients during the pandemic. BACKGROUND: CCNs play an important role during pandemics characterized by highly contagious, life-threatening disease. Understanding the experience of CCNs during a pandemic is particularly important because of the high rate of burnout within this group, as well as a shortage of these caregivers across the globe. METHODS: Using Heidegger's interpretive phenomenological approach, interviews were conducted with 10 CCNs caring for COVID-19 patients. The goal of the interviews was to access a deep layer of understanding regarding participants' lived experience. RESULTS: Themes of role frustration, emotional and physical exhaustion, and the importance of presence were revealed. CONCLUSION: Themes revealed suggest a number of actions hospital administrators could take to support CCNs as they experience the challenges of a pandemic.

COVID-19/nursing , Critical Care Nursing , Nursing Staff, Hospital/psychology , Adult , Emotions , Fatigue , Female , Humans , Male , Nurse's Role , Qualitative Research , SARS-CoV-2
Nurse Pract ; 46(7): 22-28, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1276242


ABSTRACT: COVID-19-associated pneumonia is a complex acute care diagnosis that requires careful evaluation and management. This article includes pertinent recommendations for management of acutely ill patients with COVID-19 pneumonia.

Advanced Practice Nursing , COVID-19/nursing , Pneumonia, Viral/nursing , Critical Care Nursing , Humans , Nursing Diagnosis
Br J Nurs ; 30(11): 626, 2021 Jun 10.
Article in English | MEDLINE | ID: covidwho-1266953
Med Care ; 59(5): 371-378, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1254915


BACKGROUND: Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for coronavirus disease 2019 (COVID-19), while retaining capacity for other emergency conditions, is one of the most challenging tasks faced by health care providers and policymakers during the pandemic. Health systems must be well-prepared to cope with large and sudden changes in demand by implementing interventions to ensure adequate access to care. We developed the first planning tool for the COVID-19 pandemic to account for how hospital provision interventions (such as cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affect the capacity of hospitals to provide life-saving care. METHODS: We conducted a review of interventions implemented or considered in 12 European countries in March to April 2020, an evaluation of their impact on capacity, and a review of key parameters in the care of COVID-19 patients. This information was used to develop a planner capable of estimating the impact of specific interventions on doctors, nurses, beds, and respiratory support equipment. We applied this to a scenario-based case study of 1 intervention, the set-up of field hospitals in England, under varying levels of COVID-19 patients. RESULTS: The Abdul Latif Jameel Institute for Disease and Emergency Analytics pandemic planner is a hospital planning tool that allows hospital administrators, policymakers, and other decision-makers to calculate the amount of capacity in terms of beds, staff, and crucial medical equipment obtained by implementing the interventions. Flexible assumptions on baseline capacity, the number of hospitalizations, staff-to-beds ratios, and staff absences due to COVID-19 make the planner adaptable to multiple settings. The results of the case study show that while field hospitals alleviate the burden on the number of beds available, this intervention is futile unless the deficit of critical care nurses is addressed first. DISCUSSION: The tool supports decision-makers in delivering a fast and effective response to the pandemic. The unique contribution of the planner is that it allows users to compare the impact of interventions that change some or all inputs.

COVID-19 , Health Planning Guidelines , Health Services Needs and Demand , Hospitals , Surge Capacity , Workforce , Critical Care Nursing , England , Equipment and Supplies, Hospital , Health Personnel , Hospital Bed Capacity , Humans
Chest ; 160(5): 1714-1728, 2021 11.
Article in English | MEDLINE | ID: covidwho-1248853


BACKGROUND: The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS: Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS: Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS: Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION: We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.

Attitude of Health Personnel , COVID-19 , Delivery of Health Care/organization & administration , Health Workforce , Intensive Care Units/organization & administration , Physicians , Arizona , California , Critical Care Nursing , Elective Surgical Procedures , Equipment Reuse , Female , Hospitals, Community/organization & administration , Humans , Internship and Residency , Leadership , Louisiana , Male , Michigan , New York , Nurses/supply & distribution , Organizational Policy , Personal Protective Equipment/supply & distribution , Process Assessment, Health Care , Qualitative Research , SARS-CoV-2 , Stakeholder Participation , Surge Capacity , Tertiary Care Centers/organization & administration , Washington
J Contin Educ Nurs ; 52(6): 294-300, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1248070


BACKGROUND: The global COVID-19 pandemic has created unprecedented challenges to the health care workforce. Little is known about the effect of the pandemic on new RNs and their preparedness for such a crisis. This study explored the lived experiences of RNs transitioning from students to professionals during the pandemic. METHOD: Semistructured interviews were conducted with 15 new RNs working in acute care facilities during the Maryland COVID-19 State of Emergency. RESULTS: Three themes were identified to describe the experiences of new nurses transitioning to practice in the midst of the COVID-19 pandemic: uncertainty, vulnerability, and resilience. CONCLUSION: New nurses need greater support during transition to practice. Initiatives to improve trusting relationships between new nurses and their organizations and support of the development of essential relationships (e.g., peers, frontline management, and educators) could enhance new nurses' resilience and commitment to stay with the organization. [J Contin Educ Nurs. 2021;52(6):294-300.].

COVID-19/nursing , Clinical Competence , Critical Care Nursing , Nurse's Role/psychology , Nursing Staff, Hospital/education , Nursing Staff, Hospital/psychology , Professional Role/psychology , Adult , Female , Humans , Male , Maryland , Pandemics , Qualitative Research , SARS-CoV-2 , Young Adult
Nurs Adm Q ; 45(3): 226-233, 2021.
Article in English | MEDLINE | ID: covidwho-1211445


New York City quickly became the epicenter of coronavirus disease-2019 (COVID-19) in early March of 2020. While hospitals were aware of the potential of COVID-19, the volume of critically ill patients that flooded the hospitals in the New York City area was clearly not anticipated. Hospital staff worked quickly to create COVID-19-free areas, but were overcome with the volume of COVID-positive critically ill patients. Many newly admitted patients required respiratory support with mechanical ventilation. As Governor Cuomo issued executive orders to stay at home in mid-March, some patients were afraid to go into hospitals despite symptoms of respiratory distress. Once these patients came to the hospital, they were often critically ill. Emergency departments and intensive care units filled rapidly, overwhelming staff and equipment needs with such things as pumps, dialysis machines, medications, and personal protective equipment. Plans for the day were disrupted with frequent rapid response calls and the need for additional beds. Key issues that confronted the COVID-19 response in critical care units at NYU Langone Health included communication, patient and staff safety.

COVID-19/nursing , Critical Care Nursing/trends , Nurses/psychology , Critical Care Nursing/methods , Humans , New York , Nurses/statistics & numerical data , Patient Safety/standards , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution