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1.
Prof Case Manag ; 26(2): 62-69, 2021.
Article in English | MEDLINE | ID: covidwho-1087857

ABSTRACT

PURPOSE: Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease known as COVID-19, case management has emerged as a critical intervention in the treatment of cases, particularly for patients with severe symptoms and medical complications. In addition, case managers have been on the front lines of the response across the health care spectrum to reduce risks of contagion, including among health care workers. The purpose of this article is to discuss the case management response, highlighting the importance of individual care plans to provide access to the right care and treatment at the right time to address both the consequences of the disease and patient comorbidities. PRIMARY PRACTICE SETTINGS: The COVID-19 response spans the full continuum of health and human services, including acute care, subacute care, workers' compensation (especially catastrophic case management), home health, primary care, and community-based care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: From the earliest days of the pandemic, case managers have assumed an important role on the front lines of the medical response to COVID-19, ensuring that procedures are in place for managing a range of patients: those who were symptomatic but able to self-isolate and care for themselves at home; those who had serious symptoms and needed to be hospitalized; and those who were asymptomatic and needed to be educated about the importance of self-isolating. Across the care spectrum, individualized responses to the clinical and psychosocial needs of patients with COVID-19 in acute care, subacute care, home health, and other outpatient settings have been guided by the well-established case management process of screening, assessing, planning, implementing, following up, transitioning, and evaluating. In addition, professional case managers are guided by values such as advocacy, ensuring access to the right care and treatment at the right time; autonomy, respecting the right to self-determination; and justice, promoting fairness and equity in access to resources and treatment. The value of justice also addresses the sobering reality that people from racial and ethnic minority groups are at an increased risk of getting sick and dying from COVID-19. Going forward, case management will continue to play a major role in supporting patients with COVID-19, in both inpatient and outpatient settings, with telephonic follow-up and greater use of telehealth.


Subject(s)
COVID-19/nursing , Case Management/standards , Critical Care Nursing/education , Health Personnel/education , Health Personnel/psychology , Patient Care Planning/standards , Patient-Centered Care/standards , Adult , Case Management/statistics & numerical data , Curriculum , Education, Nursing, Continuing , Female , Humans , Male , Middle Aged , Pandemics , Patient Care Planning/statistics & numerical data , Patient-Centered Care/statistics & numerical data , Practice Guidelines as Topic , SARS-CoV-2
3.
BMJ Glob Health ; 5(11)2020 11.
Article in English | MEDLINE | ID: covidwho-936903

ABSTRACT

Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country's Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.


Subject(s)
COVID-19 , Hospital Units , Tertiary Care Centers , COVID-19/nursing , COVID-19/prevention & control , COVID-19/therapy , Critical Care Nursing/education , Critical Care Nursing/organization & administration , Critical Illness/therapy , Hospital Design and Construction , Humans , Malawi , Quality of Health Care , Referral and Consultation
4.
J Contin Educ Nurs ; 51(9): 402-411, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-729674

ABSTRACT

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].


Subject(s)
Coronavirus Infections/therapy , Critical Care Nursing/education , Critical Care Nursing/standards , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Health Personnel/education , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Adult , Betacoronavirus , COVID-19 , Curriculum , Education, Nursing, Continuing/organization & administration , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Systems Analysis
6.
Am J Crit Care ; 29(5): e104-e107, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-646188

ABSTRACT

BACKGROUND: In response to the coronavirus pandemic, New York State mandated that all hospitals double the capacity of their adult intensive care units In this facility, resources were mobilized to increase from 104 to 283 beds. OBJECTIVE: To create and implement a 3-hour curriculum to prepare several hundred non-critical care staff nurses to manage critically ill patients with coronavirus disease 2019. METHODS: Critical care nursing leaders and staff developed and implemented a flexible critical care nursing curriculum tailored to the diverse experience, expertise, and learning needs of non-critical care nursing staff who were being redeployed to critical care units during the surge response to the pandemic. Curricular elements included respiratory failure and ventilator management, shock and hemodynamics, pharmacotherapy for critical illnesses, and renal replacement therapy. A skills station allowed hands-on practice with common critical care equipment. RESULTS: A total of 413 nurses completed training within 10 days. As of June 2020, 151 patients with coronavirus disease 2019 still required mechanical ventilation at our institution, and 7 of 10 temporary intensive care units remained operational. Thus most of the nurses who received this training continued to practice critical care. A unique feature of this curriculum was the tailored instruction, adapted to learners' needs, which improved the efficiency of content delivery. CONCLUSIONS: Program evaluation is ongoing. As recovery and restoration proceed and normal operations resume, detailed feedback from program participants and patient care managers will help the institution maintain high operational readiness should a second wave of critically ill patients with coronavirus disease 2019 be admitted.


Subject(s)
Betacoronavirus , Coronavirus Infections/nursing , Critical Care Nursing/education , Curriculum , Education, Nursing/methods , Pneumonia, Viral/nursing , COVID-19 , Humans , New York , Pandemics , SARS-CoV-2 , Time
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