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1.
J Med Internet Res ; 23(2): e25518, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1574300

ABSTRACT

BACKGROUND: COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. OBJECTIVE: The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. METHODS: Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. RESULTS: Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). CONCLUSIONS: Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care.


Subject(s)
Ambulatory Care/methods , COVID-19/therapy , Hospitalization/statistics & numerical data , Patient Isolation , Telemedicine/methods , Adolescent , Adult , Aged , Australia , COVID-19/physiopathology , Cohort Studies , Disease Management , Emergency Service, Hospital/statistics & numerical data , Female , Hospitals , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Nursing Assessment , Patient Discharge , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Telephone , Young Adult
2.
PLoS One ; 16(7): e0254077, 2021.
Article in English | MEDLINE | ID: covidwho-1295523

ABSTRACT

BACKGROUND: Nurse identification of patient deterioration is critical, particularly during the COVID-19 pandemic, as patients can deteriorate quickly. While the literature has shown that nurses rely on intuition to make decisions, there is limited information on what sources of data experienced nurses utilize to inform their intuition. The objectives of this study were to identify sources of data that inform nurse decision-making related to recognition of deteriorating patients, and explore how COVID-19 has impacted nurse decision-making. METHODS: In this qualitative study, experienced nurses voluntarily participated in focused interviews. During focused interviews, expert nurses were asked to share descriptions of memorable patient encounters, and questions were posed to facilitate reflections on thoughts and actions that hindered or helped their decision-making. They were also asked to consider the impact of COVID-19 on nursing and decision-making. Interviews were transcribed verbatim, study team members reviewed transcripts and coded responses, and organized key findings into themes. RESULTS: Several themes related to decision-making were identified by the research team, including: identifying patient care needs, workload management, and reflecting on missed care opportunities to inform learning. Participants (n = 10) also indicated that COVID-19 presented a number of unique barriers to nurse decision-making. CONCLUSIONS: Findings from this study indicate that experienced nurses utilize several sources of information to inform their intuition. It is apparent that the demands on nurses in response to pandemics are heightened. Decision-making themes drawn from participants' experiences can to assist nurse educators for training nursing students on decision-making for deteriorating patients and how to manage the potential barriers (e.g., resource constraints, lack of family) associated with caring for patients during these challenging times prior to encountering these issues in the clinical environment. Nurse practice can utilize these findings to increase awareness among experienced nurses on recognizing how pandemic situations can impact to their decision-making capability.


Subject(s)
COVID-19/nursing , Clinical Decision-Making , Nurses/psychology , Nursing Care/psychology , Pandemics , SARS-CoV-2 , Adult , Aged , Female , Humans , Interviews as Topic , Male , Middle Aged , Nurse-Patient Relations , Nursing Assessment , Professional-Family Relations , Qualitative Research , Symptom Assessment , Workload
3.
J Clin Nurs ; 30(7-8): 952-960, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1066726

ABSTRACT

AIMS AND OBJECTIVES: To document the level of frailty in sub-acute COVID-19 patients recovering from acute respiratory failure and investigate the associations between frailty, assessed by the nurse using the Blaylock Risk Assessment Screening Score (BRASS), and clinical and functional patient characteristics during hospitalisation. BACKGROUND: Frailty is a major problem in patients discharged from acute care, but no data are available on the frailty risk in survivors of COVID-19 infection. DESIGN: A descriptive cross-sectional study (STROBE checklist). METHODS: At admission to sub-acute care in 2020, 236 COVID-19 patients (median age 77 years - interquartile range 68-83) were administered BRASS and classified into 3 levels of frailty risk. The Short Physical Performance Battery (SPPB) was also administered to measure physical function and disability. Differences between BRASS levels and associations between BRASS index and clinical parameters were analysed. RESULTS: The median BRASS index was 14.0 (interquartile range 9.0-20.0) denoting intermediate frailty (32.2%, 41.1%, 26.7% of patients exhibited low, intermediate and high frailty, respectively). Significant differences emerged between the BRASS frailty classes regards to sex, comorbidities, history of cognitive deficits, previous mechanical ventilation support and SPPB score. Patients with no comorbidities (14%) exhibited low frailty (BRASS: median 5.5, interquartile range 3.0-12.0). Age ≥65 years, presence of comorbidities, cognitive deficit and SPPB % predicted <50% were significant predictors of high frailty. CONCLUSIONS: Most COVID-19 survivors exhibit substantial frailty and require continuing care after discharge from acute care. RELEVANCE TO CLINICAL PRACTICE: The BRASS index is a valuable tool for nurses to identify those patients most at risk of frailty, who require a programme of rehabilitation and community reintegration.


Subject(s)
COVID-19 , Frailty , Nurse's Role , Nursing Assessment , Subacute Care , Aged , Aged, 80 and over , COVID-19/nursing , COVID-19/rehabilitation , Cross-Sectional Studies , Female , Frailty/nursing , Humans , Male , Risk Assessment/methods , Severity of Illness Index
4.
J Nurs Care Qual ; 36(2): 105-111, 2021.
Article in English | MEDLINE | ID: covidwho-954424

ABSTRACT

BACKGROUND: Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. LOCAL PROBLEM: Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. METHODS: Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. INTERVENTIONS: A new self-proning nursing protocol was implemented outside the intensive care unit. RESULTS: Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. CONCLUSIONS: Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.


Subject(s)
COVID-19/nursing , Hospital Units/organization & administration , Nursing Assessment/organization & administration , Patient Positioning/nursing , Prone Position , Academic Medical Centers , COVID-19/epidemiology , Chicago/epidemiology , Evidence-Based Nursing/organization & administration , Health Care Surveys , Hospitals, Urban , Humans , Nursing Staff, Hospital , Quality Improvement/organization & administration , Tertiary Care Centers
5.
Australas J Ageing ; 40(1): 48-57, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-954357

ABSTRACT

OBJECTIVE: To develop and conduct preliminary feasibility testing of a clinical screening instrument for early identification of COVID-19 infection in older people residing in residential aged care services (RACS). METHODS: A qualitative study was conducted using a multi-modal approach involving examination of existing literature and national guidelines for COVID-19 clinical screening, formulation of a discussion document with peer review and feasibility testing of a prototype screening tool. RESULTS: Existing COVID-19 clinical screening tools do not consider age-related impacts on clinical presentation. The qualitative analysis identified the important clinical elements to include were a lower threshold for temperature, occurrence of a recent fall and change in functional status. The new elements also had to be simple and feasible to implement. Overall feedback was positive with all participants recommending the use of the new tool. CONCLUSION: A new screening tool for RACS residents was developed addressing the pathophysiological changes with ageing and atypical features of COVID-19 infection.


Subject(s)
COVID-19/diagnosis , Nursing Assessment/methods , Symptom Assessment , Aged , Feasibility Studies , Female , Homes for the Aged , Humans , Male , Nursing Homes , Victoria
7.
Rev Bras Enferm ; 73(suppl 2): e20200260, 2020.
Article in English, Portuguese | MEDLINE | ID: covidwho-788929

ABSTRACT

OBJECTIVE: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. METHOD: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem). RESULTS: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. FINAL CONSIDERATIONS: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Homes for the Aged , Nursing Assessment/methods , Nursing Homes , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adult , Aged , Brazil/epidemiology , COVID-19 , Communication , Coronavirus Infections/epidemiology , Coronavirus Infections/nursing , Coronavirus Infections/transmission , Delphi Technique , Disinfection/methods , Disinfection/standards , Family , Female , Geriatric Nursing , Health Education , Humans , Male , Medical Waste Disposal/methods , Middle Aged , Mortuary Practice/methods , Nursing Assessment/organization & administration , Nursing Assessment/standards , Occupational Health , Patient Isolation , Pneumonia, Viral/epidemiology , Pneumonia, Viral/nursing , Pneumonia, Viral/transmission , SARS-CoV-2
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