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1.
BMJ Open ; 11(12): e049668, 2021 12 23.
Article in English | MEDLINE | ID: covidwho-1598698

ABSTRACT

PURPOSE: The COVID-19 pandemic has influenced hospital work and healthcare workers all over the world. We explored how Danish nurses coped with the fast, comprehensive organisational changes in their workplace and identified barriers to and facilitators for organisations ensuring the best possible conditions for nurses to meet these challenges. The study focuses on the organisational setting and how it did or did not support the nurses in their work. METHODS: A qualitative explorative design was used in interviewing 23 nurses who had worked at a COVID-19 ward in one of three hospitals. Data were collected in the summer of 2020, and the analysis was inspired by Paul Ricoeur's theory of narratives and interpretation. RESULTS: The presence of managers in the wards helped the nurses in the form of psychological and practical support. Working within an organisation that provides a safe environment was essential for nurses. The experience of a safe environment allowed nurses to ask questions, which supported them in finding solutions to specific tasks in the new and critical working environment. Barriers to handling the new situation were an absence of managers and a lack of a sense of belongingness and trust. CONCLUSION: This study highlights the need for management to be present in the ward and for organisational support to be available to nurses so they can provide optimal treatment and care when working in new and unknown conditions during a pandemic. Practical assistance from managers to ease the job is beneficial. Furthermore, the presence of management is essential to provide psychological support and create a safe environment because this allows nurses to ask questions about how to better manage new and critical tasks.


Subject(s)
COVID-19 , Nurses , Nursing Staff, Hospital , Denmark/epidemiology , Hospitals , Humans , Organizational Innovation , Pandemics/prevention & control , SARS-CoV-2
2.
J Cyst Fibros ; 20 Suppl 3: 3-8, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587345

ABSTRACT

BACKGROUND: Novel therapies have dramatically changed cystic fibrosis (CF) and innovative care delivery systems are needed to meet future patient needs. Telehealth has been shown to be an efficient and desirable form of care delivery. The COVID-19 pandemic caused a rapid shift to telehealth, and this presented a unique opportunity to study facilitators, barriers, and satisfaction with this mode of care delivery. We aim to report survey methods, demographics and telehealth use among CF care programs, patients, and families during the pandemic. METHODS: CF programs completed two surveys between July 29 and September 18, 2020, and between April 19 and May 19, 2021. Patients and families completed a similar survey between August 31 and October 30, 2020. The surveys addressed topics assessing the pandemic's financial impact, telehealth modes and experiences, licensure and reimbursement issues, health screening, and remote monitoring. Quantitative data were analyzed with descriptive statistics and were compared to the CF Foundation Patient Registry. RESULTS: Most programs (278 at timepoint one and 274 at timepoint two) provided telehealth during the pandemic. The percent of visits containing either telephone or video components changed from 45% to 25% over the time periods. Additionally, 424 patients and families from various ages and backgrounds responded to the survey and 81% reported having a telehealth visit. CONCLUSIONS: The pandemic accelerated telehealth adoption and these datasets are a valuable source for exploring telehealth barriers and facilitators, the quality-of-care experience, financial and workforce implications, the impact on underrepresented populations, and implications for coverage and reimbursement.


Subject(s)
COVID-19 , Cystic Fibrosis , Health Services Accessibility , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Communicable Disease Control/methods , Communication Barriers , Continuity of Patient Care , Costs and Cost Analysis , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Male , Organizational Innovation , Patient Satisfaction/statistics & numerical data , Quality of Health Care , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology
3.
J Cyst Fibros ; 20 Suppl 3: 1-2, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587341

ABSTRACT

The findings of this body of work are presented in the eight articles included in this supplement. The impact and perspectives of adult and pediatric care teams and patient/families are covered with special attention to mental health care, the financial and personnel impacts within care programs, the experiences of vulnerable and underrepresented patient populations, and implementation of remoting monitoring. Commentaries from colleagues provide a broader perspective, offering reflections on the findings and their implications regarding the future CF care model.


Subject(s)
COVID-19 , Cystic Fibrosis , Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care/trends , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Continuity of Patient Care , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Organizational Innovation , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology
4.
J Cyst Fibros ; 20 Suppl 3: 49-54, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587337

ABSTRACT

BACKGROUND: Due to the COVID-19 pandemic, there was an uptake of telehealth in cystic fibrosis care. Previous studies show disparities in telehealth use based on socioeconomic status (SES). We aimed to: (1) understand telehealth use and perceptions and (2) identify the facilitators and barriers to telehealth use among people with CF and their families (PwCF) from diverse racial/ethnic and socioeconomic backgrounds. METHODS: We conducted an analysis of the 2020 Cystic Fibrosis State of Care surveys completed by PwCF (PFSoC), CF Care Programs (SoC1) and the CF Foundation Patient Registry (CFFPR). RESULTS: A total of 424 PwCF and 286 programs responded to the PFSoC and SoC1. Among PwCF, 90% self-identified as White, 6% as Hispanic/Latino, and 2% as Black. Racial/ethnic minorities were less likely to have had a telehealth visit (p=.015). This difference was pronounced among the Hispanic/Latino population (p<.01). Telehealth use did not differ by health insurance and was similarly offered independent of financial status. Compared to PwCF who denied financial constraints, those who reported financial difficulties found telehealth more difficult to use (p=.018) and were less likely to think that their concerns (p=.010) or issues that mattered most to them (p=.020) were addressed during telehealth. Programs perceived lack of technology, language barriers, and home conditions as barriers to telehealth in vulnerable populations. CONCLUSION: PFSoC and SoC1 identified differences in telehealth use and care perceptions by ethnicity, race, and socioeconomic characteristics. Further studies are needed to understand how telehealth can change access to CF care in diverse subpopulations.


Subject(s)
COVID-19 , Communication Barriers , Cystic Fibrosis , Minority Health , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Cystic Fibrosis/economics , Cystic Fibrosis/ethnology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Financial Stress/ethnology , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Healthcare Disparities/ethnology , Healthcare Disparities/standards , Humans , Minority Health/ethnology , Minority Health/standards , Minority Health/statistics & numerical data , Needs Assessment , Organizational Innovation , SARS-CoV-2 , Socioeconomic Factors , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology , Vulnerable Populations/statistics & numerical data
5.
J Cyst Fibros ; 20 Suppl 3: 16-20, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587336

ABSTRACT

BACKGROUND: Chronic care delivery models faced unprecedented financial pressures, with a reduction of in-person visits and adoption of telehealth during the COVID-19 pandemic. We sought to understand the reported financial impact of pandemic-related changes to the cystic fibrosis (CF) care model. METHODS: The U.S. CF Foundation State of Care surveys fielded in Summer 2020 (SoC1) and Spring 2021 (SoC2) included questions for CF programs on the impact of pandemic-related restrictions on overall finances, staffing, licensure, and reimbursement of telehealth services. Descriptive analyses were conducted based on program type. RESULTS: Among the 286 respondents (128 pediatric, 118 adult, 40 affiliate), the majority (62%) reported a detrimental financial impact to their CF care program in SoC1, though fewer (42%) reported detrimental impacts in SoC2. The most common reported impacts in SoC1 were redeployment of clinical staff (68%), furloughs (52%), hiring freezes (51%), decreases in salaries (34%), or layoffs (10%). Reports of lower reimbursement for telehealth increased from 30% to 40% from SoC1 to SoC2. Projecting towards the future, only a minority (17%) of program directors in SoC2 felt that financial support would remain below pre-pandemic levels. CONCLUSIONS: The COVID-19 pandemic resulted in financial strain on the CF care model, including challenges with reimbursement for telehealth services and reductions in staffing due to institutional changes. Planning for the future of CF care model needs to address these short-term impacts, particularly to ensure a lack of interruption in high-quality multi-disciplinary care.


Subject(s)
COVID-19 , Continuity of Patient Care , Cystic Fibrosis , Health Services Accessibility , Models, Organizational , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Continuity of Patient Care/organization & administration , Continuity of Patient Care/standards , Costs and Cost Analysis , Cystic Fibrosis/economics , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Health Services Needs and Demand , Humans , Organizational Innovation , Personnel Staffing and Scheduling/organization & administration , Reimbursement Mechanisms/trends , SARS-CoV-2 , Telemedicine/economics , Telemedicine/methods , United States/epidemiology
6.
Med Teach ; 43(5): 546-553, 2021 05.
Article in English | MEDLINE | ID: covidwho-1561862

ABSTRACT

BACKGROUND: There is a growing literature on how medical education adapts to the COVID-19 pandemic. However, there is a need to examine the facilitators and barriers of these adaptations. This study explores the strengths, weaknesses, opportunities, and threats (SWOT) of how Italian medical schools adapted their curricula to the COVID -19 pandemic. METHODS: The authors conducted an online survey of directors of medical curricula in Italy. Free-text responses to open-ended questions about curricular adaptations and reflections on these adaptations were analysed using qualitative thematic analysis. RESULTS: Twenty out of 60 Italian medical school directors completed the survey. Strengths identified were rapid responses and a spirit of cooperation. Weaknesses included dependency on clinical facilities, teachers' limited skills to use technology, and lack of mental health support for staff. Opportunities highlighted were clear government rules, new ways of teaching and a renewed focus on underrepresented topics. Threats expressed included impaired relationships, difficulties related to online assessment, lack of IT access, and legal and insurance issues. CONCLUSIONS: This study, in documenting the curricular adaptations of Italian medical schools during an active global pandemic, and recording the perspectives of medical education leaders, offers important lessons for the future.


Subject(s)
COVID-19 , Curriculum/trends , Education, Medical, Undergraduate/trends , Humans , Italy , Organizational Innovation , Pandemics , SARS-CoV-2 , Schools, Medical
9.
J Nurs Adm ; 51(11): 543-545, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1504076

ABSTRACT

Sufficient sleep is vital to the health and safety of healthcare workers and patients alike. Despite this, formal sleep promotion programs rarely exist within healthcare. Guidance does exist for how to incorporate strategies within healthcare organizations. Nurse leaders can spearhead efforts by promoting healthy sleep and instituting change through scheduling practices, unit policies, and supporting staff when barriers to healthy sleep develop.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Nursing Staff, Hospital/psychology , Organizational Innovation , Sleep/physiology , Fatigue/etiology , Humans , Leadership , Organizational Culture
11.
Am J Phys Med Rehabil ; 100(11): 1100-1104, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1483693

ABSTRACT

ABSTRACT: Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.


Subject(s)
Clinical Clerkship , Education, Distance/methods , Education, Medical, Undergraduate/methods , Models, Educational , Physical and Rehabilitation Medicine/education , Adult , COVID-19 , Curriculum , Educational Measurement , Female , Humans , Male , Minnesota , Organizational Innovation , Pandemics , SARS-CoV-2
14.
J Nurs Manag ; 29(7): 1983-1991, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1462857

ABSTRACT

AIMS: To identify the organisational changes faced by front-line nurses working with COVID-19 patients during the first wave and describe how they responded to these changes. BACKGROUND: The COVID-19 pandemic has altered the provision of care and the management of health care around the world. Evolving information about SARS-CoV-2 meant that health care facilities had to be reorganised continually, causing stress and anxiety for nurses. METHODS: Qualitative study based on Rapid Research Evaluation and Appraisal (RREAL). The research took place in hospital and community health settings of the Spanish national health system with a purposive sampling of 23 front-line nurses. Semi-structured interviews were conducted between May and June 2020. The duration was 30-45 min per interview. We used the Dedoose® data analysis software to perform a thematic analysis. RESULTS: Nurses responded to organisational changes using the following strategies: improvisation, adaptation and learning. CONCLUSION: Our rapid approach allowed us to record how nurses responded to changing organisation, information that is easily lost in a disaster such as the COVID-19. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing about their strategies can help planning for future health disasters, including subsequent waves of the COVID-19.


Subject(s)
COVID-19 , Nurses , Humans , Organizational Innovation , Pandemics , SARS-CoV-2 , Spain
16.
Health Care Manage Rev ; 45(4): 277, 2020.
Article in English | MEDLINE | ID: covidwho-1440669
17.
J Healthc Manag ; 66(5): 336-339, 2021.
Article in English | MEDLINE | ID: covidwho-1434536
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