The lived experiences of family members who visit their relatives in Covid-19 intensive care unit for the first time: A phenomenological study.

BACKGROUND: COVID-19 patient experiences in the intensive care unit (ICU) are marked by family separation. Families understand the importance of isolation and hospital visiting policies, but they consider it necessary to visit their loved ones and use personal protective equipment. OBJECTIVE: To describe the lived experiences of family members in their first contact with a relative in a COVID-ICU. METHODS: A phenomenological study was conducted using Cohen's method. The subjects were interviewed using an open-question format to allow them full freedom of expression. Twelve family members were recruited between February and March 2021. RESULTS: Analysis of the qualitative data resulted in five major themes: (1) fear of contagion related to donning/doffing procedures, (2) positive emotions related to first contact with the hospitalized relative, (3) concern for the emotional state of the hospitalized relative, (4) impact of the COVID-ICU and comparisons between imagination and reality regarding the severity of the disease, and (5) recognition of and gratitude toward healthcare professionals. CONCLUSIONS: It has been confirmed that visits to the ICU reduce anxiety among family members. Our findings constitute an internationally relevant contribution to understanding of the needs of relatives who meet loved ones for the first time while wearing personal protective equipment.

The Virtual Patient and Family Advisory Council in the COVID-19 Era.

BACKGROUND: In 2016, we launched our first Patient and Family Advisory Council (PFAC) as a means of collaborating with our patients and families to improve care. Using an Internet-based remote meeting technology, we transitioned to a virtual platform in April. METHODS: We have conducted 12 PFAC meetings across 4 sites to date. Virtual PFAC meeting topics over the past few months include communication about the coronavirus, community resources needed by patients during the pandemic, telehealth visit troubleshooting, current office policy, and changing work flow. A convenience sample of advisors generated qualitative responses on the transition from in-person meetings to a virtual platform. RESULTS: Attendance increased as we transitioned to a virtual platform from 13.2 advisors to 14.7 advisors. Advisors affirm the value of a PFAC and importance of patient engagement, especially during this pandemic. Patient advisors confirm the role of patient voice in pandemic-induced practice changes. DISCUSSION: The transition of our PFACs to a virtual platform continues to generate critically important partnerships between patients and providers. In this time of health care uncertainty and stress for patients, providers, and staff, this partnership remains our most valuable asset. CONCLUSION: Patient voice provides reliable and relevant information for practices through virtual PFAC meetings.

Neonatal family-centered care in a pandemic.

Family-centered care (FCC) has become the normative practice in Neonatal ICUs across North America. Over the past 25 years, it has grown to impact clinician-parent collaborations broadly within children's hospitals as well as in the NICU and shaped their very culture. In the current COVID-19 pandemic, the gains made over the past decades have been challenged by "visitor" policies that have been implemented, making it difficult in many instances for more than one parent to be present and truly incorporated as members of their baby's team. Difficult access, interrupted bonding, and confusing messaging and information about what to expect for their newborn can still cause them stress. Similarly, NICU staff have experienced moral distress. In this perspective piece, we review those characteristics of FCC that have been disrupted or lost, and the many facets of rebuilding that are presently required.

Paramedic delivery of bad news: a novel dilemma during the COVID-19 crisis.

As a result of the COVID-19 global pandemic, paramedics in the UK face unprecedented challenges in the care of acutely unwell patients and their family members. This article will describe and discuss a new ethical dilemma faced by clinicians in the out-of-hospital environment during this time, namely the delivery of bad news to family members who are required to remain at home and self-isolate while the critically unwell patient is transported to hospital. I will discuss some failings of current practice and reflect on some of the ethical and practical challenges confronting paramedics in these circumstances. I conclude by making three recommendations: first, that dedicated pastoral outreach teams ought to be set up during pandemics to assist family members of patients transported to hospital; second, I offer a framework for how bad news can be delivered during a lockdown in a less damaging way; and finally, that a new model of bad news delivery more suited for unplanned, time-pressured care should be developed.

"Call Me by My Name": Improving Communication with Family Members at the Bedside via the Caregiver Identification Badge.

BACKGROUND: Patient and family experience are integral to the care that we provide. In the pediatric hospital setting, multiple family members are directly involved in patient care. We identified the need for greater caregiver name recognition at The Hospital for Sick Children, Toronto, ON. OBJECTIVE: We aimed to improve communication between healthcare providers and families via the optimization of caregiver identification badges. METHODS: We used a qualitative, narrative study design to explore perceptions surrounding caregiver identification badges via unstructured interviews. RESULTS: We identified key hospital and family stakeholders. Unstructured interviews supported the theory that badge optimization could improve communication and patient care. Our initiative, however, was abruptly interrupted by the emergence of the COVID-19 pandemic. CONCLUSION: Communication with patients and families is crucial across medical disciplines. The optimization of caregiver identification badges to facilitate the use of preferred names and pronouns will ultimately lead to the more effective and safer delivery of high-quality care.

A Multisite Survey of NICU Healthcare Professionals' Perceptions About Family-Centered Care.

BACKGROUND: Family-centered care contributes to improved outcomes for preterm and ill infants. Little is known about the perceptions of neonatal intensive care unit (NICU) healthcare professionals regarding the degree to which their NICU practices or values family-centered care. PURPOSE: The aims of this study were to describe attitudes and beliefs of NICU healthcare professionals about family-centered care and to explore professional characteristics that might influence those views. METHODS: Data were derived from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care with mobile-enhanced family-integrated care. Neonatal intensive care unit healthcare professionals completed the Family-Centered Care Questionnaire-Revised (FCCQ-R), a 45-item measure of 9 core dimensions of Current Practice and Necessary Practice for family-centered care. RESULTS: A total of 382 (43%) NICU healthcare professionals from 6 NICUs completed 1 or more of the FCCQ-R subscales, 83% were registered nurses. Total and subscale scores on the Necessary Practice scale were consistently higher than those on the Current Practice scale for all dimensions of family-centered care (mean: 4.40 [0.46] vs 3.61 [0.53], P < .001). Only years of hospital experience and NICU site were significantly associated with Current Practice and Necessary Practice total scores. IMPLICATIONS FOR PRACTICE: Ongoing assessment of the perceptions of NICU healthcare professionals regarding their current practice and beliefs about what is necessary for the delivery of high-quality family-centered care can inform NICU education, quality improvement, and maintenance of family-centered care during the COVID-19 pandemic. IMPLICATIONS FOR RESEARCH: Further research is needed to identify additional factors that predict family-centered care perceptions and behaviors.

Strengthening Vaccine Confidence and Acceptance in the Pediatric Provider Office.

Although vaccine acceptance and uptake are overall high among children in the United States, vaccine delays or refusals are a growing concern. Vaccine hesitancy is a challenge for the pediatric provider, given the diverse factors associated with hesitancy and the limited evidence on effective strategies for addressing vaccine hesitancy in the provider office. In this article, we review available evidence and approaches for vaccine communication, including the importance of using a whole-team approach, building trust, starting the conversation early, using a presumptive approach for vaccine recommendations, motivational interviewing with parents who have concerns for vaccines, and additional techniques for responding to parent questions. We also review organizational strategies to help create a culture of immunization in the practice, including evidence-based approaches for increasing vaccine uptake and efficiency. Although these communication approaches and organizational strategies are intended to reassure parents who are vaccine hesitant that all routine, universally recommended vaccines are safe and effective, they likely will take on increased significance as the development, implementation, and evaluation of coronavirus disease 2019 vaccines continue to unfold. [Pediatr Ann. 2020;49(12):e523-e531.].

Perspectives on Telephone and Video Communication in the Intensive Care Unit during COVID-19.

Rationale: During the coronavirus disease (COVID-19) pandemic, many intensive care units (ICUs) have shifted communication with patients' families toward chiefly telehealth methods (phone and video) to reduce COVID-19 transmission. Family and clinician perspectives about phone and video communication in the ICU during the COVID-19 pandemic are not yet well understood. Increased knowledge about clinicians' and families' experiences with telehealth may help to improve the quality of remote interactions with families during periods of hospital visitor restrictions during COVID-19.Objectives: To explore experiences, perspectives, and attitudes of family members and ICU clinicians about phone and video interactions during COVID-19 hospital visitor restrictions.Methods: We conducted a qualitative interviewing study with an intentional sample of 21 family members and 14 treating clinicians of cardiothoracic and neurologic ICU patients at an academic medical center in April 2020. Semistructured qualitative interviews were conducted with each participant. We used content analysis to develop a codebook and analyze interview transcripts. We specifically explored themes of effectiveness, benefits and limitations, communication strategies, and discordant perspectives between families and clinicians related to remote discussions.Results: Respondents viewed phone and video communication as somewhat effective but inferior to in-person communication. Both clinicians and families believed phone calls were useful for information sharing and brief updates, whereas video calls were preferable for aligning clinician and family perspectives. Clinicians and families expressed discordant views on multiple topics-for example, clinicians worried they were unsuccessful in conveying empathy remotely, whereas families believed empathy was conveyed successfully via phone and video. Communication strategies suggested by families and clinicians for remote interactions include identifying a family point person to receive updates, frequently checking family understanding, positioning the camera on video calls to help family see the patient and their clinical setting, and offering time for the family and patient to interact without clinicians participating.Conclusions: Telehealth communication between families and clinicians of ICU patients appears to be a somewhat effective alternative when in-person communication is not possible. Use of communication strategies specific to phone and video can improve clinician and family experiences with telehealth.

Communicating cystic fibrosis newborn screening results to parents.

The way results of cystic fibrosis (CF) newborn screening are communicated to parents is critical yet is done differently across the globe. We surveyed parents of 101 children in our tertiary London paediatric centre with a 48% response rate. Parental responses were as follows: 40/42 (95%) said the information could not have been given over the phone and 39/43 (91%) said they wanted both partners present; 27/42 (64%) said it was helpful having the health visitor also present; and 37/40 (92%) felt it was acceptable to wait until the next day for the sweat test. We have reduced the time from first contact to arriving in the home to 2-3 h.Conclusion: We believe that this survey backs up our approach of a home visit by a CF nurse specialist with the family's health visitor to break the news. This is challenging in the current COVID-19 pandemic. What is Known: • Breaking bad news can have a lasting impact on parents when not done the right way. • Giving results of cystic fibrosis (CF) newborn screening is done differently within the UK and around the world. What is New: • Our parental survey revealed that the majority (92%) believed this should be done face to face and not over the telephone. • There was a mixed response to whether the parents should be told the genotype (assuming the CF centre knew), and thus the CF diagnosis before the confirmatory sweat test was carried out.

Impact of the COVID-19 pandemic on pediatricians' clinical activity in Cameroon.

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.

Nurses' Role in Providing Comprehensive Communication, Prognostication, and Palliative Care During the COVID-19 Pandemic.

This article presents the case of a mother of young children who has terminal stage IV cancer with whom providers had not discussed goals of care and prognostication. Communications about prognostication and goals of care are commonly initiated by physicians. Adolescents and young and middle-age adults with complex chronic or terminal illness often are not provided with timely, clear, complete information or palliative care support. Early palliative care for chronically ill patients facilitates discussions of prognostication and goals of care, in addition to providing symptom management. Such discussions do not diminish hope but rather allow patients to adjust hope to attain an optimal quality of life. Nurses can become active, confident advocates for patients with terminal illness of any age, and they are well positioned to assess patients and engage in goals of care and end-of-life conversations. It is especially important that palliative care nurses promote and maintain these early and comprehensive discussions during the COVID-19 pandemic because this population is at a high risk of complications from the coronavirus.

[An ethical Response in the Care of Nursing Homes in the COVID-19 Pandemic]. / Una Respuesta ÉTica en la AtenciÓN a Residencias de Ancianos en la Pandemia COVID-19.

With the arrival of the COVID-19 pandemic, the risk of a possible lack of care for the elderly in nursing homes became evident. We summarize the experience of a multidisciplinary team with volunteer professionals from different specialties who carried out support for healthcare professionals in nursing homes. This team was implemented from both Primary and Specialty Care managements. Its work paradigm was proposed by our home hospitalization team, which included direct care of the most complex patients and general counselling on isolation, hygiene and preventive measures within the nursing homes. Thanks to this support, the elderly population placed there, with suspected or diagnosed COVID-19, received adequate care from an interdisciplinary team, which led part of the pressure to be released from their professional workers, and many family members were aware that there was no neglect of the elderly. Commitment from various levels of care in a coordinated effort has prevented a vulnerable population from being left unattended during the pandemic.

Beyond the First Wave: Consequences of COVID-19 on High-Risk Infants and Families.

The novel coronavirus disease 2019 (COVID-19) pandemic is affecting care for high-risk newborns in ways that will likely be sustained beyond the initial pandemic response. These novel challenges present an urgent imperative to understand how COVID-19 impacts parent, family, and infant outcomes. We highlight three areas that warrant targeted attention: (1) inpatient care: visitation policies, developmental care, and communication practices; (2) outpatient care: high-risk infant follow-up and early intervention programs; and (3) parent psychosocial distress: mental health, social support, and financial toxicity. Changes to care delivery in these areas provide an opportunity to identify and implement novel strategies to provide family-centered care during COVID-19 and beyond. KEY POINTS: · The COVID-19 pandemic is influencing care delivery for high-risk newborns and their families.. · Rapid changes to care delivery are likely to be sustained beyond the initial pandemic response.. · We have an urgent imperative to understand how COVID-19 impacts infant, parent, and family outcomes..

Family members' concerns about relatives in long-term care facilities: Acceptance of visiting restriction policy amid the COVID-19 pandemic.

AIM: The policy enforcing visiting restriction during the COVID-19 pandemic may cause feelings of social isolation among residents in long-term care facilities. This study aimed to explore family members' concerns for their relatives during the lockdown period, assess their level of acceptance of the visiting restriction policy and determine the associated factors. METHODS: From the 156 family members interviewed, demographic data, satisfaction with overall care quality, worry and concerns for their relatives, acceptance of the visiting restriction and arrangement for the residents if cluster infections occur in the facility were recorded. RESULTS: Among the members interviewed, 83 (53.2%) were men; mean age of members was 56.3 ± 9.8; most were offspring of residents in the facility (n = 121, 77.6%), most visited the residents at least once a week (n = 113, 72.4%) before the lockdown. The most common concerns of the family members for their relatives were psychological stress (38.5%), followed by nursing care (26.9%) and daily activity (21.1%). Nearly 84.6% of those interviewed accepted the visiting restriction policy, and a higher satisfaction rating independently associated with acceptance of the visiting restriction policy (odds ratio 2.15). CONCLUSIONS: During the lockdown period, staff members should provide more psychological information about residents to their family members. Higher satisfaction rating was found to be independent of the acceptance of the visiting restriction policy. Therefore, good quality of care of the facility wins the trust of family members, and this might mitigate the tension between the family members and staff during a major crisis. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; 20: 938-942.