Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU): Survey Results of SICU Team Members.

Increasing palliative care presence in the intensive care unit (ICU) improves symptom management, increases goals-of-care discussion, and reduces unnecessary procedures in ICU patients. An interdisciplinary study team developed a palliative care trigger program in a 17-bed surgical ICU (SICU). Surgical ICU patients who met 3 triggers (ICU length of stay > 10 days, repeat ICU admission, and metastatic cancer) automatically received a palliative care consult. The purpose of the current study was to survey SICU health care professionals before and after the institution of the palliative care trigger program. Overall, the palliative care trigger program was viewed positively by interdisciplinary team members with increased team communication and decreased resistance for the inclusion of palliative care in the SICU plan of care. The palliative care trigger program was successfully developed and implemented in a SICU and was accepted by the interdisciplinary team members caring for SICU patients. Team member feedback is being used to expand the palliative care trigger program to improve care for SICU patients.

Family experiences reported by healthcare worker parents during the COVID-19 pandemic.

PURPOSE: Parents, who were working as essential frontline healthcare workers experienced unique stressors during the COVID-19 pandemic including disruption of regular routines, long lapses away from family, extreme work stress and subsequent difficulty in compartmentalizing work-related concerns when at home. The purpose of this study was to assess COVID-19 exposure and impact of frontline healthcare workers who are parents. DESIGN & METHODS: This study quantitatively assessed the COVID-19 exposure and impact and qualitatively explored perceptions of parents of children 9 to 17 years of age, who were also frontline healthcare workers. RESULTS: Participants (N = 79) using the COVID-19 Exposure and Family Impact Survey (CEFIS) reported exposure mean scores of 10.03 (SD = 2.63); and impact scores mean scores of 3.18 (SD = 0.46). Thematic analysis identified four themes, each with 2 subthemes: 1) family stressors increased (e.g., concerns about health and safety, losses of lifestyle patterns); 2) changes in children's health and well-being (e.g., isolation from family and friends, mental health problems); 3) virtual school difficulties (e.g., parent and student challenges, home school option); 4) skill building opportunities (e.g., enhanced emotional connections, increased family activities). CONCLUSION: The CHAMPS Family Health Study suggests that families of essential workers are especially vulnerable to the effect of COVID-19, as are those families of essential workers who include child/ren with special health care needs. PRACTICE IMPLICATIONS: Preparation for future emergencies requires strategies to mitigate consequences and promote well-being. These results highlight the need for supportive approaches to decrease the negative consequences of stress and to augment skills for family connection and cooperation.

The Symptom Experience of Older Adults with Mobility Difficulties: Qualitative Interviews.

Eighteen million older adults have mobility limitations, defined as difficulty walking a quarter of a mile or climbing stairs unassisted. Little is known about how symptom burden impacts mobility difficulty in older adults. Understanding the burden of symptoms responsible for mobility difficulties may be an area for intervention to improve mobility and to prevent adverse outcomes. We conducted 31 semi-structured qualitative interviews (one interview per participant) regarding the symptom burden experience associated with a current mobility difficulty. Thematic analysis revealed symptoms were limiting, were barriers to participation in daily activities, and produced a psychological and emotional burden that negatively impacted quality of life. Older adults employed various strategies to overcome the symptom burden. Participants also believed symptoms were a non-modifiable part of the aging process and at times felt disregarded by healthcare professionals. Future interventions should focus on reducing the symptom burden experience for older adults to improve mobility and prevent adverse outcomes.

The Relationship of Fear of Falling and Quality of Life: The Mediating Effects of Frailty and Depression.

PURPOSE: To examine the sequential explanatory roles of frailty and depression in the relationship between fear of falling (FOF) and health-related quality of life (HRQoL) in older adults. DESIGN: Secondary data analysis. METHODS: Path models were constructed hypothesizing frailty and depression as serial mediators of the relationship between FoF and HRQoL. FINDINGS: Depression independently and along with frailty serially mediated the relationship between FoF and mental HRQoL. CONCLUSIONS: Frailty and depression are not typically considered when assessing the effect of FOF on HRQoL. CLINICAL EVIDENCE: Understanding the mediating effects and common risk factors on FOF and HRQoL may be an area for interventional development for older adults.

Self-reported symptom causes of mobility difficulty contributing to fear of falling in older adults.

BACKGROUND: Self-reported symptom causes of mobility difficulty that contribute to  fear of falling (FOF) in older adults has not been fully explored as an area for intervention. AIMS: Identify the prevalence of self-reported symptoms causing mobility difficulties and to examine the difference in FOF by symptom category. METHODS: Conduct a secondary data analysis of a population-based cohort of community-dwelling older adults, ≥ 70 years, enrolled in the MOBILIZE Boston study. The analysis included 242 older adults reported difficulty walking » mile (0.4 km) and/or climbing one flight of stairs. Participants identified the main symptom cause of the mobility difficulty from a list of 32 symptoms, grouped into five categories. FOF was measured using the Tinetti Falls Efficacy Scale. RESULTS: Pain was the primary symptom causing mobility difficulty (38%), followed by endurance (21%), weakness (13%), balance (9%), and other (3%). Although a greater proportion of participants who identified balance as the primary symptom category had significantly higher FOF compared to others, there was a greater number overall who reported pain as their main symptom who also had FOF. Therefore, pain contributed to a higher relative burden of FOF in the population than did balance symptoms. DISCUSSION: Various symptoms affect mobility and are associated with FOF, a known fall risk factor. Many older adults identify pain as the main cause of their mobility difficulty and report FOF. CONCLUSIONS: Improving pain symptoms for older adults may improve mobility and reduce fear of falling, potentially averting further decline in mobility and independence.

The experience of baccalaureate clinical nursing faculty transitioning to emergency remote clinical teaching during the COVID-19 pandemic: Lessons for the future.

BACKGROUND: Experiential clinical learning in undergraduate nursing education allows for fusion of nursing knowledge with practice to ensure the development of competent graduate nurses. The global COVID-19 pandemic necessitated an abrupt transition from in-person clinical educational experiences to emergency remote clinical teaching. OBJECTIVES: The purpose of this study was to describe the experiences of baccalaureate nursing clinical faculty who transitioned from in-person clinical to emergency remote clinical teaching during the COVID-19 pandemic in spring 2020. DESIGN: A qualitative descriptive design was used. SETTING: The study took place in the United States. PARTICIPANTS: Nineteen baccalaureate nursing clinical faculty participated in the study. METHODS: Participants engaged in semi-structured, in-depth, online interviews. RESULTS: Five themes emerged from the data: transition, collaboration and support, the joy of teaching, authentic professional experience, and the overarching primary theme, stress of the moment. CONCLUSIONS: The transition to emergency remote clinical teaching during the COVID-19 pandemic caused stress and anxiety. However, there were important lessons learned about how to best support students and faculty while providing a robust online learning experience. Understanding the experiences of clinical nursing faculty during this abrupt transition can support recommendations for best practices in the future.

Original Research: Nurses' Experiences of Caring for Patients and Families During the COVID-19 Pandemic: Communication Challenges.

OBJECTIVE: The purpose of this study was to gain a better understanding of the perceptions and experiences of nurses caring for patients and families under the COVID-19 pandemic's socially restrictive practices and policies. BACKGROUND: The COVID-19 global pandemic has affected the delivery of health care to patients and their families, with many aspects altered because of the need for social distancing, social isolation, and visitation restriction policies. These policies have created communication challenges for interdisciplinary health care teams, patients, and families. As frontline caregivers, nurses have felt strongly the impact of these challenges. METHODS: A qualitative descriptive study was conducted among 17 RNs who were caring for patients during the COVID-19 pandemic and were recruited via social media posts on Facebook, Twitter, and LinkedIn. Watson's theory of human caring served as the conceptual framework for the study. RESULTS: Several themes emerged regarding nurses' experiences of communication with patients and families. These include communication challenges and barriers, prioritization, integration of group communication, nurse self-reflection, and acceptance of gratitude. CONCLUSIONS: The study findings underscore the importance of nurses' communication with patients and families under the pandemic's restricted conditions. They demonstrate the value of nurses' ability to innovate in fostering all parties' participation in the plan of care, and highlight the comfort nurses provide to patients who are isolated from loved ones. Strategies that fostered communication were identified, as were areas for further research.

Factors associated with health-related quality of life in PACE participants.

Health-related quality of life (HRQoL) is an important measure of how health and illness affect the lives of older adults. This study aimed to determine the relationship between frailty, fear of falling, and depression with HRQoL in nursing home eligible community-dwelling older adults. A cross-sectional correlational design and chart review were conducted. Eighty four participants (mean age = 70.33 [SD = 6.33]) were surveyed on frailty, fear of falling, depression and physical and mental health measures of HRQoL. Increased frailty, fear of falling, and depression were associated with decreased physical and mental health and well-being. When controlling for sociodemographics, frailty and fear of falling were predictive of lower physical health and well-being whereas depression was independently predictive of lower mental health and well-being. The results of this study will assist in assessment and targeted interventions for modifiable risk factors that affect the HRQoL of nursing home eligible community-dwelling older adults.

Factors associated with the risk for falls in PACE participants.

OBJECTIVE: The purpose was to determine the relationship between frailty, fear of falling, and depression with falls risk in vulnerable community-dwelling older adults. METHODS: A cross-sectional correlational design and chart review were completed. Nursing home eligible older adults ≥55 who live in the community were surveyed on frailty, fear of falling, depression, and the risk for falls. Pearson's correlation, multiple regression and hierarchical regression were used to analyze the data. RESULTS: Increased frailty, fear of falling, and depression were significantly associated with an increased risk for falls. Frailty and fear of falling were significant predictors of the risk for falls while depression did not contribute to the regression model. When controlling for sociodemographics, frailty, fear of falling, and incontinence were significant predictors for the risk for falls. DISCUSSION: The results of this study will assist in assessment and interventions to decrease the risk for falls in high risk older adults.