A service evaluation of phased- and stepped-care psychological support for health and social care workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in this context is not well documented. AIMS: To evaluate a stepped-care psychological support pathway for HSCWs from Homerton Healthcare Foundation Trust in London, which offered psychological first aid, evidence-based psychological therapies and group-based well-being workshops. METHOD: The service evaluation used a pre-post approach to assess depression, anxiety, functional impairment and post-traumatic stress disorder symptom change for those who attended sessions of psychological first aid, low- or high-intensity cognitive-behavioural therapy or a combination of these. In addition, the acceptability of the psychological first aid sessions and well-being workshops was explored via feedback data. RESULTS: Across all interventions, statistically significant reductions of depression (d = 1.33), anxiety (d = 1.37) and functional impairment (d = 0.93) were observed, and these reductions were equivalent between the interventions, as well as the demographic and occupational differences between the HSCWs (ethnicity, staff group and redeployment status). HSCWs were highly satisfied with the psychological first aid and well-being workshops. CONCLUSIONS: The evaluation supports the utility of evidence-based interventions delivered as part of a stepped-care pathway for HSCWs with common mental health problems in the context of the COVID-19 pandemic. Given the novel integration of psychological first aid within the stepped-care model as a step one intervention, replication and further testing in larger-scale studies is warranted.

The cost-effectiveness of antenatal and postnatal education and support interventions for women aimed at promoting breastfeeding in the UK.

BACKGROUND: Breastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. Breastfeeding rates in the UK are low for various reasons including cultural barriers, inadequate support to initiate and sustain breastfeeding, lack of information, or choice not to breastfeed. Education and support interventions have been developed aiming at promoting breastfeeding rates. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion. RESULTS: The incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16-26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40-£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35-40%. CONCLUSIONS: Available breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.

Hidden Tales of Ebola: Airing the Forgotten Voices of Ugandan "Ebola Nurses".

INTRODUCTION: According to the Centers for Disease Control and Prevention, Ebola has affected the lives of thousands, including health care workers. With few studies describing the experience of nurses who survived Ebola, the study aimed to describe Ugandan nurses' experiences. METHOD: Using a phenomenological design, in-depth interviews were conducted among five Ugandan nurses who contracted Ebola and survived. RESULT: Thematic analysis revealed themes of expectations of dying, hopelessness, loneliness, and betrayal by family, community, and the health system. DISCUSSION: Results support the need for policies targeting holistic practice protocols to protect all health care professionals during future outbreaks. Last, nursing survivors should have access to government-guaranteed support programs, including free health care and financial stipends. These results and recommendations transcend to the current reality of living with COVID-19 (coronavirus disease 2019). Efficient practice protocols could protect all rights and privileges and contribute to access to treatment and stigma removal.

Nurses' Use of Spiritual Practices in Caring for Self During the Pandemic.

Stressful life events often disrupt individuals' assumptive world, challenging their self-identity and altering their lives. Suffering from stressful life events may have a profound negative impact on a person's life. Nurses felt great demands on their spiritual selves even as they responded to the grave situations and caring demands needed to care for the spirits of their patients during the coronavirus (COVID-19) pandemic. However, with intentionality, suffering and stress can be ameliorated by engaging in spiritual self-care and self-renewing activities. Spirituality is recognized as an essential factor in a person's health and well-being and is integral to the process of growing through life events, such as illness, grief, and bereavement. Nurses may choose to use spiritual practices, either religious or nonreligious, to buffer the effects of stressful life events. The concept of caring for self has long being promoted, by scholars, as an essential need of nurses to care for themselves, not so they can keep on giving to others but because each nurse is worthy of being cared for by self. In the era of the pandemic in which stressful work environment, social distancing, and self-isolation make it difficult to maintain interconnectedness and build relationships, despair can occur. Spiritual practices are examples of the resources that can be used effectively in times of stress to reduce the negativity that life stressors create in individuals.

Narratives of older persons' frailty and physical activity in relation to environmental landscapes and time.

AIMS AND OBJECTIVES: The objective of this study was to explore the influence of the environmental landscape on the physical activity of older persons experiencing frailty. BACKGROUND: This manuscript describes the second phase of an unpublished larger study in the northern province of Lampang, Thailand. Phase One revealed that 14% of 1,788 older persons surveyed were found to have experienced frailty according to Fried's frailty phenotypes, and low physical activity was associated with frailty. In the light of frailty, how older persons experience physical activity in their day-to-day living environments warrants in-depth exploration. DESIGN: This was a qualitative study guided by narrative inquiry. METHODS: In-depth interviews and observations were conducted with 13 older persons living with frailty. The method of analysis was thematic and performance analysis. RESULTS: Two broad themes relating to the environmental landscapes were as follows: (a) limiting environmental landscapes and (b) engaging environmental landscapes. These landscapes, which change across time, refer to physical and social spaces, and beliefs of older persons and their family that have either positive or negative impacts on physical activity of frail older persons. CONCLUSION: Complex interactions between physical and social spaces and beliefs of older persons and family influence the physical activity behaviours of older persons living with frailty. IMPLICATIONS FOR PRACTICE: This study warrants education and policy aiming at creating optimal environmental landscapes to promote physical activity in frail older persons.

Town & Gown.

Innovative approaches for building "town and gown" relationships between practicing school nurses, community partners, and universities/colleges are presented through exemplars relating to research, education, policy, and practice. The exemplars demonstrate the critical factors of successful partnerships as validated by their outcomes.

On Virtual Presence.

Advances in health care and communication technology have expanded nursing practice to nontraditional environments that preclude the physical presence of the nurse for a caring encounter. An increasing number of nurses are creating and maintaining nurse-patient relationships and practicing in a diverse range of specialties in virtual/distance environments. Can nursing presence as a caring modality be "real" in a virtual/distance environment? A new ontology of nursing presence is offered that transcends people, place, space, and time.

Clarifying a vision for health literacy: a holistic school-based community approach.

Health literacy has come to the forefront as an emerging health issue. Processes are needed to incorporate health literacy across community-wide settings. The purpose of this article is to describe the process used to assist community partners in a school health program in clarifying their vision of health literacy from which a more holistic approach to the care of school-aged children and the community was co-created.

Transnational mothers crossing the border and bringing their health care needs.

PURPOSE: The purpose of this study was to explore the experiences of transnational Latina mothers who immigrated to the United States without legal documentation or their children. DESIGN: The study used a qualitative approach to collect data from eight transnational Latina mothers from South Florida during the summer of 2009. METHODS: Data were collected using open-ended questions in one-on-one, in-depth interviews that lasted 1 to 2 hr. FINDINGS: A hermeneutic phenomenological analysis of the data yielded seven essential themes from the participants' stories: living in extreme poverty, having hope, choosing to walk away from poverty, suffering through the trip to and across the border, mothering from afar, valuing family, and changing personally. CONCLUSIONS: The results indicate that transnational Latina mothers find meaning in mothering from afar through embodied sacrifice, suffering, hoping for a better life for their children, and family reunification. These results have implications for healthcare providers, social workers, policy makers, and educators whose professional responsibility is to advocate for, and to enhance the health and social well-being of, transnational mothers. CLINICAL RELEVANCE: Although this study focused on transnational Latina mothers in the United States, transnational motherhood is a worldwide phenomenon. Healthcare professionals play an instrumental role in providing culturally specific and evidence-based care to women who migrate without their children.

Understanding homelessness using a simulated nursing experience.

Students have an opportunity to understand the full experience of being homeless using simulated community nursing situations with a high-fidelity simulator. The Community Nursing Practice Model provides a context for using this innovative teaching strategy to enable students to respond holistically to the needs of the homeless.

Delegation guided by school nursing values: comprehensive knowledge, trust, and empowerment.

As health care institutions in the United States respond to shrinking budgets and nursing shortages by increasing the use of unlicensed assistive personnel (UAP), school nursing practice is changing from providing direct care to supervising activities delegated to UAP. Therefore, delegation is a critical area of concern for school nurses. The purpose of this qualitative research study was to explore values guiding the delegation of health care tasks to UAP in school settings from the perspective of the school nurse. An inquiry focus group was conducted with 64 Florida school nurses. Values guiding delegation were comprehensive knowledge, trust, and empowerment. These values provided a framework for guiding the delegation process.

The usefulness of the community nursing practice model in grounding practice and research: narratives from the United States and Africa.

A community nursing practice (CNP) model is presented as the synthesis of a decade of experience of caring for persons and communities. Values form the basis of the model and provide the grounding for practice. Transcendent values of respect, caring, and wholeness are explicated in the actualizing values of primary health care: access, essentiality, empowerment, intersectoral collaboration, and community participation. Usefulness of the CNPM in providing a framework for community nursing practice at school-based community wellness centers in both the United States and Africa is described. Narratives of practice and research presented in the unique voice of three faculty members illuminate the model's values and paradigmatic view of person, nursing, community, and environment. These narratives provide insight into how the CNPM has served as a heuristic in the design of creative responses to calls for nursing in community nursing practice, education, and research.

Development of a school nursing research agenda in Florida: a Delphi study.

Research is important to the image, visibility, and viability of school nursing. Each state school nursing association should evaluate member commitment to school nursing research based on their unique set of financial, educational, and organizational resources. A 3-round Delphi study was conducted in which Florida school nurses identified research priorities. The 10 priority research topics were (a) obesity/nutrition, (b) role of the school nurse, (c) legal/ethical issues, (d) emergencies, (e) health education, (f) absenteeism/attendance, (g) diabetes and insulin, (h) injuries, (i) health services, and (j) asthma. These topics form the state research agenda and will be used to guide the development of multisite school nursing studies.

Conversation Intervention with Alzheimer's Patients: Increasing the Relevance of Communication.

The effectiveness of conversation in improving verbal communication of nursing home residents with Alzheimer's disease was compared to exercise and a combination of both interventions. Fifty-five participants were randomly assigned to treatment group and raters were blinded. Treatment was given three times weekly for 30 minutes, for 16 weeks. Although all groups evidenced decline in the total number of words used as a group, the conversation-only subjects' performance was significantly better in terms of the number of nonredundant units of information produced (p = .0433) and conciseness (p = .0101) using analysis of covariance controlling for baseline performance. Individual subjects' change in performance was also examined. Active engagement in structured one-on-one conversation may improve relevance of communication in this population.