Perceptions and experiences of healthcare providers during COVID-19 pandemic in Karachi, Pakistan: An exploratory qualitative study

Objective: To explore healthcare provider\u27s perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.Design and setting: We conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Study data were analysed manually using the conventional content analysis technique.Participants: Key-informant interviews (KIIs) were conducted with senior management and hospital leadership and in-depth interviews (IDIs) were conducted with front-line healthcare providers.Results: A total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was \u27challenges faced by front-line healthcare providers working in COVID-19 wards. Healthcare workers experienced increased anxiety due to the fear of acquiring infection and transmitting it to their family members. They felt overwhelmed due to the exhaustive donning and doffing process, intense work and stigmatisation. The second theme was \u27enablers supporting healthcare providers to deal with the COVID-19 pandemic\u27. Front liners pointed out several enabling factors that supported hospital staff including a safe hospital environment, adequate training, a strong system of information sharing and supportive management. The third theme was \u27recommendations to support the healthcare workforce during the COVID-19 crisis\u27. Healthcare workers recommended measures to mitigate current challenges including providing risk allowance to front-line healthcare providers, preparing a backup health workforce, and establishing a platform to address the mental health needs of the healthcare providers.Conclusion: This study provides an initial evidence base of healthcare providers\u27 experiences of managing patients with COVID-19 in the early stage of the pandemic and highlights measures needed to address the encountered challenges. It offers lessons for hospitals in low-income and middle-income countries to ensure a safe working environment for front-line workers in their fight against COVID-19

Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series

<p>Abstract</p> <p>Background</p> <p>Continuing challenges to timely adoption of evidence-based clinical practices in healthcare have generated intense interest in the development and application of new implementation methods and frameworks. These challenges led the United States (U.S.) Department of Veterans Affairs (VA) to create the Quality Enhancement Research Initiative (QUERI) in the late 1990s. QUERI's purpose was to harness VA's health services research expertise and resources in an ongoing system-wide effort to improve the performance of the VA healthcare system and, thus, quality of care for veterans. QUERI in turn created a systematic means of involving VA researchers both in enhancing VA healthcare quality, by implementing evidence-based practices, and in contributing to the continuing development of implementation science.</p> <p>The efforts of VA researchers to improve healthcare delivery practices through QUERI and related initiatives are documented in a growing body of literature. The scientific frameworks and methodological approaches developed and employed by QUERI are less well described. A QUERI Series of articles in <it>Implementation Science </it>will illustrate many of these QUERI tools. This <it>Overview </it>article introduces both QUERI and the Series.</p> <p>Methods</p> <p>The <it>Overview </it>briefly explains the purpose and context of the QUERI Program. It then describes the following: the key operational structure of QUERI Centers, guiding frameworks designed to enhance implementation and related research, QUERI's progress and promise to date, and the Series' general content. QUERI's frameworks include a core set of steps for diagnosing and closing quality gaps and, simultaneously, advancing implementation science. Throughout the paper, the envisioned involvement and activities of VA researchers within QUERI Centers also are highlighted. The Series is then described, illustrating the use of QUERI frameworks and other tools designed to respond to implementation challenges.</p> <p>Conclusion</p> <p>QUERI's simultaneous pursuit of improvement and research goals within a large healthcare system may be unique. However, descriptions of this still-evolving effort, including its conceptual frameworks, methodological approaches, and enabling processes, should have applicability to implementation researchers in a range of health care settings. Thus, the <it>Series </it>is offered as a resource for other implementation research programs and researchers pursuing common goals in improving care and developing the field of implementation science.</p

Telehealth Solutions for In-hospital Communication with Patients Under Isolation During COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis that has quickly overwhelmed our healthcare system. It has led to significant shortages in personal protective equipment (PPE), ventilators, and intensive care unit beds across the nation. As the initial entry point for patients with suspected COVID illness, emergency departments (ED) have had to adapt quickly to prioritize the safety of patients and providers while still delivering optimal, timely patient care. COVID-19 has presented many challenges for the ED that also extend to all inpatient services. Some of these key challenges are the fundamental tasks of communicating with patients in respiratory isolation while minimizing PPE usage and enabling all patients who have been affected by hospitals’ visitor restrictions to connect with their families. We discuss the design principles behind implementing a robust in-hospital telehealth system for patient-provider and patient-family communication, provide a review of the strengths and weaknesses of potential videoconferencing options, and deliver concise, step-by-step guides for setting up a secure, low-cost, user-friendly solution that can be rapidly deployed

Examining sensor-based physical activity recognition and monitoring for healthcare using Internet of Things: A systematic review.

Due to importantly beneficial effects on physical and mental health and strong association with many rehabilitation programs, Physical Activity Recognition and Monitoring (PARM) have been considered as a key paradigm for smart healthcare. Traditional methods for PARM focus on controlled environments with the aim of increasing the types of identifiable activity subjects complete and improving recognition accuracy and system robustness by means of novel body-worn sensors or advanced learning algorithms. The emergence of the Internet of Things (IoT) enabling technology is transferring PARM studies to open and connected uncontrolled environments by connecting heterogeneous cost-effective wearable devices and mobile apps. Little is currently known about whether traditional PARM technologies can tackle the new challenges of IoT environments and how to effectively harness and improve these technologies. In an effort to understand the use of IoT technologies in PARM studies, this paper will give a systematic review, critically examining PARM studies from a typical IoT layer-based perspective. It will firstly summarize the state-of-the-art in traditional PARM methodologies as used in the healthcare domain, including sensory, feature extraction and recognition techniques. The paper goes on to identify some new research trends and challenges of PARM studies in the IoT environments, and discusses some key enabling techniques for tackling them. Finally, this paper consider some of the successful case studies in the area and look at the possible future industrial applications of PARM in smart healthcare

Re-thinking technology and its growing role in enabling patient empowerment

© The Author(s) 2018. The presence and increase of challenges to eHealth in today’s society have begun to generate doubts about the capability of technology in patient empowerment, especially within the frameworks supporting empowerment. Through the review of existing frameworks and articulation of patient demands, weaknesses in the current application of technology to support empowerment are explored, and key constituents of a technology-driven framework for patient empowerment are determined. This article argues that existing usage of technology in the design, development and implementation of patient empowerment in the healthcare system, although well intentioned, is insufficiently constituted, primarily as a result of fragmentation. Systems theory concepts such as holism and iteration are considered vital in improving the role of technology in enabling patient empowerment

Working at the coal face: The contribution of Programme Tutors in supporting practice-based learning in nursing

This paper reports the findings of a Centre for Excellence in Teaching and Learning-funded project to explore key features of effective support for pre-registration nursing students in practice settings. Background The cultivation of positive practice learning environments for students of nursing, including high quality learning support, has been long established as a thorny issue for nurse educators and practitioners. Indeed it was a key theme for the very first nursing research series, supported by the Royal College of Nursing, in the early 1980’s. This included Fretwell’s (1982) work on ward teaching and learning, Orton’s (1981) work on the ward learning environment and Ogier’s (1982) work on the role of the ward sister. Since then there has been an explosion of research in this area. As a profession we have a responsibility to ensure high quality learning support for students in practice settings. If we do not, there will be wide-ranging implications for the quality of patient care, work-related stress, role satisfaction, retention and attrition and professional reputation. Given the significant investment in nurse education and the need to retain nurses in the workforce, it is unsurprising therefore that the practice learning environment has emerged as a key policy issue in the United Kingdom and internationally. Previous research indicates that relationships between the learner and staff are crucial in supporting learning in practice (Pearcey and Elliott, 2004) and that ‘learning is maximised when the learner is effectively partnered with a clinician and experiences are shared’ (Henderson et al., 2009, p.178). In this context, The Programme Tutor (PT) – a role unique to the pre-registration nursing programme at The Open University (OU) – is crucial in facilitating learning in the practice setting. The purpose of the PT role is to work longitudinally with both students and their mentors to support learning in practice and monitor student progress. The PT therefore plays a pivotal role in facilitating learning in the practice setting, aspects of which may have potential for transfer to the wider health education sector. Objectives The overall aim of the project was to critically examine the experiences of a sample of PTs supporting students and mentors on the pre-registration nursing programme at the OU in order to identify the key features of effective PT practice. These features would then inform the continuing development of the programme. Two PTs were recruited as co-researchers on the project, the objectives of which were to: • Explore PT’s experiences of supporting students and mentors • Explore PT’s views regarding student progression • Identify how PTs ‘grow’ into their role • Identify enabling and disabling factors contributing to role effectiveness • Examine the boundaries between the role of the PT and mentor • Explore variations in the PT role across the UK. Data collection and analysis A sample of 20 PTs working on the final practice module of the pre-registration nursing programme, and located across the nations and regions of the UK, was identified. Following ethical approval, telephone interviews were conducted using an interview guide informed by both a review of the literature and the experience of the PT co-researchers. Telephone interviews were used in preference to individual face-to-face interviews in order to accommodate the dispersed geographical spread of participants. The interviews were recorded using digital recording equipment and following transcription, conventional approaches to qualitative data analysis were used to identify common themes across the data. The ethical principles of confidentiality, anonymity and informed consent were upheld throughout the study. The sample was assured that confidentiality would be maintained at all times throughout the project. Anonymity was protected by using pseudonyms both for PTs and organisations. Informed consent was gained at the start of the project and participants were able to withdraw from the project at any stage. Findings suggest that PTs find their role both rewarding and vital in the context of creating supportive learning environments and ultimately supporting students’ transition to become registered practitioners. Being an effective communicator and establishing and maintaining relationships with students, mentors and service managers was described as crucial to the success of the role. Understanding the pressures within practice environments and being able to acknowledge the realities of ‘working at the coalface’ enabled PTs to support both students and mentors in such settings. Conclusion This paper will elaborate more fully the findings of the project, illustrated with reference to verbatim quotes from the data. Although a role unique to the OU pre-registration nursing programme, there may be aspects of the role which could be transferable to other practice-based learning settings. This will be interactively debated with conference delegates. (word count 800) References Fretwell, J. E. (1982) Ward teaching and Learning, Royal College of Nursing, London. Henderson, A., Twentyman, M., Eaton, E., Creedy, D., Stapleton, P. and Lloyd, B. (2009) Creating supportive clinical learning environments: an intervention study, Journal of Clinical Nursing, 19, pp.171-182. Ogier, M. E. (1981) An ideal sister, Royal College of Nursing, London Orton, H. D. (1981) Ward learning climate, Royal College of Nursing, London Pearcey, P. A. and Elliott, B. E. (2004) Student impressions of clinical nursing, Nurse Education Today, 18, pp.29-31

The COVID-19 pandemic: resilient organisational response to a low-chance, high-impact event

The global healthcare sector is currently in the midst of the COVID-19 pandemic, a ‘low-chance, high-impact’ event which will require healthcare systems, and the organisations within them, to maintain organisational resilience in order to respond effectively. However, contrary to the instinctive reaction to tighten control, the quality of response depends on healthcare systems’ capacity to loosen control and, subsequently, enhance improvisation. Three factors critical to enhancing an organisation’s capacity for improvisation are highlighted; increasing autonomy, maintaining structure and creating a shared understanding. By drawing on the case of Christchurch Hospital’s response to a major earthquake, this paper demonstrates the vital role that improvisation can play within a clinical setting, when responding to a low-chance, high-impact event. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained

Support and its Impact on the Lived Experiences of African Caribbean Nurses as Students and Practitioners in the British National Health Service (NHS)

Current participation by the children of immigrants in UK nursing education is very low. There are implications for culturally sensitive care delivery and the increasing demographic shift towards an ageing population. Those who arrived during the HMS Windrush period immediately after World War 2 are now beginning to use NHS services more frequently. This paper will provide insights into Black British African Caribbean nurses’ perceptions of support as students and clinical practitioners. It draws on original research, which explored factors, that impact on participation of British African Caribbean people in careers in nursing. The paper is specifically concerned with support which was one of four key findings from the research. UK policy requires that all services, including health services, should reflect the diversity of the communities they serve. This presents opportunities and challenges that need to be explored and addressed, as the UK grapples with increased nursing shortages and low retention rates of qualified staff. The British National Health Service (NHS) has benefited from major contributions of African Caribbean communities who were specifically invited and recruited to help to rebuild the economy and the infrastructure. There is some evidence that Children of the post Windrush era, who were born here, may choose not to participate in nursing as a career because of the experiences of discrimination suffered by their parents and grandparents in the NHS. This paper explores the views of British African Caribbean nursing participants as students and workers, in their own voices. It specifically highlights the role of support in their experiences and its direct impact on their decision making and success with regards to career choices in nursing. It will consider the role that bespoke support can play in enabling successful participation, career building and the implications for nursing education