Fibrotic interstitial lung disease - palliative care needs:a World-Café qualitative study

Objectives: The importance of palliative care in those with advanced fibrotic interstitial lung diseases (F-ILD) is recognised, but the palliative care requirements of patients and caregivers affected by F-ILD regardless of disease course are not established. We set out to explore this and identify optimal solutions in meeting the needs of a F-ILD population in Ireland. Methods: Implementing a World-Café qualitative research approach, we captured insights evolving, iteratively in interactive small group discussions in response to six predefined topics on palliative care and planning for the future. Thirty-nine stakeholders participated in the World-Café including 12 patients, 13 caregivers, 9 healthcare professionals, 4 industry representatives and 1 representative of the clergy. Results: Palliative care emerged as fundamental to the care and treatment of F-ILDs, regardless of disease progression. Unmet palliative care needs were identified as psychological and social support, disease education, inclusion of caregivers and practical/legal advice for disease progression and end-of-life planning. Participants identified diagnosis as a particularly distressing time for patients and families. They called for the introduction of palliative care discussions at this early-stage alongside improvements in integrated care, specifically increasing the involvement of primary care practitioners in referrals to palliative services. Conclusion: Patients and caregivers need discussions on palliative care associated with F-ILD to be included at the point of diagnosis. This approach may address persisting inadequacies in service provision previously identified over the course of the last decade in the UK, Ireland and European F-ILD patient charters.</p

Development of visiting professor role to nursing home group: providing sustainable education for older person care

This paper explores the process involved in the development, in 2021, of a new role of visiting professor to Nursing Homes Ireland (NHI), in collaboration with the Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences. The role was developed following the Covid 19 pandemic and will support the NHI National Nursing Committee in identifying their needs and that of the society it serves by providing leadership, research and education programmes that are aligned to the university and the NHI members’ values. An evidence review was undertaken to identify studies relating to older person care and the impact of Covid 19 on nursing home residents during and following the Covid-19 pandemic. A cross-sectional on-line survey was undertaken in 2022, to capture educational needs and perceptions about work environment with a sample of 65 NHI staff representing all grades. This was followed by two focus groups held virtually with The NHI National Nursing Committee (n = 12). Thematic analysis of all findings indicates a wide range of recommendations needed to make the role a reality. These include: staff development, standards, competencies, safeguarding, leadership, strategy, advanced management, legal and ethical issues, governance and regulation and research principles. Analyses led to the development of a professional strategic plan (2022-24) which was then distributed to the NHI National Nursing Committee for comment, advice, further recommendations and finally implementation by the visiting professor. Implementation continues. The Visiting professor role is recognised by the NHI National Nursing Committee and senior managers as a collaborative one during which programme delivery is interactive. Significant outcomes and further scope to continue with the role in a sustainable manner are recognised. </p

Development of visiting professor role to nursing home group: providing sustainable education for older person care

This paper explores the process involved in the development, in 2021, of a new role of visiting professor to Nursing Homes Ireland (NHI), in collaboration with the Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences. The role was developed following the Covid 19 pandemic and will support the NHI National Nursing Committee in identifying their needs and that of the society it serves by providing leadership, research and education programmes that are aligned to the university and the NHI members’ values. An evidence review was undertaken to identify studies relating to older person care and the impact of Covid 19 on nursing home residents during and following the Covid-19 pandemic. A cross-sectional on-line survey was undertaken in 2022, to capture educational needs and perceptions about work environment with a sample of 65 NHI staff representing all grades. This was followed by two focus groups held virtually with The NHI National Nursing Committee (n = 12). Thematic analysis of all findings indicates a wide range of recommendations needed to make the role a reality. These include: staff development, standards, competencies, safeguarding, leadership, strategy, advanced management, legal and ethical issues, governance and regulation and research principles. Analyses led to the development of a professional strategic plan (2022-24) which was then distributed to the NHI National Nursing Committee for comment, advice, further recommendations and finally implementation by the visiting professor. Implementation continues. The Visiting professor role is recognised by the NHI National Nursing Committee and senior managers as a collaborative one during which programme delivery is interactive. Significant outcomes and further scope to continue with the role in a sustainable manner are recognised. </p

Worsening of mental health outcomes in nursing home staff during the COVID-19 pandemic in Ireland.

BackgroundMental health issues in nursing home staff during the COVID-19 pandemic have been significant; however, it is not known if these issues persist following widespread vaccination and easing of restrictions.ObjectiveTo quantify the mental health of nursing home staff at different timepoints during the COVID-19 pandemic in the Republic of Ireland.Design/methodsTwo identical, online, cross-sectional, nationwide, anonymous surveys of Republic of Ireland nursing home staff at two timepoints (survey 1 (S1, n = 390): November 2020 to January 2021; survey 2 (S2, N = 229: November 2021 to February 2022) during the COVID-19 pandemic. Convenience sampling was used with staff self-selecting for participation. Methods included the World Health Organisation's Well-Being Index (WHO-5), the Impact of Events Scale-Revised (IES-R), the Moral Injury Events Scale (MIES), two Likert-scale items regarding suicidal ideation and planning, the Work Ability Score (WAS), the Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale, and a 15-item questionnaire assessing perceptions of the outbreak with one additional Likert-scale item on altruism. Descriptive analysis examined differences between staff based on their classification in one of three groups: nurses, healthcare assistants (HCA) and nonclinical staff. Pseudonymous identifiers were used to link responses across surveys.ResultsAn insufficient number of participants completed both surveys for linked analyses to be performed; therefore, we performed an ecological comparison between these two independent surveys. More staff reported moderate-severe post-traumatic stress symptoms (S1 45%; S2 65%), depression (S1: 39%; S2 57%), suicidal ideation (S1: 14%; S2 18%) and suicidal planning (S1: 9%; S2 15%) later in the pandemic. There was a higher degree of moral injury at S2 (S1: 20.8 standard deviation (SD) 9.1; S2: 25.7 SD (11.3)) and use of avoidant (maladaptive) coping styles at S2 (S1: 20.8 (6.3); S2 23.0 (6.3)) with no notable differences found in the use of approach (adaptive) coping styles. Staff reported more concerns at S2 regarding contracting COVID-19, social stigma, job stress, doubts about personal protective equipment and systems and processes.ConclusionIn comparison to our previous survey, mental health outcomes appear to have worsened, coping did not improve, and staff concerns, and worries appear to have increased as the pandemic progressed. Follow-up studies could help to clarify is there are any lingering problems and to assess if these issues are related to the pandemic and working conditions in nursing homes

Nursing home staff mental health outcomes, by role (Survey 2).

Nursing home staff mental health outcomes, by role (Survey 2).</p

Mental health outcomes compared between timepoints one and two.

Mental health outcomes compared between timepoints one and two.</p

Covid-19 cases, deaths and percentage of the population fully vaccinated in the Republic of Ireland in relation to the timing of surveys 1 and 2.

Covid-19 cases, deaths and percentage of the population fully vaccinated in the Republic of Ireland in relation to the timing of surveys 1 and 2.</p

Worsening of mental health outcomes in nursing home staff during the COVID-19 pandemic in Ireland

Background: Mental health issues in nursing home staff during the COVID-19 pandemic have been significant; however, it is not known if these issues persist following widespread vaccination and easing of restrictions. Objective: To quantify the mental health of nursing home staff at different timepoints during the COVID-19 pandemic in the Republic of Ireland. Design/methods: Two identical, online, cross-sectional, nationwide, anonymous surveys of Republic of Ireland nursing home staff at two timepoints (survey 1 (S1, n = 390): November 2020 to January 2021; survey 2 (S2, N = 229: November 2021 to February 2022) during the COVID-19 pandemic. Convenience sampling was used with staff self-selecting for participation. Methods included the World Health Organisation's Well-Being Index (WHO-5), the Impact of Events Scale-Revised (IES-R), the Moral Injury Events Scale (MIES), two Likert-scale items regarding suicidal ideation and planning, the Work Ability Score (WAS), the Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale, and a 15-item questionnaire assessing perceptions of the outbreak with one additional Likert-scale item on altruism. Descriptive analysis examined differences between staff based on their classification in one of three groups: nurses, healthcare assistants (HCA) and nonclinical staff. Pseudonymous identifiers were used to link responses across surveys. Results: An insufficient number of participants completed both surveys for linked analyses to be performed; therefore, we performed an ecological comparison between these two independent surveys. More staff reported moderate-severe post-traumatic stress symptoms (S1 45%; S2 65%), depression (S1: 39%; S2 57%), suicidal ideation (S1: 14%; S2 18%) and suicidal planning (S1: 9%; S2 15%) later in the pandemic. There was a higher degree of moral injury at S2 (S1: 20.8 standard deviation (SD) 9.1; S2: 25.7 SD (11.3)) and use of avoidant (maladaptive) coping styles at S2 (S1: 20.8 (6.3); S2 23.0 (6.3)) with no notable differences found in the use of approach (adaptive) coping styles. Staff reported more concerns at S2 regarding contracting COVID-19, social stigma, job stress, doubts about personal protective equipment and systems and processes. Conclusion: In comparison to our previous survey, mental health outcomes appear to have worsened, coping did not improve, and staff concerns, and worries appear to have increased as the pandemic progressed. Follow-up studies could help to clarify is there are any lingering problems and to assess if these issues are related to the pandemic and working conditions in nursing homes.</p

Demographic characteristics of nursing home staff, by role (Survey 2).

Demographic characteristics of nursing home staff, by role (Survey 2).</p