Nursing Home COVID-19 Impact Analysis Dashboard: A Prototype

The interactive dashboard developed in this study serves to better understand the impact of COVID-19 within nursing homes across the USA. It allows stakeholders to make informed decisions related to the spread of COVID-19 over a 14-month period starting May 2020. Analytics techniques are used to customize the dashboard and enhance its visualization and interactive capabilities. The design science research method was used to create the interactive dashboard as a design artifact to help stakeholders get answers to improve the livelihood conditions for residents in nursing homes. Use of this artifact improves access to information for policy makers and other stakeholders that could not have been possible without an integrated view. The information can inspire new policies for nursing home facilities to improve their situation in light of the pandemic

Climate, Environment, And Public Health In Western North Carolina

The frequency and severity of extreme weather events are expected to increase in the context of a changing climate. Populations across the globe are vulnerable and already experiencing the health effects of a changing climate. Western North Carolina (WNC) is no exception. The last decade was the warmest ever on record. This past year, 2019, broke historical records in North Carolina, and temperature anomalies in WNC largely drove this pattern. The indirect and direct effects of climate on human health are complicated and modulated by underlying social vulnerabilities that enhance the severity and sensitivity of population exposure to climate hazards. In this paper, we discuss the complex pathways through which climate hazards impact health in WNC and the on-going efforts among the academic and public health community to address these emerging climate-related health threats. Specifically, we highlight the changing patterns in (1) temperature-related disease, (2) vector-borne disease, (3) natural hazards, (4) mental health impacts and the (5) built environment. Lastly, we identify important research needs and partnerships required to motivate effective and meaningful engagement with the public and policymakers around the regional impacts of climate change on human health, potential solutions, and co-benefits of resilience planning in WNC

Evaluation of a COVID ‐19 fundamental nursing care guideline versus usual care: The COVID‐NURSE cluster randomized controlled trial

Aim: To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID‐19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health‐related quality of life and cost‐effectiveness. Design: Parallel two‐arm, cluster‐level randomized controlled trial. Methods: Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID‐19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient‐reported co‐primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention‐to‐treat analyses. Results: We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570–572 (98.1%–98.5%) patient participants in 14 clusters. We found no evidence of between‐group differences on any patient, nurse or economic outcomes. We found between‐group differences over time, in favour of the intervention, for three of our five co‐primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the ‘other’ ethnicity subgroup. Conclusion: We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non‐white British patients' experience of care. Implications for the Profession and/or Patient Care: We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. Impact: Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non‐white British patients' experience of care. Reporting Method: CONSORT and CONSERVE. Patient or Public Contribution: Patients with experience of hospitalization with COVID‐19 were involved in guideline development and writing, trial management and interpretation of findings

Report-back for geo-referenced environmental data: A case study on personal monitoring of temperature in outdoor workers

Few studies have evaluated the benefits of reporting back participatory environmental monitoring results, particularly regarding participant motivation toward behavioural modification concerning workplace heat exposure. This study evaluated the individual data report-back for geo-located environmental temperature and time activity patterns in grounds maintenance crews in three geographic regions across the South-eastern United States. Surveys collected information on worker interpretation of their results and intended action(s) to reduce heat exposure. Worker response was highly positive, especially among more experienced workers who expressed a greater willingness to modify personal behaviour to reduce heat stress. Individual-level report-back of environmental data is a powerful tool for individuals to understand and act on their personal exposure to heat

Quasi-Experimental Evaluation of Text-based Crisis Patterns in Youth following Hurricane Florence in the Carolinas, 2018

IMPORTANCE Crisis text lines have proven to be an effective and low-cost means for delivering texting-based mental health support to youth. Yet there has been limited research examining the use of these services in capturing the psychological impact of youth affected by a weather-related disaster. OBJECTIVE This ecologic study examined changes in help-seeking behavior for youth in North and South Carolina, USA, before and after Hurricane Florence (2018). DESIGN AND MAIN OUTCOMES A retrospective, interrupted time-series design was used to examine pre- and post-hurricane changes in crisis text volume among youth help seekers in the Carolinas for the following outcomes: (1) text for any reason; (2) stress & anxiety; (3) depression; and (4) suicidal thoughts. RESULTS Results showed an immediate and sustained increase in crisis texts for stress/anxiety and suicidal thoughts in the six weeks following Florence. Overall, an immediate 15% increase in crisis texts for anxiety/stress (SE=.05, p=0.005) and a 17% increase in suicidal thoughts (SE=.07, p=0.02) occurred during the week of the storm. Text volume for anxiety/stress increased 17% (SE=.08, p=0.005) and 23% for suicidal ideation (SE=.08, p=0.01) in the 6-week post-intervention period. Finally, forecast models revealed observed text volume for all mental health outcomes was higher than expected in the 6 weeks post-Florence. CONCLUSIONS AND RELEVANCE A low-cost, crisis texting intervention platform provided 24/7 mental health support available to young people in the Carolinas impacted by Hurricane Florence. These findings highlight a new application for text-based crisis support services to address the mental health consequences among individuals following a weather-related disaster

Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey

Aims To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. Design Online survey with open-ended questions to collect qualitative data. Methods In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. Results A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients’ significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using ‘runners’ and interdisciplinary input. 3) Addressing patients’ well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients’ wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. Conclusions Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. Impact As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial

COVID-NURSE: Evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus-Protocol for a cluster randomised controlled trial

Introduction Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse–patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs. Methods and analysis we aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients’ Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations. Ethics and dissemination Research governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University’s FutureLearn web platform. Trial registration number ISRCTN13177364; Pre-results