COVID-19: What is next for nursing in public health emergency?
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ABSTRACT:
SUBMITTER: Zhang XJ
PROVIDER: S-EPMC7291995 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Publications
COVID-19: What is next for nursing in public health emergency?
Zhang Xiu-Jie XJ Shi Tie-Ying TY Sun Li L
Nurse education in practice 20200612
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Project description:ObjectiveTo explore changes to rural nursing and allied health placements during the latter stage of the COVID-19 public health emergency.SettingRegional, rural and remote Australia.ParticipantsNursing and allied health students with a scheduled University Department of Rural Health (UDRH) facilitated rural placement between 1 January 2022 and 31 October 2022.DesignCross-sectional online survey (n = 333), followed by semi-structured interviews (n = 21).ResultsAlmost all students surveyed (98.5%) were able to undertake their placement, although 13.1% reported changes to the setting, timing or delivery of training. Placement tasks (47.3%), experience of the local community (39.0%) and connection with other students (39.6%) were the placement aspects most commonly reported to have changed. However, most students were satisfied with their placement (86.0%), agreed their placement provided quality clinical training (79.3%) and wanted to work rurally after their experience (73.2%). Nursing students had lower odds of reporting satisfaction with placement (OR, 0.49 [95% CI 0.24-0.99, p = 0.03]), while placements longer than 4 weeks had almost twice the odds of promoting rural intention (OR, 1.84 [95% CI 1.09-3.15, p = 0.02]). Placement changes were associated with: fear of contracting COVID-19; circulating illness; health workforce shortages; and health and safety compliance.ConclusionsDespite changes, most students found rural placements undertaken during 2022 to be quality learning experiences which left them satisfied and wanting to work rurally. UDRHs should advocate for longer placements, improve remote supervision and accommodation infrastructure, and help prepare and support students for challenging learning environments to promote positive rural training experiences during public health emergencies.
| S-EPMC11811919 | biostudies-literature
Project description:BackgroundDespite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking.ObjectiveTo examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs.ParticipantsMedical directors or attending physicians in NHs.ApproachWe conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use.Main measuresThe extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision.Key resultsParticipants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment.ConclusionsParticipants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.
| S-EPMC10010241 | biostudies-literature
Project description:A new coronavirus outbreak emerged on the 31st of December 2019 in Wuhan, China, causing commotion among the medical community and the rest of the world. This new species of coronavirus has been termed 2019-nCoV and has caused a considerable number of cases of infection and deaths in China and, to a growing degree, beyond China, becoming a worldwide public health emergency. 2019-nCoV has high homology to other pathogenic coronaviruses, such as those originating from bat-related zoonosis (SARS-CoV), which caused approximately 646 deaths in China at the start of the decade. The mortality rate for 2019-nCoV is not as high (approximately 2–3%), but its rapid propagation has resulted in the activation of protocols to stop its spread. This pathogen has the potential to become a pandemic. It is therefore vital to follow the personal care recommendations issued by the World Health Organization.
| S-EPMC7173827 | biostudies-literature
Project description:ImportanceTelehealth services expanded rapidly during the COVID-19 public health emergency (PHE).ObjectiveTo evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE.Design, setting, and participantsIn this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024.Main outcomes and measuresCallers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared.ResultsDuring W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics.Conclusions and relevanceBased on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.
| S-EPMC11238022 | biostudies-literature
Project description:BackgroundThe emergence of coronavirus disease 2019 (COVID-19) forced many eye care providers to implement telehealth services while in-person visits were reserved for essential and/or emergency eye care.ObjectiveThis study documents how an optometry group successfully implemented telehealth to care for patients during the outbreak of the COVID-19 pandemic in the United States.DesignRetrospective, comparative case series.MethodsRecords were reviewed for patients seen in an academic optometry clinic from 23 March through 7 April 2020, the period of the Massachusetts stay-at-home advisory issued in response to COVID-19. Patients who completed telehealth visits were compared with those who received in-person care. Services delivered by telehealth included a check of symptoms, medication refills, health education, and assurance of future follow up. The study took into account the reason for each visit, as well as the rate of scheduled and completed follow-up appointments. Patient satisfaction with in-person care was evaluated by Press Ganey patient experience surveys.ResultsOut of 855 patients scheduled, 421 patients completed telehealth encounters (49%), and 46 patients completed in-clinic visits (5.4%). A further 272 patients canceled appointments (32%), 123 patients were unable to be contacted (14%), and 8 patients declined care offered by telehealth (0.94%). Most patients who were cared for by telehealth returned to see optometrists (88%). By contrast, most patients who required in-person visits during this period were subsequently seen by ophthalmologists (58%, p < 0.001). Patient satisfaction remained high for in-person visits that took place during the COVID-19-related emergency, with improvements noted in patient satisfaction regarding 'information about delays' (47 % versus 100%, p = 0.007) and 'concern for questions or worries' (76% versus 100%, p = 0.037) compared with the same period 1 year prior.ConclusionOptometrists rapidly embraced telehealth to deliver eye care to their patients during the COVID-19 public health emergency. Most eye issues were able to be addressed through telehealth; urgent eye problems were triaged and referred to the optometry clinic, when appropriate.
| S-EPMC9527121 | biostudies-literature
Project description:Since 2013, the US Centers for Disease Control and Prevention has offered the Public Health Emergency Management Fellowship to health professionals from around the world. The goal of this program is to build an international workforce to establish public health emergency management programs and operations centers in participating countries. In March 2021, all 141 graduates of the fellowship program were invited to complete a web survey designed to examine their job roles and functions, assess their contributions to their country's COVID-19 response, and identify needs for technical assistance to strengthen national preparedness and response systems. Of 141 fellows, 89 successfully completed the survey. Findings showed that fellowship graduates served key roles in COVID-19 response in many countries, used skills they gained from the fellowship, and desired continuing engagement between the Centers for Disease Control and Prevention and fellowship alumni to strengthen the community of practice for international public health emergency management.
| S-EPMC9745245 | biostudies-literature
Project description:ImportanceThe COVID-19 public health emergency (PHE) caused substantial changes in hospital operations. The net effect of these changes on hospital financial performance is unclear.ObjectiveTo evaluate changes in hospital financial performance before and during the COVID-19 PHE.Design, setting, and participantsThis longitudinal within-hospital cohort analysis from 2017 to 2021 used national RAND hospital data merged with American Community Survey data. A total of 4223 short-term acute care or critical access hospitals in the US with financial data spanning 2017 to 2021 were evaluated.ExposureFinancial performance during the first 2 years of the PHE.Main outcomes and measuresThe main outcome was PHE financial distress calculated based on net operating income (operating revenue minus operating expenses). Within-hospital changes in net operating income over time were evaluated with and without COVID-19 relief funding. From henceforth, 2020/2021 means the weighted average financial performance for both calendar year 2020 and 2021. Hospitals were characterized as having new financial distress if (1) their average 2020/2021 net operating income was negative and (2) the average 2020/2021 net operating income was less than that hospital's pre-2020 net operating income. Predictors of new financial distress were evaluated using logistic regression and predictors of COVID-19 relief using 2-part models.ResultsIn this sample of 4423 hospitals, 3529 (80.0%) received PHE funds during 2020/2021. A total of 846 (19.1%) were located in a census tract with more than 20% Hispanic residents. Of the total number of hospitals, 720 (16.3%) of hospitals had PHE financial distress, whereas 2047 (46.3%) had PHE financial distress after excluding COVID-19 relief funding from net operating income. The majority of hospitals (n = 3337; 74.8%) had a positive net operating income across 2020/2021, with 785 (17.8%) hospitals moving from a negative pre-2020 to a positive 2020/2021 net operating income. In adjusted analyses, hospitals treating a higher proportion of Hispanic populations were more likely to have PHE distress (adjusted odds ratio, 1.3; 95% CI, 1.1-1.6; P = .02). Median (IQR) operating margins from 2020/2021 were at an all-time high of 6.5% (0.2%-13.3%) compared with pre-2020 operating margins of 2.8% (-2.8% to 9.3%).Conclusions and relevanceIn this cohort study of US hospitals, the large majority had positive financial performance during 2020/2021, partly due to COVID-19 relief funds. However, hospitals serving Hispanic populations had substantially worsened financial performance during 2020/2021, even after accounting for COVID-19 relief. That COVID-19 relief funding aided in operating margins reaching all-time highs indicates funding amounts may have been larger than was necessary for many hospitals. With COVID-19 relief funding ending yet COVID-19 related continuing to affect hospital expenses, ongoing monitoring of hospital financial performance is vital to ensure patients retain access to care.
| S-EPMC10349333 | biostudies-literature
Project description:BackgroundSocial media platforms have long been recognised as major disseminators of health misinformation. Many previous studies have found a negative association between health-protective behaviours and belief in the specific form of misinformation popularly known as 'conspiracy theory'. Concerns have arisen regarding the spread of COVID-19 conspiracy theories on social media.MethodsThree questionnaire surveys of social media use, conspiracy beliefs and health-protective behaviours with regard to COVID-19 among UK residents were carried out online, one using a self-selecting sample (N = 949) and two using stratified random samples from a recruited panel (N = 2250, N = 2254).ResultsAll three studies found a negative relationship between COVID-19 conspiracy beliefs and COVID-19 health-protective behaviours, and a positive relationship between COVID-19 conspiracy beliefs and use of social media as a source of information about COVID-19. Studies 2 and 3 also found a negative relationship between COVID-19 health-protective behaviours and use of social media as a source of information, and Study 3 found a positive relationship between health-protective behaviours and use of broadcast media as a source of information.ConclusionsWhen used as an information source, unregulated social media may present a health risk that is partly but not wholly reducible to their role as disseminators of health-related conspiracy beliefs.
| S-EPMC7298098 | biostudies-literature
Project description:Background/objectivesAlmost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges.DesignOutbreak investigation.SettingThree NHs in southeast Michigan.ParticipantsAll residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system.MethodsUpon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility-wide testing and the following intervention measures: cohorting of COVID-19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID-19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14-day outcomes.ResultsA total of 29 cases of COVID-19 were identified at three participating NHs. Nineteen cases of COVID-19 were identified through symptom-triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point-prevalence survey required hospitalization, and five were discharged home within 14 days.ConclusionProactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID-19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.
| S-EPMC7675453 | biostudies-literature
Project description:BackgroundDuring the COVID-19 pandemic, social media became an important and easily accessible source of information to keep the population informed. In this study, we explored how Portuguese health entities used social media during the public health emergency caused by COVID-19 disease.MethodsA retrospective study on Portuguese public health entities' communication with the public using social media platforms was performed. Data were retrieved from Facebook, Instagram, and Twitter. All retrieved posts were analyzed, and the engagement of the public was calculated. A thematic analysis of all COVID-19-related posts was conducted.ResultsThe analysis of each social media platform revealed that during the COVID-19 pandemic, health entities reinforced their presence on social media platforms. The most published posts were related to "epidemiological context" and "encouragement to take actions" to avoid the spread of COVID-19. High engagement frames were not associated with the most frequently published posts.ConclusionsAlthough health entities have reinforced their presence on social media platforms, they do not take full advantage of these platforms to improve health literacy.
| S-EPMC9564587 | biostudies-literature