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Challenges in Caring for Patients in the Time of COVID-19

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 27365

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Dr. Sara Campagna

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Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
Interests: nursing education; clinical nursing research; nursing; clinical trials; nursing research; evidence based nursing

Dr. Marco Clari

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Guest Editor

Department of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy
Interests: health-care workers; nurses; self-care; epidemiology; meta-analysis
Special Issues, Collections and Topics in MDPI journals

Dr. Alessio Conti

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Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
Interests: clinical nursing; nursing education; nursing assessment; advanced practice nursing; nursing; nursing diagnosis

Dr. Silvia Gonella

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Guest Editor

1. Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
2. Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
Interests: communication; nursing home; palliative care; dementia care; family carers
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The novel coronavirus, also known as SARS-Cov-2 or COVID-19, has become a worldwide concern for policy-makers, educators, researchers, and all healthcare professionals who are engaged in clinical care.

Managers and healthcare professionals were challenged to apply the four main principles of biomedical ethics in taking care of their patients, i.e., autonomy, justice, beneficence, and non-maleficence, when mobilizing and allocating scarce resources; they often had to confront challenging decisions, such as which patients were more likely to benefit from an intensive care unit bed or mechanical ventilation. Additionally, the safety and distress of healthcare professionals who were exposed to exhausting working shifts, often in circumstances of limited personal protective equipment availability, raised ethical concerns. Families were not involved in their relative’s care and often did not have the opportunity to stay close to them at the end of their life. Thus, healthcare professionals’ family and patient relationships have been inevitably compromised.

Moreover, COVID-19 implied challenges of teaching and learning. Educators faced the pedagogical challenge of teaching online and were required to develop new communicative and technology skills, adapt materials, and re-structure lessons to provide high-quality teaching. Similarly, students’ learning has been challenging: while some students appreciated remote learning due to more flexible organization and a reduction in traveling time, others struggled due to the lack of access to reliable technology or Wi-Fi, or limited support, particularly for those with disabilities. Thus, issues related to equity created unfair barriers. The pandemic has starkly highlighted the fragility of our education systems.

Finally, COVID-19 has changed the way we conduct research, with increased risk of reinforcing existing inequalities and further excluding marginalized groups. COVID-19 reduced researchers’ opportunities to reach potential participants in person and made them rely more on digital technologies. This increased the risk of excluding those who are socio-economically deprived, lack digital literacy, or are unwell. Thus, researchers had to struggle to find new strategies to reach and maintain contact with participants while not being physically there.

However, we have also learned lessons from COVID-19. The pandemic has prompted us to rethink traditional ways of doing things, including students’ education and research, promoting collaboration among research institutions and increasing public trust in the work of researchers.

Therefore, articles that consider both scientific and practical or implementation features about these topics are appreciated. Research articles, literature reviews, and reflections on experiences are welcome in this issue; clinical cases, conference proceedings, opinion papers, position papers, brief reports, and commentaries are also accepted.

Dr. Sara Campagna
Dr. Marco Clari
Dr. Alessio Conti
Dr. Silvia Gonella
Guest Editors

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Keywords

challenges
COVID-19
education
healthcare professionals
management
patients
policymakers
research

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Published Papers (10 papers)

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Research

19 pages, 393 KiB

Open AccessArticle

The Family and Community Nurses Cultural Model in the Times of the COVID Outbreak: A Focused Ethnographic Study

by Michela Barisone, Erica Busca, Erika Bassi, Enrico De Luca, Emanuele Profenna, Barbara Suardi and Alberto Dal Molin

Int. J. Environ. Res. Public Health 2023, 20(3), 1948; https://doi.org/10.3390/ijerph20031948 - 20 Jan 2023

Cited by 3 | Viewed by 2317

Abstract

The ageing population, increasingly frail and chronically ill, and COVID-19 pandemic challenges have highlighted national health systems’ vulnerability and, more strongly/to a greater extent, the pivotal role of the family and community nurse (FCN). However, the recent introduction of FCNs in primary care settings has yet to be explored in Italy. This study aimed to identify the FCNs’ cultural model and its implementation during the COVID-19 outbreak. A focused ethnographic study was performed in a primary care community service in northern Italy. Participants were FCNs (N = 5), patients and caregivers (N = 12). Qualitative data were collected through semi-structured interviews, field notes, observation of FCNs’ activities and access to documents. Qualitative analysis identified themes concerned with crucial aspects of FCNs’ activities, role implementation, and their relationship with patients and families. This study illuminated how the FCN strategically takes care of and identifies patients’ and community needs. Although the COVID-19 outbreak hindered effective FCN project implementation, this study highlighted that the pandemic provided a chance to better identify cultural, organisational and educational weaknesses that need to be addressed to support the full accomplishment of FCNs’ scope of practice. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

13 pages, 1113 KiB

Open AccessArticle

Long-Term Consequences of COVID-19 Disease Specific to Women: Exploratory Research

by Karolina Juszko, Patryk Szary, Justyna Mazurek, Sebastian Rutkowski, Błażej Cieślik, Joanna Szczepańska-Gieracha and Robert Gajda

Int. J. Environ. Res. Public Health 2023, 20(1), 150; https://doi.org/10.3390/ijerph20010150 - 22 Dec 2022

Cited by 3 | Viewed by 2634

Abstract

This study was designed to explore COVID-19 in a biopsychosocial model, taking into account the different mental and social consequences of the disease in women and men. A sociodemographic questionnaire containing anthropometric data, socioeconomic data, lifestyle data, health status before COVID-19, course of COVID-19, symptoms, and complications after COVID-19 was administered to 83 women and 64 men to investigate their mental health (MH) and quality of life (QoL). The Hospital Anxiety (HADS-A) and Depression (HADS-D) Scale, the Perceived Stress Scale (PSS-10) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) were adopted. Abnormal results in HADS-D and HADS-A were obtained in 33 (39.8%) women and 10 (15.6%) men and in 26 (31.3%) women and 14 (21.9%) men, respectively. Women experienced a lower level of QoL than men. The prolonged duration of COVID-19 symptoms was associated with increased anxiety in women during recovery. Good self-reported health before COVID-19 in women was associated with reduced QoL. Women had more symptoms of COVID-19 than men, and they experienced neurological complications more often. The presence of neurological complications in women appears to be associated with increased perceived anxiety and reduced QoL. This is an exploratory study whose results can influence future research with larger and more diverse samples. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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11 pages, 587 KiB

Open AccessArticle

Telerehabilitation in the Transitional Care of Patients with Sequelae Associated with COVID-19: Perception of Portuguese Nurses

by Neuza Reis, Maria José Costa Dias, Luís Sousa, Inês Agostinho, Miguel Toscano Ricco, Maria Adriana Henriques and Cristina Lavareda Baixinho

Int. J. Environ. Res. Public Health 2022, 19(24), 17096; https://doi.org/10.3390/ijerph192417096 - 19 Dec 2022

Cited by 5 | Viewed by 2255

Abstract

The COVID-19 pandemic brought many changes and challenges to health professionals, due to a lack of knowledge when dealing with the disease, fear of contagion, and the sequelae that characterize long COVID. To deal with this situation, respiratory rehabilitation programs are recommended in face-to-face and/or telerehabilitation modalities. (1) Background: This study had as its primary aim identifying the aspects/components to be considered in the planning and implementation of telerehabilitation interventions that guarantee transitional care for people with long COVID-19 after hospitalization and as a secondary aim identifying the positive aspects of telerehabilitation. (2) Methods: The method used to answer the research question was a focus group, carried out online with eight nurses specialized in rehabilitation nursing. The answers to the semi-structured interview were subjected to content analysis, and qualitative data analysis software (WebQDA^®) was used to organize and analyze the findings. (3) Results: Four categories emerged from the content analysis: coordination between care levels; transitional care telerehabilitation intervention; advantages of telerehabilitation; and opportunities. (4) Conclusions: These findings make an important contribution to the reorganization of transitional care, allowing the identification of central aspects to be considered in the planning and implementation of telerehabilitation programs for people with long COVID. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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12 pages, 555 KiB

Open AccessArticle

Clinical Characterization of the Three Waves of COVID-19 Occurring in Southern Italy: Results of a Multicenter Cohort Study

by Mariantonietta Pisaturo, Antonio Russo, Viraj Pattapola, Roberta Astorri, Paolo Maggi, Fabio Giuliano Numis, Ivan Gentile, Vincenzo Sangiovanni, Annamaria Rossomando, Valeria Gentile, Giosuele Calabria, Raffaella Pisapia, Alessio Vinicio Codella, Alfonso Masullo, Valentina Iodice, Giancarlo Giolitto, Roberto Parrella, Giuseppina Dell’Aquila, Michele Gambardella, Felicia Di Perna and Nicola Coppola Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(23), 16003; https://doi.org/10.3390/ijerph192316003 - 30 Nov 2022

Cited by 8 | Viewed by 1694

Abstract

Aims: To characterize patients hospitalized for COVID-19 in the three waves in Southern Italy. Methods: We conducted a multicenter observational cohort study involving seventeen COVID-19 Units in Campania, southern Italy: All adult (≥18 years) patients, hospitalized with a diagnosis of SARS-CoV-2 infection from 28 February 2020 to 31 May 2021, were enrolled. Results: Two thousand and fifteen COVID-19 hospitalized patients were enrolled; 392 (19%) in the first wave, 917 (45%) in the second and 706 (35%) in the third wave. Patients showed a less severe clinical outcome in the first wave than in the second and third waves (73%, 65% and 72%, respectively; p = 0.003), but hospitalization expressed in days was longer in the first wave [Median (Q1–Q3): 17 (13–25) v.s. 14 (9–21) and 14 (9–19), respectively, p = 0.001)] and also mortality during hospitalization was higher in the first wave than in the second and third waves: 16.6% v.s. 11.3% and 6.5%, respectively (p = 0.0001). Multivariate analysis showed that older age [OR: 1.069, CI (1046–1092); p = 0.001], a worse Charlson comorbidity index [OR: 1042, CI (1233–1594; p = 0.0001] and enrolment during the first-wave [OR: 1.917, CI (1.054–3.485; p = 0.033] were predictors of mortality in hospitalized patients. Conclusions: Improved organization of the healthcare facilities and the increase in knowledge of clinical and therapeutic management have contributed to a trend in the reduction in mortality during the three waves of COVID-19. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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13 pages, 335 KiB

Open AccessArticle

‘Safety First’: Residents, Families, and Healthcare Staff Experiences of COVID-19 Restrictions at an Irish Residential Care Centre

by Michael Connolly, Anita Duffy, Mary Ryder and Fiona Timmins

Int. J. Environ. Res. Public Health 2022, 19(21), 14002; https://doi.org/10.3390/ijerph192114002 - 27 Oct 2022

Cited by 1 | Viewed by 1829

Abstract

The COVID-19 pandemic and the need to stem the transmission and protect the most vulnerable in society led to infection control restrictions effectively locking down an entire country. These restrictions were also imposed on residential care settings for older people, initially in March 2020, and subsequently at varying times throughout the year that followed. Furthermore, the restrictions led to the suspension in all visiting to residents expect in exceptional circumstances and on compassionate grounds. The purpose of this research study was to develop an understanding of the experience of residents, their families, and carers in an Irish residential care setting during the COVID-19 lockdown. Data were collected in a residential care centre for older people in Ireland, using semi-structured interviews of residents, family members and staff. Interviews were conducted in person for residents and virtually for family members and staff. In total 29 people were interviewed. Data were analysed using Braun and Clarke’s thematic data analysis approach. Four themes and three subthemes were developed from the data. The main themes were ‘difficult but safe’, ‘communication’, ‘staff going above and beyond’, ‘what about the future?’ Residents, families and staff of the residential care setting had to manage and cope with the challenges of the restrictions imposed during COVID-19 lockdown. This study highlighted the negative impacts of visiting restrictions on staff, residents and their family members during the COVID-19 lockdown. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

14 pages, 662 KiB

Open AccessArticle

The Experience of COVID-19 Visitor Restrictions among Families of People Living in Long-Term Residential Care Facilities during the First Wave of the Pandemic in Ireland

by Nicola Cornally, Caroline Kilty, Catherine Buckley, Rónán O’Caoimh, Mark R. O’Donovan, Margaret P. Monahan, Caroline Dalton O’Connor, Serena Fitzgerald and Irene Hartigan

Int. J. Environ. Res. Public Health 2022, 19(11), 6559; https://doi.org/10.3390/ijerph19116559 - 27 May 2022

Cited by 13 | Viewed by 2493

Abstract

Public health responses to COVID-19 in long-term residential care facilities (LTRCFs) have restricted family engagement with residents. These restrictions impact on quality of care and the psychosocial and emotional well-being of family caregivers. Following a national cross-sectional web-based survey, respondents were invited to provide personal reflections on visitor restrictions. This study aims to describe the consequences of these restrictions for individuals living in LTRCF and their families during the first wave of the COVID-19 pandemic. Data from open-ended questions contained within the survey were analyzed using Braun and Clarke’s (2006) method of thematic analysis. Four themes were identified: 1. Altered Communication and Connection; 2. Emotional and Psychological Impact; 3. Protecting and Caring Role of Staff; 4. Family Role. Throughout the narrative accounts, it is evident that the visitor restrictions impacted on the emotional and mental well-being of families. Some respondents expressed frustration that they could not assist staff in essential care provision, reducing meaning and purpose in their own lives. COVID-19 LTRCF visitor restrictions made little distinction between those providing essential personal care and those who visit for social reasons. A partnership approach to care provision is important and should encompass strategies to maintain the psychosocial and emotional well-being of families and their relatives during times of self-isolating or restrictive measures. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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14 pages, 1172 KiB

Open AccessArticle

One Word to Describe My Experience as a COVID-19 Survivor Six Months after Its Onset: Findings of a Qualitative Study

by Alvisa Palese, Maddalena Peghin, Valentina Bressan, Margherita Venturini, Valentina Gerussi, Giulia Bontempo, Elena Graziano, Erica Visintini and Carlo Tascini

Int. J. Environ. Res. Public Health 2022, 19(9), 4954; https://doi.org/10.3390/ijerph19094954 - 19 Apr 2022

Cited by 2 | Viewed by 2036

Abstract

The COVID-19 pandemic emotionally affected the lives of patients cared for in different settings. However, a comprehensive view of the whole experience as lived by survived patients, from the onset of the disease and over time, is substantially unknown to date. A descriptive qualitative design was implemented according to the Standards for Reporting Qualitative Research. Adult patients (=1067) cared for during the first wave (March/April 2020) capable of answering an interview and willing to participate were interviewed (=397) by phone with an interview guide including open- and closed-ended questions. In this context, they were asked to summarise with a metaphor their entire COVID-19 experience at six months. Then, the emotional orientation (positive, neutral, or negative) of the metaphors expressed was identified. The participants were mainly female (206; 51.9%), with an average age of 52.6 years (CI 95% 50.4–53.6), reporting a mild severity of COVID-19 disease at the onset (261; 65.7%) and the perception of being completely healed (294; 70%) at six months. The patients summarised their experiences mainly using negative-oriented (248; 62.5%) metaphors; only 54 (13.6%) reported positive-oriented metaphors and a quarter (95; 23.95) neutral-oriented metaphors. Nearly all positive-oriented metaphors were reported by patients with symptoms at the onset (53; 98.1%), a significantly higher proportion compared to those reporting negative- (219; 88.3%) and neutral–oriented (78; 82.1%) metaphors (p = 0.014). While no other clinical features of the disease were associated, among females, significantly more negative-oriented metaphors emerged. Moreover, neutral-oriented metaphors were reported by younger patients (49.5 years, CI 95% 64.11–52.92) as compared to those negative and positive that were reported by more mature patients (53.9; CI 95% 52.04–55.93 and 54.8; CI 95% 50.53–59.24, respectively) (p = 0.044). Nurses and healthcare services require data to predict the long-term needs of patients. Our findings suggest that, for many patients, the COVID-19 lived experience was negative over time. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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9 pages, 310 KiB

Open AccessArticle

Choosing between Homologous or Heterologous COVID-19 Vaccination Regimens: A Cross-Sectional Study among the General Population in Italy

by Marco Clari, Alessandro Godono, Beatrice Albanesi, Elena Casabona, Rosanna Irene Comoretto, Ihab Mansour, Alessio Conti, Valerio Dimonte and Catalina Ciocan

Int. J. Environ. Res. Public Health 2022, 19(5), 2944; https://doi.org/10.3390/ijerph19052944 - 3 Mar 2022

Cited by 2 | Viewed by 1703

Abstract

A shortage of COVID-19 vaccines and reports of side-effects led several countries to recommend a heterologous regimen for second vaccine doses. This study aimed to describe the reasons behind individuals’ choices of a homologous or a heterologous second vaccination. This cross-sectional study enrolled individuals under 60 who had received a first dose of Vaxzevria and could choose between a homologous or heterologous regimen for their second dose. Quantitative (socio-demographic, clinical characteristics) and qualitative data were collected and analysed through a generalized linear model and thematic analysis, respectively. Of the 1437 individuals included in the analysis, the majority (76.1%) chose a heterologous second dose of the COVID-19 vaccination. More females chose a heterologous vaccination regimen (p = 0.003). Younger individuals also tended to choose heterologous vaccination (p < 0.001). The main motivation in favour of heterologous vaccination was to follow the Italian Ministry of Health recommendations (n = 118; 53.9%). This study showed that most individuals, mainly younger people and females, chose a heterologous dose of COVID-19 vaccination after their first viral vector vaccine. Heterologous vaccinations could be an effective public health measure to control the pandemic as they are a safe and efficient alternative to homologous regimens. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

18 pages, 544 KiB

Open AccessArticle

Challenges Experienced by Italian Nursing Home Staff in End-of-Life Conversations with Family Caregivers during COVID-19 Pandemic: A Qualitative Descriptive Study

by Silvia Gonella, Paola Di Giulio, Alexandra Antal, Nicola Cornally, Peter Martin, Sara Campagna and Valerio Dimonte

Int. J. Environ. Res. Public Health 2022, 19(5), 2504; https://doi.org/10.3390/ijerph19052504 - 22 Feb 2022

Cited by 12 | Viewed by 3233

Abstract

End-of-life conversations are among the most challenging of all communication scenarios and on the agenda of several healthcare settings, including nursing homes (NHs). They may be also difficult for experienced healthcare professionals (HCPs). This study explores the difficulties experienced by Italian NH staff in end-of-life conversations with family caregivers (FCs) during COVID-19 pandemic to uncover their educational needs. A qualitative descriptive study based on inductive thematic analysis was performed. Twenty-one HCPs across six Italian NHs were interviewed. Four themes described their experiences of end-of-life conversations: (1) communicating with FCs over the overall disease trajectory; (2) managing challenging emotions and situations; (3) establishing a partnership between HCPs and FCs; (4) addressing HCPs’ communication skills needs. HCPs had to face multiple challenging situations that varied across the care period as well as complex emotions such as anxiety, guilt, uncertainty, fear, anger, or suffering, which required tailored answers. COVID-19 pandemic increased FCs’ aggressive behaviors, their distrust, and uncertainty due to visitation restrictions. HCPs had to overcome this by developing a set of strategies, including adoption of an active-listening approach, supportive communication, and explicit acknowledgement of FCs’ emotions. Since communication needs were mostly practical in nature, HCPs valued practical communication training. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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12 pages, 338 KiB

Open AccessArticle

The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study

by Hanneke J. A. Smaling, Bram Tilburgs, Wilco P. Achterberg and Mandy Visser

Int. J. Environ. Res. Public Health 2022, 19(1), 519; https://doi.org/10.3390/ijerph19010519 - 4 Jan 2022

Cited by 41 | Viewed by 5595

Abstract

Social distancing measures imposed because of the COVID-19 pandemic presented challenges to the health and wellbeing of people with dementia, family carers, and healthcare professionals. This study investigated the impact of these measures on all involved in the care for people with dementia. For this qualitative study, 20 family carers and 20 healthcare professionals from home care and long-term care (LTC) participated in a semi-structured interview. Interviews were analysed using an inductive thematic analysis approach. For people with dementia, the social distancing measures resulted in a deterioration of physical health. The impact on their emotional state and behaviour depended on the stage of dementia. Family carers experienced difficulty coping with visiting restrictions, anxiety regarding safety, and changes in carer burden. Healthcare professionals had an increased workload, and felt guilty about adhering to restrictive measures. Differences between home care and LTC were reported (i.e., societal initiatives focussed on LTC, scarcity of activities for community-dwelling people with dementia, use of personal protective equipment more intrusive for home care). The social distancing measures had a negative impact on persons with dementia, their family carers, and healthcare professionals. More attention is needed for community-dwelling people with dementia and family carers in times of social isolation. Full article

(This article belongs to the Special Issue Challenges in Caring for Patients in the Time of COVID-19)

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