Learning lessons from the paediatric critical care response to the SARS-CoV-2 pandemic in England and Wales: a qualitative study

ObjectivesTo explore the experiences of clinical leads in paediatric critical care units (PCCUs) in England and Wales during the reorganisation of services in the initial surge of the SARS-CoV-2 pandemic and to learn lessons for future surges and service planning.MethodsA qualitative study design using semistructured interviews via virtual conferencing was conducted with consultant clinical leads and lead nurses covering 21 PCCUs. Interviews were conducted over a period of 2 weeks, 2 months after the initial SARS-CoV-2 surge. Interview notes underwent thematic analysis.ResultsThematic analysis revealed six themes: leadership, management and planning; communication; workforce development and training; innovation; workforce experience; and infection prevention and control. Leadership was facilitated through clinician-led local autonomy for decision-making and services were better delivered when the workforce was empowered to be flexible in their response. Communication was preferred through collaborative management structures. Further lessons include recognising workforce competencies in surge preparations, the use of virtual technology in facilitating training and meetings, the importance of supporting the well-being of the workforce and the secondary consequences of personal protective equipment use.ConclusionsDuring the 2020 SARS-CoV-2 pandemic, an agile response to a rapidly changing situation was enabled through effective clinical leadership and an adaptive workforce. Open systems of communication across senior clinical and management teams facilitated service planning. Support for all members of the workforce through implementation of appropriate and innovative education and well-being solutions was vital in sustaining resilience. This learning supports planning for future surge capacity across paediatric critical care locally and nationally.

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1 Paediatric Transport Safety Collaborative (PTSIC): Critical Events with Family Presence During Paediatric Critical Care Transport

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.000 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e1-e1

Author(s):

Aaisham Ali ◽

Michael Miller ◽

Saoirse Cameron ◽

Anna Gunz

Keyword(s):

Critical Care ◽

Critically Ill ◽

Patient Outcomes ◽

Well Being ◽

Critical Events ◽

Family Presence ◽

Paediatric Patients ◽

Increased Risk ◽

Transport Team ◽

Paediatric Critical Care

Abstract Background Health care of children in Canada is regionalized; thus, critically ill paediatric patients require transfer to a tertiary care centre for definitive medical and surgical management. There are risks inherent to transporting critically ill patients, and there is a body of literature looking to mitigate risk, which includes tracking and benchmarking quality metrics. One accepted metric is family accompaniment of a child during transport, with some studies suggesting that family accompaniment could compromise care. Currently, there has been no research that examines patient safety and outcomes during paediatric critical care transport with family presence. Objectives The primary objective of this study was to compare the rate of critical events (CEs) during the transport of paediatric patients by a specialized paediatric critical care transport team on transports with parental/caregiver accompaniment (P/CA) to those without P/CA. Secondary objectives included whether peak heart rate (HR), systolic blood pressure (SBP), and clinically relevant patient outcomes varied between groups. Design/Methods We conducted a retrospective cohort study of all patients (<18 years old) who were admitted to a Paediatric Critical Care Unit and transported by the local neonatal paediatric transport team between April 1st, 2018 and June 1st, 2019, inclusive. The primary outcome was CE occurrence using the composite definition of CE that was previously identified and defined by a national consensus process, which included patient-, transport provider-, laboratory- and system/vehicle- related safety factors. Secondary outcomes included peak and trough HR/SBP, and clinically relevant outcomes (including length of stay, mechanical ventilation free days, and severity of illness and organ dysfunction scores). Results There were a total of 178 transports eligible for analysis, and of those, 55 were with P/CA and 123 were without P/CA. The occurrence of CE was not significantly different between transports with and without P/CA (66% vs. 65%, respectively). Similarly, patient HR, SBP, and all measured clinical patient outcomes did not vary significantly between groups. Conclusion This study is the first to objectively measure CEs and relate them to patient clinical outcomes with regard to presence of P/CA during paediatric critical care transport. There was no identified increased risk to the patient or crew if parents/caregivers accompanied their child during transport. Areas of future study include whether parental/caregiver presence during transport affects patient anxiety and well-being.

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Community caregivers' perspectives of community well-being in a mining community

Health SA Gesondheid ◽

10.4102/hsag.v22i0.1061 ◽

2017 ◽

Vol 22 ◽

pp. 316-324 ◽

Cited By ~ 1

Author(s):

Vicki Koen ◽

Elizabeth Hermina Ryke ◽

Martha Jacoba Watson ◽

Elize Sonja Van Eeden

Keyword(s):

South Africa ◽

Data Collection ◽

Qualitative Study ◽

Thematic Analysis ◽

Local Community ◽

Well Being ◽

Multidisciplinary Research ◽

Mining Communities ◽

Community Wellbeing ◽

Mining Community

Mining communities throughout the Southern African Development Community are faced with numerous challenges impacting on their wellbeing. As part of an integrative multidisciplinary research project, this study sought to explore aspects that affect community wellbeing in the informal Bekkersdal mining community in South Africa from the perspective of local community caregivers. An explorative-descriptive qualitative study including 22 mainly female (91%) participants who were purposively sampled was conducted. As part of data collection, participants answered a series of open-ended questions in a questionnaire and kept journals. Thematic analysis was used to analyze that data. The results indicate aspects that either promote (contribute to) or hinder community wellbeing.

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Primary School Teachers’ Perspective of Sexual Education in Spain. A Qualitative Study

Healthcare ◽

10.3390/healthcare9030287 ◽

2021 ◽

Vol 9 (3) ◽

pp. 287

Author(s):

Fernando Jesús Plaza-del-Pino ◽

Isabelle Soliani ◽

Cayetano Fernández-Sola ◽

Joaquín Jesús Molina-García ◽

María Isabel Ventura-Miranda ◽

...

Keyword(s):

Qualitative Study ◽

Primary School ◽

Thematic Analysis ◽

Well Being ◽

Comprehensive Approach ◽

Sexual Education ◽

Social Aspects ◽

School Teachers ◽

Primary School Teachers ◽

Teaching Learning

Sexual education is a part of the teaching-learning process that addresses cognitive, psychological, physical and social aspects of sexuality. The purpose of sexual education is to provide people with knowledge, abilities, attitudes and values that will help them to have good sexual health, well-being and dignity. The objective of this study was to explore the perspective of primary school teachers regarding Sexual Education in school. A descriptive qualitative study was designed based on content thematic analysis. Fifteen open-ended interviews with primary school teachers were carried out, followed by inductive data analysis using ATLAS.ti software. Two key themes emerged from the analysis: “In search of a comprehensive approach to Sexual Education” and “Barriers to Sexual Education in schools: From the lack of training to fear of the families”. We conclude that despite the efforts to implement a comprehensive approach to Sexual Education that recognises sexuality as a right, primary school teachers face difficulties in delivering Sexual Education in schools due to a lack of training and the fear that parents will reject their children being spoken to about sexuality.

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How to bring residents’ psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes—A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0249098 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0249098

Author(s):

Sanne Kaelen ◽

Wilma van den Boogaard ◽

Umberto Pellecchia ◽

Sofie Spiers ◽

Caroline De Cramer ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Nursing Homes ◽

Qualitative Study ◽

Psychosocial Support ◽

Well Being ◽

Psychological Needs ◽

Infection Prevention And Control ◽

Organization Of Care

Background Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.

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Exploring the Experiences and Well-Being of Australian Rio Olympians During the Post-Olympic Phase: A Qualitative Study

Frontiers in Psychology ◽

10.3389/fpsyg.2021.685322 ◽

2021 ◽

Vol 12 ◽

Author(s):

Andrew Bennie ◽

Courtney C. Walton ◽

Donna O’Connor ◽

Lauren Fitzsimons ◽

Thomas Hammond

Keyword(s):

Qualitative Study ◽

Return To Work ◽

Performance Appraisal ◽

Thematic Analysis ◽

Elite Athlete ◽

Olympic Games ◽

Well Being ◽

Structured Interviews ◽

Olympic Athletes ◽

The Olympic Games

Research about the Olympic Games has primarily focused on preparing athletes for competition. Less attention has been paid to the post-Olympic-phase (POP) and athlete well-being during this time. This study explored Australian Olympic athletes’ experiences following the conclusion of the 2016 Rio Olympic Games, including the factors that may have contributed to or challenged their well-being during this time. Eighteen athletes participated in semi-structured interviews and thematic analysis revealed that when Olympic performance appraisal met prior expectations, when athletes planned for a return to work or study, and when support from a variety of sources was readily available, this positively influenced athletes’ well-being during the POP. When these factors were not in place, more challenging post-Games experiences were present, and well-being was compromised. The findings contribute to the broader literature on elite athlete well-being and at an applied level, may be used to inform targeted programs that focus on supporting athletes after an Olympic campaign.

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A Qualitative Study Exploring Perceptions of Patients With Gout

Clinical Nursing Research ◽

10.1177/1054773818769219 ◽

2018 ◽

Vol 29 (1) ◽

pp. 56-65 ◽

Cited By ~ 2

Author(s):

Li Ling Seow ◽

Nana Jiao ◽

Wenru Wang ◽

Eleanor Holroyd ◽

Gim Gee Teng ◽

...

Keyword(s):

Qualitative Study ◽

Support Groups ◽

Thematic Analysis ◽

Public Awareness ◽

Well Being ◽

Emotional Experiences ◽

Daily Lives ◽

External Resources ◽

Face To Face ◽

And Coping

Gout is a chronic disease that is on a rising trend and greatly affects one’s physical and psychosocial well-being. The aim of this study was to explore patients’ perceptions of living with gout. A descriptive qualitative study was conducted and 15 adults with gout were interviewed face-to-face between December 2014 and January 2015. Thematic analysis was used to analyze the transcribed data. The experiences of patients with gout were found to revolve around four themes: emotional experiences with gout, disruptions in daily lives, interactions with doctor, and coping with gout using internal and external resources. The in-depth understanding of the patients’ experiences indicates a need to provide holistic patient education and to involve family members to create nurse-led support groups and to raise public awareness regarding gout.

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The experiences of well-being of family caregivers in palliative care: A qualitative study using thematic analysis

Progress in Palliative Care ◽

10.1080/09699260.2021.1872135 ◽

2021 ◽

pp. 1-8

Author(s):

Tan Seng Beng ◽

Yeoh Kee Ying ◽

Cheah Ai Xin ◽

Lim Ee Jane ◽

Dong Chooi Lin ◽

...

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

Family Caregivers ◽

Thematic Analysis ◽

Well Being

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The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study

BMC Pediatrics ◽

10.1186/s12887-021-02689-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarah E. Seaton ◽

◽

Elizabeth S. Draper ◽

Christina Pagel ◽

Fatemah Rajah ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Intensive Care Units ◽

Critical Incidents ◽

Paediatric Intensive Care ◽

Junior Doctors ◽

England And Wales ◽

The Impact ◽

Paediatric Critical Care ◽

Paediatric Intensive Care Units

Abstract Background Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes. Methods We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV). Results The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07). Conclusions Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.

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Psychological Impact of Parkinson Disease Delusions on Spouse Caregivers: A Qualitative Study

Brain Sciences ◽

10.3390/brainsci11070871 ◽

2021 ◽

Vol 11 (7) ◽

pp. 871

Author(s):

Caroline J. Deutsch ◽

Noelle Robertson ◽

Janis M. Miyasaki

Keyword(s):

Qualitative Study ◽

Thematic Analysis ◽

Psychological Impact ◽

Well Being ◽

Interdisciplinary Teams ◽

Structured Interviews ◽

Clinical Interviews ◽

Spouse Caregivers ◽

And Behavior ◽

The Impact

There is growing research on carers of people with Parkinson’s disease (PD) experiences. However, the impact on carers by PD delusions is not specifically examined. We conducted a qualitative study using semi-structured interviews of spouse carers of PD patients with delusions. Thematic analysis was employed using MAXQDA 2018. Twelve spouse participants (SPs) were interviewed. Four themes emerged: Managing incredulity: trying to make sense of delusion content; Hypervigilance: constant alertness to bizarre and threatening discourse and behavior; Defensive strategizing: anticipating delusions and potential consequences; Concealing and exposing: ambivalence about disclosing the effect of delusions yet wanting support. SPs reported effects on their emotional well-being and marital relationship and challenges to an orderly, predictable life. SPs were reluctant to share their experiences due to delusion content (often infidelity and sexual in nature) and a desire to protect their spouses’ image. SPs’ awareness of the potential for delusional thought was low prior to their occurrence. Conclusions: education surrounding potential neurobehavioral changes should occur for patients and carers. Clinicians should be aware that the impact of delusions on carers is often greater than disclosed in clinical interviews. Interdisciplinary teams speaking separately to spousal carers may improve disclosure and delivery of appropriate psychological support.

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