scholarly journals Impact of Neonatal Outcome on Language Used to Describe Periviable Birth Experience

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Courtney Casbon ◽  
Meera Patel ◽  
Brownsyne Tucker Edmonds
Keyword(s):  
Infant Death ◽  
Information Dissemination ◽  
Neonatal Outcome ◽  
Structured Interview ◽  
Healthcare Team ◽  
Birth Experience ◽  
Comfort Care ◽  
Death Experience ◽  
Patient’S Perception ◽  
The Impact

Motivation and Purpose: The experience of giving birth to a periviable neonate between 22-25 weeks gestation varies greatly among women depending on numerous factors. Studying periviable narrative experiences will allow us to isolate those factors that create a more positive experience, even in the instance of a negative neonatal outcome (infant death). Results may be used to advise future caregiving approaches so they may be tailored to the needs of women in these situations. This study aimed to qualitatively assess the extent of the relationship between neonatal outcome and the language used by women and their important others (IOs) to describe periviable birth experience three months postpartum. Method: A semi-structured interview guide was used to investigate participants’ perceptions of their delivery experience and subsequent NICU experience, if applicable, at three months postpartum. Interviews were transcribed verbatim and coded for themes by three investigators. Conventional content analysis was conducted using NVivo 12. Results: Twenty-three women and twelve IOs were recruited at two hospitals between 2016 and 2018. Women and IOs who experienced infant death negatively described their delivery experience if they also negatively described healthcare team (HCT) interactions, including providers’ communication, clinical judgement, and personality traits. Specifically, participants with overall negative birth experiences described not understanding various clinical decisions and felt uninformed on topics pertinent to their or their infant’s care. Alternatively, women and IOs who experienced infant death who positively described their delivery experience also positively described NICU care (including HCT interactions) and infant death experience (comfort care). These results highlight the impact of HCT interactions and communication on a patient’s perception of delivery despite a negative neonatal outcome. Conclusion: These findings could suggest that improvements in communication and information dissemination from the HCT may have the ability to improve a patient’s periviable birth experience despite a negative neonatal outcome. 

scholarly journals Impact of Neonatal Outcome on Language Used to Describe Periviable Birth Experience

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Meera Patel ◽  
Courtney Casbon ◽  
Nazeli Morales ◽  
Brownsyne Tucker Edmonds
Keyword(s):  
Infant Death ◽  
Information Dissemination ◽  
Neonatal Outcome ◽  
Structured Interview ◽  
Healthcare Team ◽  
Birth Experience ◽  
Comfort Care ◽  
Death Experience ◽  
Patient’S Perception ◽  
The Impact

Motivation and Purpose: The experience of giving birth to a periviable neonate between 22-25 weeks gestation varies greatly among women depending on numerous factors. Studying periviable narrative experiences will allow us to isolate those factors that create a more positive experience, even in the instance of a negative neonatal outcome (infant death). Results may be used to advise future caregiving approaches so they may be tailored to the needs of women in these situations. This study aimed to qualitatively assess the extent of the relationship between neonatal outcome and the language used by women and their important others (IOs) to describe periviable birth experience three months postpartum.     Method: A semi-structured interview guide was used to investigate participants’ perceptions of their delivery experience and subsequent NICU experience, if applicable, at three months postpartum. Interviews were transcribed verbatim and coded for themes by three investigators. Conventional content analysis was conducted using NVivo 12.     Results: Twenty-three women and twelve IOs were recruited at two hospitals between 2016 and 2018. Women and IOs who experienced infant death negatively described their delivery experience if they also negatively described healthcare team (HCT) interactions, including providers’ communication, clinical judgement, and personality traits. Specifically, participants with overall negative birth experiences described not understanding various clinical decisions and felt uninformed on topics pertinent to their or their infant’s care. Alternatively, women and IOs who experienced infant death who positively described their delivery experience also positively described NICU care (including HCT interactions) and infant death experience (comfort care). These results highlight the impact of HCT interactions and communication on a patient’s perception of delivery despite a negative neonatal outcome.     Conclusion: These findings could suggest that improvements in communication and information dissemination from the HCT may have the ability to improve a patient’s periviable birth experience despite a negative neonatal outcome.   

Effect of infant mortality on subsequent fertility of women in jordan: a life table analysis

1984 ◽  
Vol 16 (2) ◽  
pp. 219-229 ◽  
Author(s):  
C. M. Suchindran ◽  
A. L. Adlakha
Keyword(s):  
Infant Death ◽  
Proportional Hazards ◽  
Child Survival ◽  
Fertility Survey ◽  
Birth Intervals ◽  
Rural And Urban ◽  
Subsequent Fertility ◽  
High Birth Order ◽  
Death Experience ◽  
The Impact

SummaryThe proportional hazards models of birth intervals based on the data from the 1976 Jordan Fertility Survey indicate that in Jordan the influence of infant death on subsequent fertility is not uniform among all population subgroups. Child survival seems to have only minimal influence on fertility among less educated women and women at low birth orders. In contrast, the probability of a subsequent birth increases significantly following an infant death among women in the high education class and among women in the high birth order group. The impact of infant death is similar among rural and urban women. Further analysis shows that the observed differences in the birth intervals of women with and without infant death experience cannot be attributed to the fecundity differentials of these two groups of women.

scholarly journals Women's Birth Experience and Neonatal Outcomes, Study Design and Methodology with Baseline Characteristics. A Hospital-Based Maternal Follow-up Study

2021 ◽  
Author(s):  
Maleda Tefera ◽  
Nega Assefa ◽  
Kedir Teji Roba ◽  
Letta Gedefa
Keyword(s):  
Study Design ◽  
Neonatal Outcome ◽  
Comprehensive Evaluation ◽  
Mode Of Delivery ◽  
Structured Interview ◽  
Neonatal Outcomes ◽  
Birth Experience ◽  
Eastern Ethiopia ◽  
Follow Up Study

Abstract Background: Giving birth is a joyful, unique event and a highly individual experience in a woman's life. Childbirth experience has a significant role in developing self-confidence and positive feelings for the newborn. This experience is affected by many factors, including the mode of delivery. This paper tries to depict the experience of labor, delivery, and neonatal outcomes observed during the implementation of labor and delivery outcome study at selected hospitals in Eastern Ethiopia hospitals. Method: A hospital-based follow-up study was implemented in Hiwot Fana and Jegula Hospital in Harar, Bisidimo hospital in Eastern Hararghe, Oromia, and Dil-Chora Hospital in Dire Dawa from June 2020 to October 2020. A total of 2246 women with labor experience visited the hospitals were followed from delivery until discharge to document their experience and neonates' outcomes. Data were collected through a face-to-face interview using a structured pre-tested questionnaire. A Phenomenological approach qualitative study design will also be employed from April to May 2021. The women who give birth to normal single-term newborns through vaginal or a cesarean section will be included in the study. Women with stillbirth twin, preterm and congenital malformation, serous ill neonates, and who admitted to for more than one week will be excluded because those women will be extreme or deviant cases. In-depth interviews coupled with tape recording and note-taking will be to collect the data. A semi-structured interview guide will consider four domains of the Roy adaptation theory: an open-ended question (physiological, self-concept, role and function, and interdependence). Translated files will be transferred to open code software in a plain text format. Coding and categorization will be done on a system to generate a synthesized theme. Discussion The study will provide a comprehensive evaluation of the birth experience and its neonatal outcome in Eastern Ethiopia. Understanding women's birth experience and neonatal outcome based on birth can help health professionals look inside themselves. It will form the foundation and development of a new guideline to improve maternity care.

Voices of Distress: The Emotional Peril of Not Attaining a Dietetic Internship in Ontario

2013 ◽  
Vol 1 (3) ◽  
pp. 9
Author(s):  
Jennifer Lee Brady ◽  
Annie Hoang ◽  
Olivia Siswanto ◽  
Jordana Riesel ◽  
Jacqui Gingras
Keyword(s):  
Empirical Research ◽  
Current Model ◽  
Well Being ◽  
Structured Interview ◽  
Application Process ◽  
Dietetic Education ◽  
Dietetic Internship ◽  
The Impact ◽  
And Training ◽  
Future Growth

Obtaining dietetic licensure in Ontario requires completion of a Dietitians of Canada (DC) accredited four-year undergraduate degree in nutrition and an accredited post-graduate internship or combined Master’s degree program. Given the scarcity of internship positions in Ontario, each year approximately two-thirds of the eligible applicants who apply do not receive a position XX, XX, XX, XX, XX, XX, in press). Anecdotally, not securing an internship position is known to be a particularly disconcerting experience that has significant consequences for individuals’ personal, financial, and professional well-being. However, no known empirical research has yet explored students’ experiences of being unsuccessful in applying for internship positions. Fifteen individuals who applied between 2005 and 2009 to an Ontario-based dietetic internship program, but were unsuccessful at least once, participated in a one-on-one semi-structured interview. Findings reveal that participants’ experiences unfold successively in four phases that are characterized by increasingly heightened emotional peril: naïveté, competition, devastation, and frustration. The authors conclude that the current model of dietetic education and training in Ontario causes lasting distress to students and hinders the future growth and vitality of the dietetic profession. Further research is required to understand the impact of the current model on dietetic educators, internship coordinators, and preceptors as coincident participants in the internship application process.

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

2020 ◽  
Vol 6 (5) ◽  
pp. 1183-1189
Author(s):  
Dr. Tridibesh Tripathy ◽  
Dr. Umakant Prusty ◽  
Dr. Chintamani Nayak ◽  
Dr. Rakesh Dwivedi ◽  
Dr. Mohini Gautam
Keyword(s):  
Large Scale ◽  
National Level ◽  
Uttar Pradesh ◽  
Life Time ◽  
Structured Interview ◽  
The Other ◽  
Registration System ◽  
Action Group ◽  
Current Article ◽  
The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.     The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions.  The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.   Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.   Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

scholarly journals Infant Safe Sleep Promotion: Increasing Capacity of Child Protective Services Employees

2021 ◽  
Vol 18 (8) ◽  
pp. 4227
Author(s):  
Carolyn R. Ahlers-Schmidt ◽  
Christy Schunn ◽  
Ashley M. Hervey ◽  
Maria Torres ◽  
Cherie Sage ◽  
...  
Keyword(s):  
Infant Death ◽  
Child Protective Services ◽  
Sudden Infant Death ◽  
Sudden Infant ◽  
Protective Services ◽  
Safe Sleep ◽  
Train The Trainer ◽  
Baseline Knowledge ◽  
One Year ◽  
The Impact

Sleep-related infant deaths, including Sudden Infant Death Syndrome (SIDS), are the number one cause of death in infants between 28 days and one year of life. Nearly half of families experiencing a sleep-related infant death in Kansas were involved with the Department of Children and Families Child Protective Services (CPS), making CPS staff a priority for safe sleep training. This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs’ knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. CPS staff had significantly lower baseline knowledge on the 10-item pretest (t = 3.33, p = 0.002), but both CPS and other attendees showed significant improvement by posttest (t = 8.53, p < 0.001 and t = 4.44, p < 0.001, respectively). Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees. Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.

scholarly journals Measuring capability wellbeing in adults at different stages of life for use in economic evaluation of health and care interventions: a qualitative investigation in people requiring kidney care

2021 ◽  
Author(s):  
Paul Mark Mitchell ◽  
Samantha Husbands ◽  
Sabina Sanghera ◽  
Fergus John Caskey ◽  
Jemima Scott ◽  
...  
Keyword(s):  
Life Stage ◽  
Structured Interview ◽  
Health Conditions ◽  
Economic Evaluations ◽  
Qualitative Investigation ◽  
Key Factors ◽  
Younger Adults ◽  
Patient Groups ◽  
The Life Course ◽  
The Impact

Abstract Purpose Capability wellbeing measures, such as the ICECAP measures, have been proposed for use in economic evaluations to capture broader outcomes of health and care interventions. The ICECAP measures have been developed to reflect capabilities at different stages of life. Some patient groups include patients of different ages and at different stages of life, so it is not always apparent which ICECAP measure is most relevant. This study explores the impact of age and life stage on completion, where both ICECAP-A and ICECAP-O were completed by the same patient. Methods A think-aloud study, and an associated semi-structured interview were conducted with people receiving kidney care as a renal outpatient, kidney transplant outpatient, or through receiving facility-based haemodialysis. Qualitative analysis focused on (1) differences in responses across measures by individuals, where attributes had conceptual overlap, (2) key factors in self-reported capability levels, and (3) measure preference. Results Thirty participants were included in the study, with a mix of older and younger adults. Attributes with similar wording across measures produced similar responses compared to attributes where wording differed. Age and health were key factors for self-reported capability levels. ICECAP-A was slightly preferred overall, including by older adults. Conclusion This study suggests use of ICECAP-A in patients with certain chronic health conditions that include a mix of adults across the life course. This study highlights the importance of considering the stage of life when using capability measures and in economic evaluations of health and care interventions more generally.

scholarly journals COVD-07. THE IMPACT OF COVID-19 ON PATIENTS AND CAREGIVERS AFFECTED BY BRAIN TUMORS: THE PATIENT NAVIGATOR PERSPECTIVE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii22-ii22
Author(s):  
Kyle Walsh
Keyword(s):  
Clinical Trials ◽  
Brain Tumor ◽  
Clinical Care ◽  
Structured Interview ◽  
Patient Navigator ◽  
Structured Interviews ◽  
Social Distancing ◽  
Tumor Patient ◽  
Patient Navigators ◽  
The Impact

Abstract BACKGROUND Preliminary evidence indicates that glioma patients are at higher risk for COVID-19 complications due to systemic immunosuppression. Interruptions in cancer care may exacerbate patient and caregiver anxiety, but surveying patients/caregivers about their COVID-19 experiences is often limited by attainable sample sizes and over-reliance upon single-institution experiences. METHODS To explore how COVID-19 is impacting brain tumor patients/caregivers across the U.S., we performed semi-structured interviews with brain tumor patient navigators employed by two different 501(c)3 nonprofit organizations. A semi-structured interview guide was used, utilizing prompts and open-ended questions to facilitate dialogue. A core set of COVID-19 topics were covered, including: financial issues, coping strategies, geographic variability, variability by tumor grade/histology, disruptions in care continuity, accessing clinical trials, psychosocial issues, and end-of-life care. Interviews were audio-recorded, transcribed, and organized by discussion topic to identify emerging themes. Inductive sub-coding was completed using the constant comparison method, within and between transcripts. RESULTS/CONCLUSIONS Ten patient navigators were interviewed between April 15th and May 8th, with interviews lasting approximately one hour (range 38-77minutes). Navigators reported having contact with 183 unique brain tumor families during the pandemic (range 7–38 families per navigator). High concordance emerged across narratives, revealing important considerations for the neuro-oncology workforce. The most prominent theme was increased caregiver burden, attributed to maintaining social distancing by reducing visits from home-health aides and friends/family. A related theme that applied to both patients and caregivers was increased social isolation due to social distancing, suspension of in-person support groups, and church/temple closures. Accessing clinical trials was a recurrent issue, exacerbated by patients’ increasing unwillingness to travel. Glioblastoma patients, especially those with recurrent tumors, expressed greater reluctance to travel. Access to standard-of-care treatment was rarely interrupted, but reduced access to supportive services – especially physical and occupational therapy – was identified as an emerging COVID-related deficiency in clinical care.

scholarly journals Experiences of nurses caring for respiratory patients during the first wave of the COVID-19 pandemic: an online survey study

2021 ◽  
Vol 8 (1) ◽  
pp. e000987
Author(s):  
Nicola J Roberts ◽  
Carol A Kelly ◽  
Kate A Lippiett ◽  
Emma Ray ◽  
Lindsay Welch
Keyword(s):  
Mental Health ◽  
Online Survey ◽  
Demographic Data ◽  
Geographical Location ◽  
Working Environment ◽  
Survey Study ◽  
British Thoracic Society ◽  
Healthcare Team ◽  
Free Text ◽  
The Impact

BackgroundNurses have been at the forefront of the pandemic response, involved in extensive coordination of services, screening, vaccination and front-line work in respiratory, emergency and intensive care environments. The nature of this work is often intense and stress-provoking with an inevitable psychological impact on nurses and all healthcare workers. This study focused on nurses working in respiratory areas with the aim of identifying and characterising the self-reported issues that exacerbated or alleviated their concerns during the first wave of the COVID-19 pandemic.MethodsAn online survey was developed consisting of 90 questions using a mixture of open-ended and closed questions. Participant demographic data were also collected (age, gender, ethnicity, number of years qualified, details of long-term health conditions, geographical location, nursing background/role and home life). The online survey was disseminated via social media and professional respiratory societies (British Thoracic Society, Primary Care Respiratory Society, Association of Respiratory Nurse Specialists) over a 3-week period in May 2020 and the survey closed on 1 June 2020.ResultsThe study highlights the experiences of nurses caring for respiratory patients during the first wave of the pandemic in early 2020. Concerns were expressed over the working environment, the supply and availability of adequate protective personal equipment, the quality of care individuals were able to deliver, and the impact on mental health to nurses and their families. A high number provided free-text comments around their worries and concerns about the impact on their household; these included bringing the virus home, the effect on family members worrying about them, mental health and the impact of changing working patterns, and managing with children. Although both formal and informal support were available, there were inconsistencies in provision, highlighting the importance of nursing leadership and management in ensuring equity of access to services.ConclusionsSupport for staff is essential both throughout the pandemic and afterwards, and it is important that preparation of individuals regarding building resilience is recognised. It is also clear that psychological support and services for nurses and the wider healthcare team need to be available and quickly convened in the event of similar major incidents, either global or local.

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