‘Stressed, uncomfortable, vulnerable, neglected’: a qualitative study of the psychological and social impact of the COVID-19 pandemic on UK frontline keyworkers

ObjectivesNon-healthcare keyworkers face distinct occupational vulnerabilities that have received little consideration within broader debates about ‘essential’ work and psychological distress during the COVID-19 pandemic. The aim of this study was therefore to explore the impact of the pandemic on the working lives and mental health and well-being of non-healthcare keyworkers in the UK.DesignIn-depth, qualitative interviews, analysed using a reflexive thematic analysis.SettingTelephone or video call interviews, conducted in the UK between September 2020 and January 2021.Participants23 participants aged 26–61 (mean age=47.2) years employed in a range of non-healthcare keyworker occupations, including transport, retail, education, postal services, the police and fire services, waste collection, finance and religious services.ResultsKeyworkers experienced adverse psychological effects during the COVID-19 pandemic, including fears of COVID-19 exposure, contagion and subsequent transmission to others, especially their families. These concerns were often experienced in the context of multiple exposure risks, including insufficient personal protective equipment and a lack of workplace mitigation practices. Keyworkers also described multiple work-related challenges, including increased workload, a lack of public and organisational recognition and feelings of disempowerment.ConclusionsIn efforts to reduce psychosocial concerns among non-healthcare keyworkers, there is a need for appropriate support during the COVID-19 pandemic and in preparation for other infections (eg, seasonal influenza) in the future. This includes the provision of psychological and workplace measures attending to the intersections of personal vulnerability and work conditions that cause unique risks and challenges among those in frontline keyworker occupations.

Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study

This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was ‘Feeling safe and valued’ with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was ‘Intersection of consumer and staff/organizational needs’ with a related sub-theme of time pressure and reduced self-disclosure. The final theme was ‘Importance of the ‘whole picture’, highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.

Distress among cancer patients attending rehabilitation in the community

Purpose The aim of this study is to identify sources of distress among cancer patients attending rehabilitation in the community. Methods Participants were 430 patients recruited from a cancer rehabilitation center in Singapore between 2017 and 2018, who had rated their distress using the distress thermometer (DT) and indicated associated problems on the problem list. Chi-square tests were used to detect differences in the reported symptoms among three age groups. Exploratory factor analysis was used to identify symptom clusters. Partial correlational analysis was then performed to examine the relationship between distress, symptom clusters, and age controlling for gender and cancer type. Results About 30% of the participants reported distress ≥ 5 on the DT (mean 3.3 ± 2.5), and the mean number of problems endorsed was 8 ± 6. A higher total number of reported problems (r = .63) and younger age (r = − .21) were associated with increased distress. The younger age group also reported more problems surrounding emotions, finance, work/school, children-related issues, and physical symptoms such as sleep and nausea. Of the 12 factors identified, 9 psychosocial and physical symptom clusters correlated with distress (r ranging from .12 to .41). All results were statistically significant after adjustment (p ≤ 0.05). Conclusion Younger survivors are more at risk of distress and report greater role functioning concerns related to childcare, partner relationship, and work participation. Age-tailored and multimodal interventions may be necessary to adequately address age-related differences and help coordinate management of multiple symptom clusters across physical and psychosocial concerns.

Exploring Current Practice, Knowledge, and Training Needs for Managing Psychosocial Concerns in the Audiology Setting: Perspectives of Audiologists, Audiology Reception Staff, and Managers

Purpose The purpose of this study was to explore the current practices and training requirements for supporting clients experiencing psychosocial concerns in the audiology setting, from the perspectives of audiology clinicians, managers, and reception staff. Method Convenience sampling was used to recruit audiologists, reception staff, and clinic managers ( N = 13, M age = 32.2 ± 8.1, range: 25–47 years, 11 female) through a large hearing services provider in Western Australia. A semistructured focus group was used to elicit participant views regarding current experiences relating to clients who express psychosocial concerns in the audiology setting, familiarity with psychosocial interventions, and training requirements for delivery of psychosocial interventions in the audiological setting. Results Twenty-four subthemes were identified across six themes: (1) awareness of psychosocial well-being, (2) the role of others, (3) identifying client's psychosocial needs, (4) managing client's psychosocial needs, (5) barriers to providing psychosocial support, and (6) broadening audiological services to include psychosocial support. Conclusions Participants reported an awareness of their clients' psychosocial challenges within the audiology setting, yet they described uncertainty in how best to respond in providing support and whether this was within their scope of practice. A majority of audiology staff expressed desire and motivation to broaden the scope of their service in order to better address their clients' hearing loss–related psychosocial needs.

Talking With Children About Prognosis: The Decisions and Experiences of Mothers With Metastatic Cancer

PURPOSE: Parents with metastatic cancer report unique concerns and challenges when discussing their illness with their minor children. Greater understanding of parents’ communication experiences can facilitate these discussions. This study aimed to describe the challenges, approaches, and decisions related to discussing prognosis among a sample of mothers with metastatic cancer. METHODS: We conducted a web-based cross-sectional survey assessing the psychosocial concerns of 224 women with metastatic cancer who had minor children. This analysis focused on participant responses to structured and open-ended questions addressing communication with their children. We used descriptive statistics to summarize responses to the structured questions and qualitative content analysis for responses to open-ended questions. RESULTS: Nearly 80% (n = 176) reported they had discussed their prognosis with at least one of their children; 79% identified at least one barrier to these discussions. The most common obstacles were participants’ uncertainty about their illness trajectory (43%) and emotional distress associated with these conversations (41%). Qualitative analyses revealed three principles that guided mothers’ communication decisions: commitment to honesty and protection; child developmental readiness; and beliefs about the right time. Approaches to discussing prognosis included total honesty, using the language of chronic illness, gradual disclosure, waiting for questions, and emphasizing hope, love, and reassurance. CONCLUSION: This study provides further evidence of the complexity and challenges of parental communication with their children about metastatic cancer. There is a need for both clinicians and researchers to identify, test, and implement evidence-based strategies to assist ill parents with their communication concerns.

Patient and Parent Reported Psychosocial Concerns in Children and Adolescents With Turner syndrome

Background: Pediatric patients with Turner syndrome (TS) are reported to have a higher incidence of anxiety, depression and social isolation but there is minimal data on self-reported measures. Methods: We utilized the validated PROMIS (Patient Reported Outcomes Measurement Information System) question bank to develop 4-question short forms to assess patient and parent self-reported scores in the domains of depression, anxiety, and peer relationships in our TS cohort. Completed PROMIS short forms from TS patients seen in the multidisciplinary TS clinic between 1/1/2019 and 6/1/2020 were retrospectively analyzed. Clinical data were also abstracted from medical records and correlated with the measures of depression, anxiety, and peer relationships. Descriptive analyses of the T-scores were completed using a non-parametric Wilcoxon rank-sum test and the dyad results were analyzed for agreement between parent and patient reporting. Results: Data from 26 patients (mean age 13y, range 4.6-20.6y) were included in the analysis: 3.9% were clinically referred for depression/anxiety after psychology assessment, 15% had developmental delays and 15% had an individualized education plan. Nearly 77% had short stature (<5%ile), 58% had received growth hormone and 54% were on estrogen therapy. Median scores were not statistically different from population norms for patient (N=22) or parent (N=25) reports in the 3 domains and did not vary by age, estrogen supplementation or stature. Internal reliability of the questionnaires measured by overall Cronbach alpha for each domain were acceptable (0.73-0.93). While parent and patient reported anxiety scores were correlated (R=.452, p=.040.), the depression and peer relationship scores were not correlated. Parent-reported peer relationship scores were negatively correlated with patient-reported anxiety (R=-0.46, p=0.04) and parent reported anxiety (R=-0.43, p=0.04) scores. Parent perceived depression and anxiety measures were also correlated (R=0.77, p< 0.001) as were patient reported scores in these domains (R=0.6, p=0.003). Conclusions: In contrast to existing literature in TS indicating a higher incidence of psychosocial concerns, the patient and parent self-reported scores on depression, anxiety and peer relationship were not statistically different from the population normative data, and parent and patient perceived scores were not correlated in all domains. While the small number of patients in this pilot study may be insufficiently powered to detect a small difference in scores in these domains, the data underscores the need to develop a TS-specific validated psychosocial questionnaire that more adequately assesses the psychosocial concerns in this population.

Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic

Type 1 diabetes management can be challenging for children and their families. To address psychosocial concerns for parents of youth with type 1 diabetes, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early stages of the COVID-19 pandemic and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents’ treatment needs.

Mothers’ Worries During Pregnancy: A Content Analysis of Reddit Posts

Qualitative investigations into maternal worries during pregnancy are limited. The aim of this study was to identify the content of women’s pregnancy-related worries by completing a content analysis of posts on Reddit. A total of 217 posts by 196 unique users were analyzed. Most worries related to infant factors (32.6%), individual factors (27.1%), and antenatal care factors, such as medical procedures (25.2%). The remaining worries related to situational factors (10.9%) and the partner relationship (4.3%). Although most fears related to fetal well-being, other concerns included problems with family members, women’s own mental health, and not being a “good mother.” These findings support calls for antenatal education to more adequately address women’s psychosocial concerns.

‘Stressed, uncomfortable, vulnerable, neglected’: a qualitative study of the psychological and social impact of the COVID-19 pandemic on UK frontline keyworkers.

Aims: Non-healthcare keyworkers face distinct occupational vulnerabilities that have received little consideration within broader debates about ‘essential’ work and psychological distress during the COVID-19 pandemic. The aim of this study was therefore to explore the impact of the pandemic on the working lives and mental health and wellbeing of non-healthcare keyworkers in the UK.Methods: In-depth, semi-structured interviews were conducted with 23 participants employed in a range of non-healthcare keyworker occupations, including transport, retail, education, postal services and the police force. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a reflexive thematic approach. Results: Keyworkers experienced adverse psychological effects during the COVID-19 pandemic, including fears of COVID-19 exposure, contagion and subsequent transmission to others, especially their families. These concerns were often experienced in the context of multiple exposure risks, including insufficient PPE and a lack of workplace mitigation practices. Keyworkers also described multiple work-related challenges, including increased workload, a lack of public and organisational recognition and feelings of disempowerment. Conclusion: In efforts to reduce psychosocial concerns among non-healthcare keyworkers, there is a need for appropriate support during the COVID-19 pandemic and in preparation for other infections (e.g. seasonal influenza) in the future. This includes the provision of psychological and workplace measures attending to the intersections of personal vulnerability and work conditions that cause unique risks and challenges among those in frontline keyworker occupations.

Oxford Handbook of Respiratory Nursing

Respiratory disease is one of the leading causes of both mortality and morbidity, causing a significant burden on healthcare resources, the economy, and on individual patients and their carers. Respiratory conditions are managed in many different settings, from home and residential care through the full range of primary to tertiary care. The multifaceted nature of both diseases affecting respiration and the care options is comprehensively covered in this second edition of the Oxford Handbook of Respiratory Nursing. Offering a systematic description of the main respiratory diseases found in adults, the Handbook covers the assessment, diagnosis, and nursing management of each condition. With a special focus on the role of the multidisciplinary team in meeting the multiple care needs of respiratory patients, the Handbook covers both physical and psychosocial concerns, and both pharmacological and non-pharmacological therapies.