The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing patient care during the early phase pandemic: A mixed method study.

BACKGROUND: Healthcare workers have historically experienced symptoms of post-traumatic stress disorder, depression and anxiety with previous infectious outbreaks. It is unknown if critical care nurses have similar experiences. OBJECTIVES: The study aimed to examine the mental health of Critical Care Registered Nurses providing direct patient care during the initial phase of the COVID-19 pandemic in Canada. DESIGN: This was a convergent parallel mixed method study utilizing validated questionnaires and semi-structured qualitative interviews. SETTING: Critical care units in a single large 650 bed academic teaching hospital in western Canada. The critical care units serve a general mixed medical - surgical adult patient population. PARTICIPANTS: Critical Care Registered Nurses providing direct patient care in the intensive care and high acuity units at the designated site. METHODS: 109 participants completed two self-reported validated surveys, the Impact of Events Scale - Revised and the Depression, Anxiety and Stress Scale. 15 participants completed one-on-one semi-structured interviews that were analyzed using inductive thematic analysis. RESULTS: In the surveys, the participants reported clinical concern for (23%), probable (13%) and significant (38%) symptoms of post-traumatic stress disorder, as well as mild to severe depression (57%), anxiety (67%) and stress (54%). In the interviews, psychological distress was described as anxiety, worry, distress and fear related to: 1) rapidly changing policy and information, 2) overwhelming and unclear communication, 3) meeting patient care needs in new ways while staying safe, and 4) managing home and personal commitments to self and family. CONCLUSIONS: Critical care nurses experienced psychological distress associated with providing care to COVID-19 patients during the early phases of the pandemic.

Promoting interprofessional learning and enhancing the pre-registration student experience through reciprocal cross professional peer tutoring.

BACKGROUND: To improve collaboration and the quality of care, healthcare programmes are increasingly promoting interprofessional education thereby enabling students to learn with, from and about each other. A reciprocal peer learning model has developed among pre-registration physiotherapy and adult nursing students at Plymouth University, England. Embedded within the curriculum, it provides voluntary opportunities for year two students to become cross professional peer tutors to year one students while enhancing interprofessional understanding and skills acquisition. AIM: To explore participant experiences of two cross professional peer tutored clinical skills workshops delivered to a cohort of nursing (n = 67) and physiotherapy (n = 53) students in 2015. DESIGN: A mixed methods approach generated qualitative and quantitative data. Qualitative data was gathered via focus groups and individual interviews of peer tutors and learners (n = 27). These were recorded, transcribed and thematically analysed. The Readiness for Interprofessional Learning Scale questionnaire (n = 84) was completed before and after the workshops to consider any influence on students' attitudes towards interprofessional learning. RESULTS: Four themes evolved from thematic analysis; benefits of cross professional peer tutoring, interprofessional teamwork, quality of care and factors influencing the delivery of the workshops. Data showed students felt they developed greater understanding of interprofessional roles and acquired new skills. Peer tutors developed confidence in representing their profession while appearing to inspire early stage students. The Readiness for Interprofessional Learning Scale questionnaire data identified very positive attitudes towards interprofessional learning among the majority of students in both cohorts before and after the workshop. CONCLUSION: This study endorses the utility of enhancing the Higher Education experience by offering voluntary peer tutoring opportunities. Participating students build confidence in representing their profession, while potentially inspiring early stage students and supplementing interprofessional learning across a cohort.

A practical guide for nurses in diluent selection for subcutaneous infusion using a syringe driver.

Appropriate diluent selection in continuous subcutaneous infusion optimises symptom management and client well-being. The responsibility of diluent selection is commonly one of the attending nurse. This paper was developed with the intention of providing nurses with practical instruction for diluent selection when preparing medications for administration subcutaneously using a syringe driver. A literature review was undertaken of published journal databases and published guidelines sites. Recommendations regarding diluent choice were reviewed in two iterations by an expert panel of palliative care nurse clinicians. The principles for diluent selection are presented. They are based primarily on expert opinion level of evidence given a lack of primary research evidence in the area of diluent selection. There is a pressing need for manufacturers' guidance on diluent selection and independent research to establish the impact of diluents on drug and drug combinations when using syringe drivers. Until such time that this evidence is available to guide practice, clinicians need to be trained to inspect solutions and assess the effectiveness of the medication in controlling symptoms. The capacity of this paper to provide practical instruction has been limited by the lack of rigorous evidence available, and indeed, the process of developing this guide identified perhaps more questions than answers available at the present time.

Diluent choice for subcutaneous infusion: a survey of the literature and Australian practice.

Continuous subcutaneous infusion is a method frequently used in palliative care to manage patient symptoms. To deliver the dose required and prevent subcutaneous sites from becoming inflamed and painful, the drug is often diluted in a solution, most commonly sterile water for injection or sodium chloride. The use of sterile water for injection has been recommended for cyclizine yet beyond this example there appears to be limited clinical direction regarding diluent selection. Inconsistency or lack of guidelines can be problematic if a diluent that may enhance the effectiveness of a drug compared with an alternate is not used because of lack of knowledge or guidance. This investigation considered existing literature, drug databases and directories, and involved a survey of palliative care services to examine evidence and experience relating to diluent selection. A number of inconsistencies emerged in both the literature and practice. With the exception of five drugs for which only saline was recommended, there appeared to be an inclination to use water unless contraindicated. Given an increasing reliance on this method of symptom management, the absence of formal clinical evidence or recommendations and ambiguity in relation to the use of diluents highlights the need for these deficits to be addressed as quickly as possible.

Genetic analysis in FXI deficiency: six novel mutations and the use of a polymerase chain reaction-based test to define a whole gene deletion.

The genetic basis of factor XI (FXI) deficiency was investigated in 30 patients from 13 different families of non-Jewish origin. Twelve different mutations were detected (including six novel changes), seven missense mutations and three mutations leading to null alleles. Haplotype analysis suggested a large gene deletion in one family. We confirmed the presence of a recently reported Alu-mediated FXI gene deletion. An unrelated patient with severe deficiency was shown to be compound heterozygous for A412V and this whole gene deletion. We suggest that this recurrent gene deletion should be included in the genetic analysis of FXI deficiency.