Percepciones del personal sanitario sobre el manejo familiar del aislamiento social infantil durante la COVID-19 / Perceptions of Health Personnel on Family Management of Children's Social Isolation during COVID-19

Introducción: La propagación del nuevo coronavirus responsable de la COVID-19, amenaza la vida de millones de infantes, por lo cual, en la mayoría de los países, los niños han sido confinados en sus casas, lo que favorece de manera proporcional su protección. En sentido general, la familia no ha mostrado preparación para manejar con calidad la convivencia permanente de los niños en casa y se manifiestan violaciones del aislamiento físico de los menores. Objetivo: Analizar las percepciones del personal de salud sobre el cuidado y protección familiar de los niños a través del aislamiento social. Métodos: Se realizó un estudio de tipo exploratorio bajo un diseño transversal descriptivo, en el Consejo Popular 26 de Julio del municipio Holguín en el periodo comprendido entre diciembre de 2020 y mayo de 2021. Se aplicó una encuesta al personal sanitario (n = 17) asociado a las pesquisas en dicha área de salud. Resultados: Se identificaron fortalezas y debilidades en la atención médica a las familias con niños en la zona estudiada. El 100 por ciento de los participantes identificaron las pesquisas como una excelente herramienta para la promoción del cumplimiento del aislamiento de los pequeños. Según el criterio del 96,1 por ciento de los encuestados ocurrieron violaciones en el distanciamiento físico infantil en el área de salud seleccionada. Conclusiones: La familia tiene un rol primordial en el cumplimiento del confinamiento de los pequeños, a la vez, tiene la responsabilidad de lograr calidad en este proceso. No obstante, se evidencia la violación del distanciamiento infantil como resultado de la indisciplina familiar, que incrementa la vulnerabilidad de la infancia(AU)

Introduction: The spread of the new coronavirus responsible for COVID-19 threatens the lives of millions of infants, for which, in most countries, children have been confined to their homes, which proportionally favors their protection. In general terms, the family has not shown preparation to handle with quality the permanent coexistence of the children at home and there are violations of the physical isolation of the minors. Objective: To analyze the perceptions of health personnel about the family care and protection of children through social isolation. Methods: An exploratory study was carried out under a descriptive cross-sectional design, in 26 de Julio People´s Council in Holguín municipality from December 2020 to May 2021. A survey was applied to health personnel (n = 17) associated with the investigations in said health area. Results: Strengths and weaknesses in medical care for families with children in the studied area were identified. One hundred percent of the participants identified the studies as an excellent tool for promoting compliance with the isolation of children. According to the criteria of 96.1percent of the respondents, violations of children's physical distancing occurred in the selected health area. Conclusions: The family has a fundamental role in the fulfillment of the isolation of the children and, at the same time, it is committed to achieving quality in this process. However, the violation of childhood distancing is evident as a result of family indiscipline, which increases the vulnerability of childhood(AU)

COVID-19 and children with cancer: Parents' experiences, anxieties and support needs.

BACKGROUND: Children with cancer were designated as clinically extremely vulnerable if they were to contract SARS-CoV-2 due to immune suppression in the early phase of the COVID-19 pandemic. Our aim was to explore experiences, information and support needs, and decision making of parents with a child with cancer in response to this phase in the United Kingdom. METHODS: Parents of a child with cancer completed a survey at a time when the UK moved into a period of 'lockdown'. An online survey was developed by the research team to capture parents' experiences, information and support needs, and decision making, using closed statements and open text boxes. Descriptive quantitative analyses and qualitative thematic content analysis were undertaken. FINDINGS: One hundred seventy-one parents/caregivers completed the survey. Eighty-five percent were worried about the virus and they were vigilant about the virus (92%) or cancer symptoms (93.4%). For two-thirds (69.6%), hospital was no longer considered a safe place. Eight overarching themes were identified related to the virus: (a) risk of infection; (b) information, guidance and advice; (c) health care provision; (d) fears and anxieties; or related to lockdown/isolation: (e) psychological and social impact; (f) keeping safe under lockdown; (g) provisions and dependence; and (h) employment and income. CONCLUSIONS: This is the first study, to the best of our knowledge, to report experiences of parents of a child with cancer during the SARS-CoV-2/COVID-19 pandemic. The majority of parents were worried about SARS-CoV-2 and transmitting the virus to their child. Hospital was no longer perceived to be a safe place, and parents were worried about suboptimal cancer care. Parents described fear and anxiety and the psychological, social and economic impact of isolation.

The Psychological Experience of Obstetric Patients and Health Care Workers after Implementation of Universal SARS-CoV-2 Testing.

OBJECTIVE: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety. STUDY DESIGN: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13, 2020 and April 26, 2020. Semistructured interviews were conducted via telephone at 1 and 2 weeks posthospitalization to assess maternal mental health. Depression screening was conducted using the patient health questionnaire-2 (PHQ-2). An online survey of labor and delivery health care workers assessed job satisfaction and job-related anxiety before and during the novel coronavirus disease 2019 (COVID-19) pandemic, as well as employees' subjective experience with universal testing. Patient and employee responses were analyzed for recurring themes. RESULTS: A total of 318 asymptomatic women underwent SARS-CoV-2 testing during this 2-week period. Six of the eight women (75%) who tested positive reported negative in-hospital experiences secondary to perceived lack of provider and partner support and neonatal separation after birth. Among the 310 women who tested negative, 34.4% of multiparous women reported increased postpartum anxiety compared with their prior deliveries due to concerns about infectious exposure in the hospital and lack of social support. Only 27.6% of women, tested negative, found their test result to be reassuring. Job satisfaction and job-related anxiety among health care workers were negatively affected. Universal testing was viewed favorably by the majority of health care workers despite concerns about delays or alterations in patient care and maternal and neonatal separation. CONCLUSION: Universal testing for SARS-CoV-2 in obstetric units has mixed effects on maternal mental health but is viewed favorably by labor and delivery employees. Ongoing evaluation of new testing protocols is paramount to balance staff and patient safety with quality and equality of care. KEY POINTS: · Women with SARS-CoV-2 had a negative hospital experience.. · A negative SARS-CoV-2 test was not reassuring for patients.. · COVID-19 negatively impacts healthcare workers' well-being..

Factors influencing the perception of protective isolation in patients undergoing haematopoietic stem cell transplantation: A multicentre prospective study.

OBJECTIVES: To identify which factors can influence the patients' perception of protective isolation following Haematopoietic Stem Cell Transplantation (HSCT). METHODS: This is a prospective study conducted in 10 Italian centres, members of the Italian Group of stem cell transplant (GITMO). Patients' perception of protective isolation was assessed using the ISOLA scale between 7 and 9 days post-transplant. Statistical linear regression analysis was performed. RESULTS: The participants were 182 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. Male sex (ß = .152), education level (ß = -.245), double room (ß = .186), satisfaction with visiting hours (ß = -.174) and emotional support from nurses (ß = -.169) were independently associated with isolation-related suffering. Significant predictors of the relationship with oneself included body temperature (ß = -.179), fatigue (ß = -.192) and emotional support from nurses (ß = -.292). Factors independently associated with the relationship with others were education (ß = -.230), chemotherapy cycles (ß = -.218), pain (ß = .150) and satisfaction with visiting hours (ß = -.162). CONCLUSION: Healthcare providers should pay greater attention in caring for those patients who are at risk for a negative isolation experience. Nurses should provide emotional support.

Specific precautions: experiences of hospitalized patients / Precauciones específicas: las vivencias de pacientes internados / Precauções específicas: vivências de pacientes internados

ABSTRACT Objective: To know the perception, meanings and repercussions of specific precautions for hospitalized patients. Methods: Qualitative study with qualitative clinical methodology according to the vulnerability theoretical reference. The semi-directed interview and the Bardin content analysis were used. Results: Identification of three thematic units: (1) guidelines received, in which there was lack of information and misunderstandings about the reason for precautionary implementation; (2) perceptions about private rooms, there with both positive and negative perceptions; and (3) stigma related to the isolation condition, given patients felt constraint for being in a unit of infectious diseases and fear of being separated from the others. Final considerations: Situations of vulnerability were evidenced, both related to hospitalization and feelings aroused. The study can contribute to health services by broadening their vision beyond infection control.

RESUMEN Objetivo: Conocer la percepción, los significados y repercusiones de la precaución específica para el paciente internado. Métodos: Estudio cualitativo con metodología clínica cualitativa bajo referencial teórico de vulnerabilidad. Se utilizó la entrevista semidirigida y el análisis de contenido de Bardin. Resultados: Se identificaron tres unidades temáticas: (1) directrices recibidas, en que se observó la información insuficiente y los conceptos erróneos acerca del por qué la aplicación de precaución; (2) percepciones sobre el cuarto privado, fueron verificadas tanto percepciones positivas, como negativas; y (3) estigma relacionado a la condición de aislamiento, en la cual se identificó constreñimiento por estar en una unidad de enfermedades infecciosas y miedo por estar separados de los demás. Consideraciones finales: Las situaciones de vulnerabilidad fueron evidenciadas, relacionadas tanto a la internación ofrecida, en cuanto a los sentimientos despertados. El estudio puede contribuir con los servicios de salud, ampliando su visión más allá del control de infecciones.

RESUMO Objetivo: Conhecer a percepção, significados e repercussões da precaução específica para o paciente internado. Métodos: Estudo qualitativo com metodologia clínica qualitativa sob referencial teórico de vulnerabilidade. Utilizou-se a entrevista semidirigida e análise de conteúdo de Bardin. Resultados: Identificaram-se três unidades temáticas: (1) orientações recebidas, em que se observou insuficiência de informações e equívocos sobre o motivo da implementação da precaução; (2) percepções sobre o quarto privativo, verificou-se tanto percepções positivas, quanto negativas; e (3) estigma relacionado à condição de isolamento, na qual identificou-se constrangimento por estar em uma unidade de doenças infecciosas e medo por estarem separados dos demais. Considerações finais: Situações de vulnerabilidades foram evidenciadas, tanto relacionadas à internação ofertada, quanto aos sentimentos despertados. O estudo pode contribuir com os serviços de saúde, ampliando sua visão para além do controle de infecções.

Development and initial validation of a questionnaire to assess patients' perception of protective isolation following haematopoietic stem cell transplantation.

The aim of this study was to develop and psychometrically test a questionnaire assessing patients' perception of protective isolation following haematopoietic stem cell transplantation (HSCT). The conceptual framework for developing the questionnaire was a three-dimensional model that emerged from a metasynthesis: isolation-related suffering, relationship with oneself and relationship with others. Item selection was performed through a focus group, comparison with the findings of two phenomenological studies, and content validity with 22 experts. Cognitive interviews with five patients were used to verify face validity. A validation study was conducted in 10 Italian centres, all members of the Italian Group of stem cell transplant (GITMO). Patients completed the questionnaires between 7 and 9 days post-transplant. Dimensionality was tested through exploratory factor analysis (EFA). A total of 17 items yielded a content validity index (CVI) of 0.88. Participants included 186 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. The EFA yielded a three-factor solution, explaining 55% of the variance. The scale showed adequate psychometric properties, with the exception of three items, which were eliminated. Future studies should test the psychometric properties of the questionnaire through confirmatory factor analysis and verify its transcultural validity.

[The latest best practice guidelines relating to seclusion and restraint]. / Les dernières recommandations de bonnes pratiques sur l'isolement et la contention.

Several measures relating to seclusion and restraint are included in the French public health code. The best practice guidelines of the French National Health Authority, published in 2017, define these two notions and advise on the behaviour to adopt with regard to their implementation and monitoring. Likewise, informing and supporting the patient when these measures are lifted are critical moments which the teams must also be able to manage correctly.

Being in protective isolation following autologous haematopoietic stem cell transplantation: A phenomenological study.

AIMS AND OBJECTIVES: To explore the lived experiences of patients with haematological malignancies who had been in protective isolation during their hospital stay for autologous haematopoietic stem cell transplantation. BACKGROUND: Although protective isolation aims to benefit patients' health by preventing infection, it could also imply harmful psycho-social implications for patients, such as loneliness. DESIGN: A descriptive phenomenological study was conducted in an Italian university hospital. METHODS: Nine patients with haematological malignancies who had been in protective isolation for autologous haematopoietic stem cell transplantation were enrolled. They were interviewed during their weekly ambulatory visits, which are usually carried out up to 100 days post-transplant, and asked about their stay in isolation. Giorgi's method of analysis was used to describe the experience of protective isolation from the patient' perspective. RESULTS: Eight themes emerged: isolation is a defence, threats from which patients have to defend themselves, rules for defence, the burden of the defence, external strategies for defence, inner strengths for defence, defending loved ones and outcomes of the defence. The general structure was expressed as a defence from suffering. CONCLUSIONS: While fighting a hard battle against cancer, informants largely accepted the strict isolation measure and represented it as a shield for an effective defence. RELEVANCE TO CLINICAL PRACTICE: Nurses should provide emotional and social support to help patients feel like active fighters and strengthen their strategies for an effective defence from suffering.

The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis.

Protective isolation is aimed at preventing infection in neutropenic patients, but it is implemented inconsistently across centres and is supported by recommendations with poor evidence. This review and metasynthesis explored the experiences and the psychological implications of protective isolation in patients with haematological malignancies undergoing bone marrow (BMT) or haematopoietic stem cell transplantation (HSCT). A systematic search of multiple databases for qualitative studies exploring BMT or HSCT patients' experiences of protective isolation was completed. The metasynthesis followed the meta-aggregative method from the Joanna Briggs Institute, with four procedural steps: (1) comprehensive search, (2) quality appraisal, (3) extraction of relevant findings and (4) synthesis of the identified findings. Twenty-six findings were extracted from 11 articles included in the review. The synthesising process yielded seven categories, aggregated into three synthesised findings: (1) isolation is a source of suffering, (2) isolation can lead to relating with oneself and (3) the person does not close the door to the outside world. This metasynthesis sheds light on patients' suffering from being isolated, and the possibility of overcoming this suffering thanks to relationships that patients have with themselves and with the external world. Healthcare providers should reconsider this practise in order to avoid unnecessary patient suffering.

[Coercive Interventions in Psychiatry: Prevention and Patients' Preferences]. / Psychiatrische Zwangsmaßnahmen: Prävention und Präferenzen aus Patientenperspektive.

Objective This study explores patients' preferences and measures of prevention of coercive methods in psychiatric treatment. Methods Structured interviews of 90 patients with psychotic disorders were undertaken, most of whom had previously experienced coercive methods. Results Participants saw preventive potential in a wider availability of individual non-pharmacological therapy, improvement of staff professional competence and communication skills, high staff-to-patient ratios and retreat facilities. The majority of participants preferred forced medication and manual restraint in case of self-endangerment, and forced medication and mechanical restraint in the event of endangerment of others. Conclusion Patients' suggestions relating to prevention of coercion are in line with most expert's opinions. In case coercive methods are required, manual restraint and application of forced medication is accepted as the treatment of choice according to most patients in case of self-endangerment.

The lived experience of patients in protective isolation during their hospital stay for allogeneic haematopoietic stem cell transplantation.

PURPOSE: Patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) usually receive hospital care in protective isolation until full neutrophil recovery. Although the aim of protective isolation is to benefit patients' health by preventing risks of infection, it could have severe psychological implications. The aim of this study was to explore the lived experiences of protective isolation in adult patients who had been treated with allogeneic HSCT. METHOD: A descriptive phenomenological inquiry based on Giorgi's approach was conducted in a university hospital in Italy. Ten patients (7 female and 3 male, age range 28-66), who had undergone allogeneic HSCT to treat a haematological malignancy, were interviewed about their hospital stay in protective isolation. RESULTS: A general meaning structure was identified as being isolated to achieve transformation. The revelatory themes were as follows: (1) the special place for transformation, (2) the experience of embodied transformation, and (3) light and shade from inside and outside. Participants experienced a transformation of themselves, of their relationships with loved ones, and of the environment. CONCLUSIONS: Since patients may live the experience of being treated with allogeneic HSCT in protective isolation as a transformation process, health-care providers should monitor the psychosocial implications of the isolation practice.

The impact of meticillin-resistant Staphylococcus aureus on patients with advanced cancer and their family members: A qualitative study.

BACKGROUND: Little is known about the impact of meticillin-resistant Staphylococcus aureus on patients with advanced cancer, such as its impact on the quality of life of this vulnerable group. To date, research on meticillin-resistant Staphylococcus aureus in the palliative care setting has had a quantitative focus. AIM: The purpose of this study was to explore the impact of a meticillin-resistant Staphylococcus aureus diagnosis on patients and their carers. DESIGN: This article reports upon a qualitative interview study of nine patients with advanced cancer and meticillin-resistant Staphylococcus aureus and nine family members (n = 18). Framework analysis was used to analyse the data. SETTING/PARTICIPANTS: Patients and family members of patients with advanced cancer either admitted to the specialist palliative care unit or receiving palliative care in the hospital setting, who had a laboratory confirmed diagnosis of meticillin-resistant Staphylococcus aureus colonisation, were considered for inclusion in the study. RESULTS: Four themes were identified using framework analysis: reactions to receiving a meticillin-resistant Staphylococcus aureus diagnosis, the need for effective communication of the meticillin-resistant Staphylococcus aureus diagnosis, the enigmatic nature of meticillin-resistant Staphylococcus aureus, and lessons to guide the future care of meticillin-resistant Staphylococcus aureus patients. CONCLUSION: This article indicates that meticillin-resistant Staphylococcus aureus can have a significant impact on advanced cancer patients and their families. This impact may be underestimated, but early and careful face-to-face explanation about meticillin-resistant Staphylococcus aureus and its implications can help patients and their families to cope better with it. These findings should be considered when developing policy relating to meticillin-resistant Staphylococcus aureus management and infection control in specialist palliative care settings.

Experience of nurses caring for child with hematopoietic stem cell transplantation in general pediatric ward: a descriptive phenomenological approach.

BACKGROUND: Most studies on hematopoietic stem cell transplantation (HSCT) have focused on patients, survivors, or their family members, such as siblings and parents. Little attention has been paid to nurses caring for HSCT pediatric patients and in particular in a Taiwanese context. OBJECTIVE: The objective of this study was to explore nurses' lived experience caring for HSCT children in isolation within a general pediatric ward. METHOD: A Husserlian phenomenological approach informed the exploration of the meaning and essence of the nurses' caring experience. Data were collected using semistructured interviews. RESULTS: Twelve nurses were interviewed. Analysis of interviews yielded 3 main themes: being worried about ruining transplantation success, feeling loss of control in handling suffering, and reflecting upon the value of HSCT. CONCLUSIONS: Nurses felt the stress of caring for HSCT children because of the heavy workload and the pressure of responsibility. Witnessing the suffering of patients/families was particularly stressful. However, nurses were helped to overcome this stress by looking at the value and meaning of HSCT. IMPLICATIONS FOR PRACTICE: Nurses need practical support from nursing leaders in terms of carefully organizing patient care, controlling the nurse-to-patient ratio, and offering a safe work environment by providing systematic formal training on HSCT and receiving proper supervision. Understanding and learning are gained from nurses who are able to seek meaning from HSCT through appreciating every caregiving effort and through valuing how their nursing role contributes to the quality of patients' care.